Washington paid 64% of the $944 billion Medicaid cost in fiscal 2024: 78% in New Mexico, Kentucky and West Virginia, 64% in Virginia, 60% in Maryland

Source. MACPAC, MACStats: Medicaid and CHIP Data Book, February 2026, Exhibit 16: Medicaid spending by state, category and source of funds, fiscal 2024. Also: HHS, Federal Register 87 FR 74429, FMAP for fiscal 2024; Census Bureau, Vintage 2025 state population estimates.

Method and data

Method. Benefits and state program administration together, federal over total. The federal share of benefits follows each state’s matching rate, which rises as state income per person falls and has a 50% floor; the 90% match for the adults covered by the 2014 expansion lifts the blended share in expansion states. This is the federal share of spending, not the matching rate: Mississippi’s share is 76% and its fiscal 2024 matching rate, the highest, 77%. Medicaid per resident, on Census’s July 1, 2024 populations: Virginia $22,354 million ÷ 8,819,642 = $2,535; the states and the District $943,817 million ÷ 340,003,797 = $2,776.

State	Total Medicaid, FY2024 ($ million)	Federal ($ million)	State ($ million)	Federal share (%)	Rank
New Mexico	8,490	6,633	1,857	78.1	1
Kentucky	18,302	14,295	4,008	78.1	2
West Virginia	5,111	3,965	1,146	77.6	3
Arkansas	8,313	6,370	1,943	76.6	4
Louisiana	17,180	13,076	4,104	76.1	5
Montana	2,504	1,902	602	76.0	6
Mississippi	7,357	5,576	1,781	75.8	7
Arizona	20,388	15,391	4,998	75.5	8
Alaska	2,904	2,183	721	75.2	9
Oklahoma	9,325	7,005	2,320	75.1	10
Idaho	4,051	3,035	1,015	74.9	11
Alabama	8,402	6,151	2,252	73.2	12
District of Columbia	4,372	3,199	1,173	73.2	13
Nevada	6,176	4,507	1,669	73.0	14
North Carolina	30,213	22,041	8,173	73.0	15
Utah	5,104	3,683	1,421	72.2	16
Michigan	25,361	18,159	7,202	71.6	17
Hawaii	3,236	2,315	921	71.5	18
Iowa	8,874	6,300	2,574	71.0	19
Missouri	16,445	11,614	4,832	70.6	20
Oregon	16,993	11,954	5,039	70.3	21
Indiana	20,021	14,055	5,966	70.2	22
Ohio	35,203	24,573	10,630	69.8	23
South Carolina	10,240	7,121	3,119	69.5	24
South Dakota	1,600	1,104	496	69.0	25
Maine	4,732	3,179	1,553	67.2	26
Delaware	3,340	2,240	1,100	67.1	27
Georgia	15,577	10,348	5,229	66.4	28
Tennessee	14,345	9,499	4,846	66.2	29
Virginia	22,354	14,339	8,015	64.1	30
Nebraska	3,840	2,463	1,377	64.1	31
Rhode Island	3,725	2,321	1,404	62.3	32
Washington	21,318	13,275	8,043	62.3	33
Vermont	2,336	1,450	887	62.1	34
California	157,098	97,055	60,043	61.8	35
Kansas	5,413	3,322	2,091	61.4	36
North Dakota	1,526	936	590	61.3	37
Illinois	33,747	20,680	13,067	61.3	38
Wisconsin	12,771	7,804	4,967	61.1	39
Texas	49,398	29,905	19,494	60.5	40
Pennsylvania	44,432	26,841	17,591	60.4	41
New Jersey	24,217	14,580	9,637	60.2	42
Maryland	18,455	11,016	7,439	59.7	43
Connecticut	11,295	6,723	4,573	59.5	44
Colorado	14,674	8,614	6,060	58.7	45
Florida	35,906	20,902	15,004	58.2	46
Minnesota	19,329	11,201	8,127	57.9	47
New York	98,178	56,368	41,810	57.4	48
New Hampshire	2,622	1,489	1,133	56.8	49
Wyoming	831	471	360	56.7	50
Massachusetts	26,193	14,708	11,485	56.2	51
States and the District	943,817	607,936	335,887	64.4

Download 19-07-medicaid-spending-by-source-fy2024.csv

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Higgins Strategy. “Washington paid 64% of the $944 billion Medicaid cost in fiscal 2024: 78% in New Mexico, Kentucky and West Virginia, 64% in Virginia, 60% in Maryland” Exhibit 7, Every State Dollar (Study XIX). October 12, 2026. https://higginsstrategy.com/charts/19-07-medicaid-spending-by-source-fy2024/