From Study V · Part Three, Exhibit 2
USAspending records $87.9 billion of Medicare to North Dakota; spread by enrollment, North Dakota’s share would be $2.6 billion
Source. USAspending.gov spending by geography, FY2025 (Medicare listings 93.773, 93.774, 93.770); CMS Medicare Monthly Enrollment, 2025 annual average; CMS Medicare Geographic Variation file, 2024. Fiscal year 2025 (recorded); 2025 (enrollment); 2024 (CMS fee-for-service).
Method and data
Method. For each of the twelve states that account for 88% of recorded Medicare ($1,024.8 billion of $1,163.6 billion): the amount USAspending records to the state in FY2025, against the state’s share if the Medicare recorded to the 50 states and DC were spread by where Medicare’s enrollees live (CMS Medicare Monthly Enrollment, 2025 annual average: the state’s enrollees ÷ 68,094,870 in the 50 states and DC × $1,154.1 billion, the recorded total less Puerto Rico’s $9.5 billion, since the enrollment counts leave Puerto Rico out; North Dakota, 151,412 enrollees, $2.57 billion), and the fee-for-service Parts A and B payments CMS itself attributes to the state’s residents in 2024 (Medicare Advantage and Part D are not published by state). The recipient named on every one of these records is “MULTIPLE RECIPIENTS”; the state attached to each aggregate is the state of the entity CMS pays.
| State | Recorded to the state, FY2025 | If spread by enrollment | CMS fee-for-service by residence, 2024 |
|---|---|---|---|
| Minnesota | 181.9 | 20.05 | 4.9 |
| Indiana | 134.5 | 23.81 | 7.6 |
| Pennsylvania | 119.4 | 50.86 | 14.8 |
| Kentucky | 109.8 | 16.97 | 4.7 |
| North Dakota | 87.9 | 2.57 | 1.0 |
| Connecticut | 80.5 | 13.01 | 4.0 |
| Florida | 77.6 | 88.86 | 28.7 |
| South Carolina | 73.6 | 21.42 | 7.3 |
| Wisconsin | 51.3 | 22.85 | 5.5 |
| California | 45.4 | 120.48 | 45.7 |
| Tennessee | 43.4 | 25.60 | 7.2 |
| Missouri | 19.5 | 22.96 | 6.8 |
Download fb5-18d-medicare-as-recorded-twelve-states-fy2025.csv
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Higgins Strategy. “USAspending records $87.9 billion of Medicare to North Dakota; spread by enrollment, North Dakota’s share would be $2.6 billion” Exhibit 2, Federal Dollars by State, Over Time (Study V · Part Three). October 12, 2026. https://higginsstrategy.com/charts/fb5-18d-medicare-as-recorded-twelve-states-fy2025/