The share of states’ own money spent on Medicaid health care coverage for low-income Americans fell slightly in the second year of the program’s expansion under the Affordable Care Act (ACA), even as enrollment grew. Still, a post-recession spike in states’ costs persisted. In fiscal year 2015, Medicaid consumed 16.7 cents of each state-generated dollar—4.5 cents more per dollar than in fiscal 2000.
Although every state spent more on Medicaid than in 2000, the effect on their finances has varied after factoring in how much revenue each took in. In 2015, only two states—New York and North Dakota—spent a smaller slice of their own dollars on Medicaid than in 2000, while 10 states spent their largest percentage of any year since 2000.

Increased enrollment has been one of the major drivers of growth in Medicaid spending, with more than twice as many people enrolled in 2015 than in 2000. Because Medicaid is an entitlement program, states must …
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