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Which states had the highest Medicaid spending per capita in 2022?
Executive summary
Official and expert sources show two different ways to answer “which states had the highest Medicaid spending per capita in 2022”: total state Medicaid dollars spent was largest in California, New York and Texas (total dollars) while per‑resident or per‑enrollee measures put New York at or near the top. California spent the most dollars in FY2022—about $119 billion—while New York’s per‑capita Medicaid cost was reported as the highest of any state and New York’s total program spending was $83.4 billion that year [1] [2].
1. Big numbers vs. per‑person measures — two different questions
Asking which states “had the highest Medicaid spending per capita” can mean (a) highest total Medicaid spending (largest dollar totals) or (b) highest spending normalized by population (per resident) or by enrollees (per enrollee). Statista’s compilation of KFF data highlights total spending by state in FY2022, showing California, New York and Texas at the top in raw dollars (California ~ $118.9 billion) [1] [3]. The Empire Center’s analysis focuses on per‑capita and per‑resident measures and explicitly identifies New York as having the highest per‑resident Medicaid costs in 2022 [2].
2. California leads in total dollars; New York leads in per‑person cost
Statista (sourcing KFF) reports California expended almost $118.9 billion in Medicaid during FY2022, making it the largest single‑state dollar amount [1]. By contrast, the Empire Center cites CMS data showing New York’s Medicaid program spent $83.4 billion in the federal fiscal year ending September 2022 but that New York’s non‑federal share per resident was higher than any other jurisdiction — a measure that produces the “highest per capita” label for New York [2].
3. Why the rankings diverge: population, enrollment and health‑cost structure
High total spending tends to track with population size and program scale (California and Texas are the largest states by population) [1]. High per‑capita or per‑resident spending reflects enrollment rates, the share of high‑cost enrollees (people with disabilities, older adults), and higher underlying health‑care prices or program generosity. Empire Center notes New York covered more than one‑third of its population in Medicaid in 2022 and that spending per enrollee and per resident are driven by both higher prices and a relatively large enrollment share [2].
4. Different official measures exist — per enrollee vs. per resident vs. per capita
CMS, MACPAC and KFF publish distinct metrics: CMS and MACPAC break out spending by eligibility group and per‑enrollee amounts, while KFF/Statista publish totals by state and KFF also provides per‑enrollee metrics elsewhere [4] [1] [5]. Empire Center’s statement that New York has the highest per‑resident Medicaid cost is based on CMS financial reports and population‑adjusted calculations [2]. Available sources do not mention a single, universally adopted “per capita” ranking table for 2022 that uses the exact same denominator across all reports; different sources use different denominators (per resident, per enrollee, per full‑benefit enrollee) [2] [1] [4].
5. What the data say about enrollment and cost drivers
MACPAC’s breakdown of FY2022 Medicaid spending shows 30.3% of total spending went to people eligible on the basis of disability and 20.7% to people 65 and older — groups that drive high per‑enrollee costs [4]. Empire Center highlights that in New York, the share of the population enrolled (36%) was far above the poverty rate (12%), implying broader eligibility and higher enrollment beyond strictly low‑income groups — one reason per‑resident spending is high there [2].
6. Caveats, alternative viewpoints and limitations in the public reporting
Statista’s totals are drawn from KFF and present raw spending by state, which favors populous states [1] [3]. Empire Center is a state‑focused policy group that interprets CMS data to emphasize New York’s unusually high per‑resident costs; its framing highlights program design and enrollment differences that can raise per‑person costs [2]. MACPAC provides granular eligibility‑group breakdowns but not a single headline “per capita” ranking for all states in the snippets here [4]. Available sources do not provide a single consolidated table in these search results that lists every state sorted by identical “per capita” definitions for FY2022; therefore rankings depend on which per‑person measure a researcher uses [2] [1] [4].
7. Short answer and recommended next steps for verification
Short answer: If you mean total dollars, California, New York and Texas were the largest Medicaid spenders in FY2022 (California ~ $119B) [1] [3]. If you mean spending per resident/enrollee, New York ranked highest in per‑resident Medicaid spending in 2022 [2]. For a definitive, single ranking by a chosen per‑capita definition, consult the original CMS state scorecard and MACPAC tables or KFF’s state indicators and request the specific per‑resident vs. per‑enrollee metric you want; those are the underlying sources used in the analyses cited here [6] [7] [4].