Medicaid Financing: The Basics

(By Elizabeth Williams, Anna Mudumala, Robin Rudowitz, and Alice Burns for The Kaiser Family Foundation Published: Jan 29, 2025)

Medicaid represents nearly $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term care for low-income residents. Medicaid is administered by states within broad federal rules and jointly funded by states and the federal government through a federal matching program with no cap. With Donald Trump returning to the presidency and Republican control of the Senate and House, discussions are ramping up about major cuts to federal spending, including federal Medicaid spending, through a new government efficiency initiative and to help pay for an extension of tax cuts in the 2017 Tax Cuts and Jobs Act. Restricting federal Medicaid spending could leave states with tough choices about whether to offset reductions with state dollars, limit Medicaid utilization or benefits, or reduce coverage. Amid uncertainty for Medicaid financing at the federal level, states have also reported uncertainty regarding post-unwinding Medicaid spending and enrollment trends and recent shifts in state fiscal conditions. This brief examines the following key questions ahead of potential proposals to change Medicaid financing: Continue reading here…

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