Not all Medicaid dollars are equal. The per-beneficiary spending in the HHS dataset varies enormously by state — from $277 in Alaska to $59 in Illinois. This doesn't mean Alaska's program is more wasteful or Illinois's is more efficient. It reflects the fundamentally different ways states have structured their Medicaid programs, their cost of living, their populations, and what services they cover.
Here's a note on methodology: the "per beneficiary" figure here is total Medicaid payments divided by total beneficiary-encounters in the dataset. Because one patient may see multiple providers, the beneficiary count is inflated (the same person counted at each provider they visit). So these numbers are best used for relative comparison between states, not as absolute per-person spending.
All States Ranked by Spending Per Beneficiary
| # | State | Providers | Total Spending | Per Beneficiary |
|---|---|---|---|---|
| 1 | Alaska | 1,858 | $6.18B | $277 |
| 2 | Missouri | 15,656 | $28.01B | $242 |
| 3 | New Hampshire | 2,046 | $5.99B | $238 |
| 4 | Vermont | 1,796 | $2.97B | $229 |
| 5 | North Dakota | 1,178 | $2.16B | $214 |
| 6 | Washington DC | 1,354 | $6.11B | $199 |
| 7 | Rhode Island | 6,067 | $6.93B | $189 |
| 8 | South Dakota | 1,663 | $2.51B | $177 |
| 9 | New York | 59,321 | $144.77B | $173 |
| 10 | Maine | 2,552 | $9.49B | $170 |
| 11 | Wyoming | 1,300 | $0.90B | $164 |
| 12 | Minnesota | 8,713 | $25.25B | $164 |
| 13 | Montana | 3,426 | $5.37B | $159 |
| 14 | Iowa | 6,863 | $11.67B | $141 |
| 15 | Colorado | 12,178 | $21.60B | $139 |
| 16 | Massachusetts | 19,346 | $56.03B | $137 |
| 17 | Kansas | 5,274 | $8.40B | $136 |
| 18 | New Mexico | 4,186 | $13.69B | $130 |
| 19 | Delaware | 1,864 | $3.97B | $126 |
| 20 | Virginia | 15,631 | $29.49B | $126 |
The Bottom 10
| # | State | Providers | Total Spending | Per Beneficiary |
|---|---|---|---|---|
| 42 | Georgia | 3,628 | $5.79B | $69 |
| 43 | Ohio | 20,967 | $36.98B | $67 |
| 44 | Nebraska | 3,263 | $2.33B | $67 |
| 45 | North Carolina | 16,856 | $34.82B | $67 |
| 46 | Florida | 29,972 | $34.03B | $64 |
| 47 | Wisconsin | 10,281 | $9.81B | $64 |
| 48 | Washington | 8,128 | $16.65B | $62 |
| 49 | Illinois | 44,302 | $19.86B | $59 |
| 50 | Puerto Rico | 9,168 | $3.23B | $27 |
What Explains the Gap?
Alaska's $277 per beneficiary is the highest in the nation. Alaska has the highest cost of living of any state, a small population spread across enormous distances, and limited provider networks that drive up per-unit costs for everything from doctor visits to medical transportation. Flying patients from rural villages to Anchorage for care is routine and expensive.
Missouri's $242 is more surprising for a mid-cost-of-living state. Missouri has an extensive community behavioral health system — Compass Health, Inc. alone billed $1.28 billion, almost entirely on T1040 (certified community behavioral health clinic services). The state's approach to routing mental health and substance abuse services through Medicaid drives up per-beneficiary spending.
New York at $173 is notable because while it has the highest total spending ($144.8B), its per-beneficiary rate is only #9. The sheer volume of beneficiary encounters dilutes the ratio, even though the state has some of the highest per-unit costs and the most aggressive home care billing in the country.
Illinois at $59 — despite having 44,302 providers (the most of any state) and being a major metro area — shows the lowest per-beneficiary spend among the 50 states. This likely reflects how Illinois structures its Medicaid managed care program and the mix of services covered.
Explore Your State
Click any state above to see its top providers, cities, and spending breakdown, or browse all states from the homepage.