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NASBO Annual Report: State Medicaid Spending Up

The National Association of State Budget Officials (NASBO) released its annual state expenditures report, which examines several important aspects of state budgets. This year’s report included fiscal years 2018–2020.

High-level takeaways include:

  • overall, total state spending grew about 8 percent in fiscal year 2020;
  • federal funds are estimated to have grown about 14 percent in 2020 due to the increased federal aid to states as a result of COVID-19; and
  • state funding grew about 5 percent in fiscal year 2020.

Further, total Medicaid spending from states budgets increased 4.4 percent and federal government Medicaid spending increased 8.9 percent. The overall spending growth rate for total Medicaid expenditures in fiscal year 2019 was considerably lower, at 3.2 percent, with state funds growing 1.7 percent and federal funds increasing 4.1 percent. While Medicaid continues to be the largest percentage of total state and federal expenditures, elementary education remains the largest percentage of state-only expenditures.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Abigail Painchaud is a policy associate at America's Essential Hospitals.

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