Medicaid is both an expenditure and a source of federal revenue in state budgets. The program is funded jointly by states and the federal government through a matching formula based on a state’s personal income, and in many southern states, where per capita personal income is less than the national average, the federal government pays at least two dollars for every dollar states spend on their programs. Overall, the federal government funds the majority of Medicaid costs in the South, although the way in which states finance their share of spending on Medicaid and its impact on their budgets varies by state.
As in other regions and in the United States generally, Medicaid spending in the South is concentrated among a small number of high-need enrollees. Children and adults in the South account for a large majority of Medicaid enrollees but less than 40 percent of expenditures. The elderly and disabled, who make up only about one quarter of Medicaid enrollees, account for nearly two-thirds of spending. Looking forward, efforts to improve care and control costs in Medicaid will likely focus on these high-need, high-cost beneficiaries.