What state has the most people on Medicaid?

Editorial team Published on

California has the highest total number of Medicaid recipients in the United States, with over 12 million to 13 million people enrolled in its program (known as Medi-Cal).

Top States by Total Enrollment

  • California: Highest overall total with roughly 13 million enrollees.
  • New York, Texas, and Florida: Follow with several million recipients each, driven by their large overall state populations.

States with the Highest Percentage of Population

While California leads in raw numbers, smaller or lower-income states often have a higher percentage of their overall population relying on the program. The states with the highest reliance rates include:

  • New Mexico: Around 34% to 40% of residents.
  • Louisiana: Around 32% to 43% of residents.
  • New York: Around 28% to 32% of residents.

You can review state-by-state breakdowns and program details using the KFF Medicaid State Fact Sheets.

What is the best state to live in for Medicaid?

Connecticut, New York, Massachusetts, and California rank as the best states to live in for Medicaid coverage, offering expansive eligibility, high spending, and strong benefits.

Because Medicaid is administered at the state level, "the best" state depends on your specific needs, such as general low-income coverage, long-term disability care, or family benefits.

Top States for Medicaid

  • Connecticut: Frequently ranks as the top overall state for low-income healthcare and Medicaid/CHIP quality, backed by strong state investments in community health clinics.
  • Massachusetts: Known for MassHealth, which ranks near the top nationally for spending, quality of care, and exceptional home-care/disability waiver programs that do not force recipients into complete poverty to qualify.
  • New York: Features some of the most generous per-capita spending, high income/resource allowances for home care, and broad availability compared to non-expansion states.
  • California: Operates Medi-Cal, which provides wide-ranging benefits with no asset test for many adult categories, though some users note provider availability can vary by county.

Key Factors That Make a State "Best"

  • Medicaid Expansion: States that adopted the Affordable Care Act's expansion offer coverage to single adults earning up to 138% of the Federal Poverty Level. States that have not expanded (such as Texas, Tennessee, and Wyoming) leave massive coverage gaps for low-income adults without dependent children.
  • Income & Asset Rules: Progressive states often have higher limits or flexible "medically needy" spend-down programs for long-term care.
  • Provider Networks: High-ranking states typically invest more in provider reimbursement rates, increasing the likelihood that doctors and specialists accept the state plan.

What state has the most people on Medicare?

California has the highest total number of people on Medicare in the United States, with nearly 6.9 million beneficiaries.

Top States by Total Medicare Enrollment

  • California: ~6.9 million beneficiaries (highest total number)
  • Florida: ~4.8 million beneficiaries (second highest)
  • Texas: ~4.4 million beneficiaries
  • New York: ~3.7 million beneficiaries

Highest Percentage of Population on Medicare

If you measure by the share of the state's total population rather than raw numbers, Maine Health Data ranks highest, with approximately 27% of its residents enrolled in Medicare.

What states are the hardest to get Medicaid?

The hardest states to get Medicaid coverage in are the 10 states that have not adopted the Affordable Care Act's Medicaid expansion.

The 10 Non-Expansion States

In these states, adults without dependent children, seniors, or a qualifying disability are generally excluded from eligibility, creating a strict "coverage gap" where people earn too much for traditional Medicaid but too little to afford private insurance.

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • South Carolina
  • Tennessee
  • Texas
  • Wisconsin
  • Wyoming

Why These States Are the Hardest

  • No Income-Only Qualification: In expansion states, adults earning up to 138% of the federal poverty level qualify based on income alone. Non-expansion states do not offer this path for most childless adults.
  • Stricter Asset and Income Caps: States like Texas and Mississippi enforce extremely low monthly income limits (sometimes a fraction of the poverty line) for parents and caregivers who do qualify under traditional rules.
  • Higher Uninsured Rates: According to research from HealthCareInsider, non-expansion states consistently rank at the bottom for low-income healthcare access and overall enrollment reach.

Who are the biggest recipients of Medicaid?

Children make up the largest group of Medicaid beneficiaries by enrollment numbers, while adults and seniors with higher medical needs account for the majority of the program's spending.

By Enrollment (Who Receives the Most)

  • Children: Comprise roughly 36% to 38% of all people enrolled in Medicaid, providing health coverage to nearly 40% of all children nationwide.
  • Non-Elderly Adults: Make up around 42% of enrollees, which includes low-income parents, pregnant individuals, and expansion adults.
  • People with Disabilities: Represent about 10% of total enrollees.
  • Seniors (Ages 65+): Account for about 10% of total enrollees.

By Spending (Where the Money Goes)

While children make up the largest share of people on Medicaid, they account for only about 15% of total program spending. In contrast:

  • Seniors and People with Disabilities make up a smaller total percentage of enrollees, but they account for over half of all Medicaid spending. This is due to their need for intensive medical services, long-term care, and institutional support.
  • Nursing Home Care: Medicaid pays for over 60% of all nursing home residents in the United States, making long-term institutional and community care one of the most significant cost drivers for the program.

Federal changes to Medicaid mean hospitals will cover more of the cost for the uninsured

9 related questions found

What race is the highest on Medicaid?

In raw numbers, White (non-Hispanic) individuals make up the largest share of total Medicaid enrollees, but people of color are disproportionately enrolled relative to their share of the U.S. population.

Total Enrollment Distribution

According to national Medicaid data and KFF State Health Facts, the breakdown of total non-elderly enrollees by race and ethnicity is approximately:

  • White (non-Hispanic): ~36% to 43%
  • Hispanic / Latino: ~28% to 31%
  • Black (non-Hispanic): ~19% to 21%
  • Asian / Pacific Islander: ~4% to 5.5%
  • American Indian / Alaska Native (AIAN): ~1.3%

Disproportionate Representation

While White enrollees represent the plurality of total users due to the larger size of the total U.S. White population, minority groups rely on Medicaid at much higher rates relative to their share of the general population:

  • Hispanic people make up roughly 19.5% of the total U.S. population, but nearly 30% of Medicaid enrollees.
  • Black Americans make up about 13.7% of the U.S. population, but roughly 20% of Medicaid enrollees.
  • American Indian and Alaska Native individuals experience some of the highest reliance and coverage rates, particularly in specific categories such as coverage at the time of birth (64.6%), compared to 27.3% for White women.

Which state has the best free healthcare?

States do not offer completely "free" healthcare for everyone, but Massachusetts, New York, and California lead the nation in robust public health programs, expansive Medicaid coverage, and state-subsidized care for low-income residents.

While "free" care usually refers to Medicaid (Apple Health, MassHealth, Medi-Cal) or state-funded basic health plans, different states rank highest depending on the measure of access, cost, and low-income support.

Top States for Public Health and Low-Income Coverage

  • Massachusetts: Frequently ranked #1 in overall healthcare access and public health, its state program MassHealth provides extensive medical, hospital, and mental health coverage to a large percentage of its residents.
  • New York: Known for expansive Medicaid and a Basic Health Program that offers free or very low-cost premiums for lower-income residents, alongside unique extra benefits like non-emergency medical transportation.
  • California: Offers massive Medi-Cal expansions that provide comprehensive public health coverage to qualifying low-income individuals regardless of immigration status.
  • Connecticut & Hawaii: Consistently top the U.S. News & World Report and Commonwealth Fund scorecards for overall healthcare quality, low uninsured rates, and strong preventive care access.

Can a US citizen who never worked get Medicare?

Yes, a U.S. citizen who has never worked can still get Medicare, but how you qualify and what you pay will change based on your situation.

Basic Eligibility at Age 65

  • You must be a U.S. citizen or a lawful permanent resident.
  • You must have lived in the U.S. continuously for at least 5 years.
  • You must be 65 years old or older.

How You Can Qualify for Part A (Hospital Insurance)

  • Through a Spouse: You can get premium-free Part A if you are married for at least one year to a spouse who has enough work credits. You can also qualify if you are a divorced spouse (married 10+ years) or a widow/widower.
  • By Paying a Monthly Premium: If you do not qualify through a spouse's work history, you can still buy Medicare Part A. The monthly cost depends on any credits you or a spouse might have:
    • 30 to 39 work quarters: Reduced premium (around $285 to $311 per month).
    • Fewer than 30 work quarters: Higher full premium (often over $500 per month).

Eligibility for Part B (Medical Insurance)

  • Part B covers doctor visits and outpatient care.
  • Your personal work history does not change Part B eligibility or costs.
  • Anyone eligible for Medicare at age 65 can enroll in Part B by paying the standard monthly premium.

Qualifying Under Age 65

  • You can get Medicare early without a work history if you have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
  • You can also qualify if you receive disability benefits through a spouse or parent who has enough work credits.

What state has the lowest Medicare cost?

Florida has the lowest average monthly Medicare Advantage (Part C) premium at around $1.09 to $4.33, depending on the specific year's data, though states like Nevada, Texas, and Louisiana also consistently rank among the lowest for average plan costs.

Because Medicare costs depend on the type of coverage (such as Part B, Part C Medicare Advantage, Part D prescription, or Medigap supplements), "lowest cost" varies by category:

Lowest Cost by Category

  • Medicare Advantage (Part C) Premiums: Florida ($1.09), Nevada ($2.44–$3.09), Texas ($4.99), and Louisiana ($5.95) report the lowest average monthly plan premiums. Many areas also feature widespread access to $0-premium plans.
  • Medigap (Supplement) Plan G: States like Iowa, South Carolina, and Mississippi frequently offer some of the lowest starting monthly rates (around $79 to $84 for eligible 65-year-olds) due to high carrier competition.
  • Prescription Drug Plans (Part D): Mississippi, Kansas, and Kentucky typically record some of the lowest average monthly costs for standalone drug coverage.

Note: Regardless of your state or private plan choice, most beneficiaries still must pay the standard federal Part B premium. Total costs also depend heavily on your individual health needs and local doctor networks.

Which states have the highest Medicaid recipients?

California has the highest total number of Medicaid recipients in the United States, with approximately 11.4 million to 13 million enrollees.

States with the Highest Total Enrollment (Raw Numbers)

Large population states lead in total counts:

  • California: ~12.6 to 13 million
  • New York: ~6.5 million
  • Texas: ~4.1 million
  • Florida: ~3.6 million
  • Pennsylvania & Illinois: ~3 million each

States with the Highest Percentage of Population (Reliance Rate)

When measured by the share of the state population enrolled in Medicaid or CHIP, smaller or more economically vulnerable states rank highest:

  • Louisiana: ~30.9% to 43.4% depending on the specific annual metric
  • New Mexico: ~32.3% to 41.8% of residents
  • New York: ~32.7%
  • California: ~33.1%
  • Oregon: ~30.5%

You can review detailed data and figures on the Medicaid Enrollment by State or explore the SmartAsset Medicaid Study.