The Cost of Not Expanding Medicaid: An Updated Analysis

A woman assists her elderly husband.

Nineteen states would gain $7.14-$7.75 in federal funding for each state dollar they invest in Medicaid.



The Issue

Medicaid non-expansion states forgo significant federal funding and coverage gains.

Key Findings

  • The 19 states that have not yet expanded Medicaid could reduce the number of uninsured by more than four million people collectively by expanding Medicaid.

  • Expanding Medicaid in these states would also increase their federal funding by $595.8 billion to $664.8 billion from 2018-2027, while raising state Medicaid costs by just $82.5 billion to $90.8 billion over ten years.

  • Expanding Medicaid would also reduce uncompensated care—saving these states between $22.5 billion to $27.9 billion over ten years.

  • The report also includes a state-by-state look at the impact of Medicaid expansion on the number of uninsured, state and federal funding, and consumer health care spending.


States that have not yet expanded Medicaid could significantly reduce their uncompensated care costs and collective number of uninsured people and, while increasing their federal funding. The report is an incomplete picture of the impact of Medicaid expansion on state budgets, but, on balance, expansion is helping state budgets.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.