Nonfederal share separated into state funds, funds from health care providers, funds from local governments, and other sources of funds for four types of Medicaid payments combined in state fiscal year 2009

  State funds Funds from health care providers Funds from local governments  
  Total amount of nonfederal share State general funds Intra-agency funds Health care provider taxes Provider donations Intergovernmental transfers Certified public expenditures Other sources State description of funds from other sources by payment type
State Dollar amount Dollar amount Percentage Dollar amount Percentage Dollar amount Percentage Dollar amount Percentage Dollar amount Percentage Dollar amount Percentage Dollar amount Percentage Other sources fee-for-service Medicaid payments Other sources capitation payments to managed care organizations Other sources Medicaid Disproportionate Share Hospital supplemental payments Other sources Medicaid non-Disproportionate Share Hospital supplement payments and other Medicaid payments
Alabama $1,246,313,029.87 $218,563,442.77 17.5% $516,412,130.00 41.4% $58,499,874.00 4.7% $0.00 0.0% $43,029,051.00 3.5% $327,388,645.10 26.3% $82,419,887.00 6.6% SAME AS 2008      
Alaska $408,843,296.00 $408,843,296.00 100% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0%        
Arizona $2,124,416,028.00 $736,441,683.00 34.7% $631,417,087.00 29.7% $144,113,782.00 6.8% $0.00 0.0% $309,446,874.00 14.6% $37,704,167.00 1.8% $265,292,435.00 12.5%   TOBACCO SETTLEMENT AND TOBACCO USE TAXES    
Arkansas $936,778,153.00 $763,643,943.00 81.5% $0.00 0.0% $58,235,404.00 6.2% $0.00 0.0% $50,150,000.00 5.4% $0.00 0.0% $64,748,806.00 6.9% TOBACCO SETTLEMENT PROCEEDS AND MEDICAID TRUST FUND (SOFT DRINK TAX, AMBULANCE FEES AND MISC. PENALITIES.      
California $16,726,041,728.83 $7,865,583,438.78 47.0% $3,180,405,000.00 19.0% $560,104,447.00 3.3% $0.00 0.0% $617,292,097.00 3.7% $4,502,656,746.05 26.9% $0.00 0.0%        
Colorado $1,489,277,652.00 $1,168,982,714.00 78.5% $0.00 0.0% $41,586,034.00 2.8% $0.00 0.0% $0.00 0.0% $164,051,588.00 11.0% $114,657,316.00 7.7% TOBACCO TAX, TOBACCO SETTLEMENT AND OTHER MISCELLANEOUS REVENUE TOBACCO TAX   TOBACCO TAX AND OTHER MISCELLANEOUS REVENUE
Connecticut $2,541,821,327.00 $1,844,909,615.00 72.6% $554,308,669.00 21.8% $125,304,846.00 4.9% $0.00 0.0% $0.00 0.0% $17,298,197.00 0.7% $0.00 0.0%        
Delaware $476,894,608.00 $431,012,006.00 90.4% $43,810,140.00 9.2% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $2,072,462.00 0.4% TOBACCO SETTLEMENT FUNDS TOBACCO SETTLEMENT FUNDS TOBACCO SETTLEMENT FUNDS TOBACCO SETTLMENT FUNDS
District of Columbia $223,856,576.00 $189,786,357.00 84.8% $19,547,999.00 8.7% $0.00 0.0% $0.00 0.0% $0.00 0.0% $14,522,220.00 6.5% $0.00 0.0%        
Florida $6,637,418,168.00 $3,538,410,322.00 53.3% $440,450,188.00 6.6% $558,622,135.00 8.4% $0.00 0.0% $1,176,178,540.00 17.7% $52,115,004.00 0.8% $871,641,979.00 13.1% TOBACCO SETTLEMENT TRUST FUND, GRANTS & DONATIONS TRUST FUND, OTHER STATE FUNDS TOBACCO SETTLEMENT TRUST FUND    
Georgia $2,508,354,048.00 $1,852,046,475.00 73.8% $207,216,200.00 8.3% $263,396,580.00 10.5% $0.00 0.0% $185,477,689.00 7.4% $0.00 0.0% $217,104.00 0.0% OTHER IDENTIFIED AMOUNTS      
Hawaii $485,472,087.00 $394,076,235.00 81.2% $86,444,847.00 17.8% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $4,951,005.00 1.0%   TOBACCO SETTLEMENT FUNDS    
Idaho $293,568,300.00 $273,863,400.00 93.3% $0.00 0.0% $6,591,397.00 2.2% $0.00 0.0% $2,301,803.00 0.8% $0.00 0.0% $10,811,700.00 3.7% SCHOOL BASED SERVICES MATCH, UPL MATCH, INTEREST & PENALTIES      
Illinois $5,568,052,676.00 $1,887,410,851.00 33.9% $958,909,782.00 17.2% $956,299,184.00 17.2% $0.00 0.0% $760,582,541.00 13.7% $66,290,434.00 1.2% $938,559,884.00 16.9% $766,638,227 TOBACCO SETTLEMENT FUNDS\R\N$171,921,657 CIGARETTE/TOBACCO TAXES     INTERGOVERNMENTAL TRANSFERS PER FEDERAL BUDGET IMPROVEMENT & PROTECTION ACT
Indiana $1,603,792,127.00 $1,491,282,509.00 93.0% $0.00 0.0% $112,509,618.00 7.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0%        
Iowa $938,677,647.00 $445,241,500.00 47.4% $44,014,813.00 4.7% $16,886,168.00 1.8% $0.00 0.0% $188,603,212.00 20.1% $0.00 0.0% $243,931,954.00 26.0% SAME EXPLANATION AS STATE FISCAL YEAR 2008.      
Kansas $809,036,581.00 $744,649,642.00 92.0% $29,020,806.00 3.6% $32,954,454.00 4.1% $0.00 0.0% $0.00 0.0% $2,411,679.00 0.3% $0.00 0.0%        
Kentucky $1,265,576,205.00 $925,562,228.00 73.1% $0.00 0.0% $310,161,117.00 24.5% $0.00 0.0% $28,892,712.00 2.3% $960,148.00 0.1% $0.00 0.0%        
Louisiana $1,482,342,565.00 $1,158,230,748.00 78.1% $7,625,536.00 0.5% $105,000,000.00 7.1% $0.00 0.0% $0.00 0.0% $71,340,223.00 4.8% $140,146,058.00 9.5% STATE TRUST FUNDS      
Maine $740,775,555.00 $526,802,135.00 71.1% $36,917,716.00 5.0% $138,029,363.00 18.6% $0.00 0.0% $0.00 0.0% $641,908.00 0.1% $38,384,433.00 5.2% OTHER FINANCING IS THE STATE SHARE OF PRESCRIBED DRUG/DME REBATES AND TOBACCO SETTLEMENT FUNDS.      
Maryland $2,615,298,401.00 $2,211,847,672.00 84.6% $51,961,588.00 2.0% $226,089,141.00 8.6% $0.00 0.0% $0.00 0.0% $0.00 0.0% $125,400,000.00 4.8% CIGARETTE RESTITUTION FUND CIGARETTE RESTITUTION FUND CIGARETTE RESTITUTION FUND CIGARETTE RESTITUTION FUND
Massachusetts $5,157,933,972.00 $3,465,256,611.99 67.2% $802,771,632.00 15.6% $485,001,690.01 9.4% $0.00 0.0% $42,345,795.00 0.8% $27,562,729.00 0.5% $334,995,514.00 6.5%       MEDICAL SECURITY TRUST FUND;\R\NCOMMONWEALTH CARE TRUST FUND
Michigan $3,183,300,000.00 $1,564,000,000.00 49.1% $0.00 0.0% $858,100,000.00 27.0% $0.00 0.0% $144,000,000.00 4.5% $83,700,000.00 2.6% $533,500,000.00 16.8% OTHER NON-FEDERAL FUND SOURCES ARE STATE RESTRICTED. OTHER NON-FEDERAL FUND SOURCES ARE STATE RESTRICTED. OTHER NON-FEDERAL FUND SOURCES ARE STATE RESTRICTED. OTHER NON-FEDERAL FUND SOURCES ARE NON-HEALTH CARE RELATED DONATIONS.
Minnesota $3,055,696,837.00 $2,664,607,499.00 87.2% $33,450,936.00 1.1% $224,705,929.00 7.4% $0.00 0.0% $39,564,978.00 1.3% $93,367,495.00 3.1% $0.00 0.0%        
Mississippi $746,985,356.00 $268,928,370.00 36.0% $118,593,206.00 15.9% $204,474,283.00 27.4% $0.00 0.0% $90,446,277.00 12.1% $0.00 0.0% $64,543,220.00 8.6% TOBACCO SETTLEMENT FUNDS      
Missouri $3,263,449,250.00 $1,025,362,052.00 31.4% $164,348,740.00 5.0% $1,757,423,759.00 53.9% $0.00 0.0% $37,722,836.00 1.2% $0.00 0.0% $278,591,863.00 8.5% SAME AS ABOVE HIF \R\NHFTF   HFTF
Montana $206,096,282.00 $146,543,450.00 71.1% $0.00 0.0% $26,162,346.00 12.7% $0.00 0.0% $4,108,271.00 2.0% $0.00 0.0% $29,282,215.00 14.2% EXCISE TAX ON ALCOHOLIC BEVERAGES, MEDICAID THIRD PARTY LIABILITY, LIEN AND ESTATE RECOVERIES, I-149 TOBACCO TAX, TOBACCO TRUST FUND INVESTMENT EARNINGS, OPI SHARE OF SCHOOL-BASED SERVICES      
Nebraska $606,514,478.00 $500,463,944.00 82.5% $97,099,659.00 16.0% $2,060,686.00 0.3% $0.00 0.0% $2,289,932.00 0.4% $4,600,257.00 0.8% $0.00 0.0%        
Nevada $537,575,848.00 $316,156,283.00 58.8% $70,884,083.00 13.2% $22,222,091.00 4.1% $0.00 0.0% $126,049,208.00 23.4% $2,264,183.00 0.4% $0.00 0.0%        
New Hampshire $805,245,910.00 $408,273,865.00 50.7% $0.00 0.0% $205,918,754.00 25.6% $0.00 0.0% $191,053,291.00 23.7% $0.00 0.0% $0.00 0.0%        
New Jersey $4,731,883,859.00 $4,424,523,240.00 93.5% $0.00 0.0% $230,835,194.00 4.9% $0.00 0.0% $0.00 0.0% $55,870,425.00 1.2% $20,655,000.00 0.4%       TOBACCO TAX
New Mexico $731,190,885.00 $535,798,701.00 73.3% $74,608,884.00 10.2% $0.00 0.0% $0.00 0.0% $46,660,000.00 6.4% $5,523,300.00 0.8% $68,600,000.00 9.4% SEE NOTE ON C2 FOR FY 2008. SEE OTHER FUNDING SOURCES FOR FY 2008.    
New York $24,547,498,117.00 $15,540,669,964.70 63.3% $302,500,000.00 1.2% $740,146,036.30 3.0% $0.00 0.0% $7,964,182,116.00 32.4% $0.00 0.0% $0.00 0.0%        
North Carolina $1,769,755,481.00 $268,606,687.00 15.2% $256,364,258.00 14.5% $113,745,786.00 6.4% $0.00 0.0% $0.00 0.0% $1,131,038,750.00 63.9% $0.00 0.0%        
North Dakota $174,581,942.00 $170,168,461.00 97.5% $0.00 0.0% $3,809,126.00 2.2% $0.00 0.0% $604,355.00 0.3% $0.00 0.0% $0.00 0.0%        
Ohio $4,541,718,984.00 $3,673,954,197.00 80.9% $38,855,452.00 0.9% $600,372,137.00 13.2% $0.00 0.0% $171,256,093.00 3.8% $57,281,105.00 1.3% $0.00 0.0%        
Oklahoma $969,876,873.00 $573,980,489.00 59.2% $221,778,310.00 22.9% $41,685,879.00 4.3% $16,109,406.00 1.7% $0.00 0.0% $1,412,616.00 0.1% $114,910,173.00 11.8% TOBACCO TAX AND STATE SHARE OF DRUG REBATE AND MEDICAL REFUNDS TOBACCO TAX FUNDS AND STATE SHARE OF DRUG REBATE AND MEDICAL REFUNDS TOBACCO TAX FUNDS AND STATE SHARE OFMEDICAL REFUNDS AND DRUG REBATES TOBACCO TAX REFUNDS AND STATE SHARE OF DRUG REBATES AND MEDICAL REFUNDS
Oregon $1,081,000,000.00 $728,000,000.00 67.3% $34,000,000.00 3.1% $118,000,000.00 10.9% $0.00 0.0% $8,000,000.00 0.7% $0.00 0.0% $193,000,000.00 17.9% FEE FOR SERVICE OTHER FUND FUNDING SOURCES INCLUDE: DRUG REBATES, RECOVERIES AND MISC. MANAGED CARE ORGANIZATIONS OTHER FUNDING SOURCES INCLUDE: TOBACCO TAX AND TOBACCO SETTLEMENTS.    
Pennsylvania $7,820,982,000.00 $6,046,389,000.00 77.3% $0.00 0.0% $709,673,000.00 9.1% $0.00 0.0% $38,188,000.00 0.5% $109,592,000.00 1.4% $917,140,000.00 11.7% TOBACCO SETTLEMENT FUND, LOTTERY FUND, MISC REVENUE TOBACCO SETTLEMENT FUND, MISC REVENUE TOBACCO SETTLEMENT FUNDS  
Rhode Island $715,402,643.00 $547,802,643.01 76.6% $0.00 0.0% $167,599,999.99 23.4% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0%        
South Carolina $1,286,012,248.00 $646,946,849.00 50.3% $78,526,467.00 6.1% $370,142,210.00 28.8% $0.00 0.0% $6,395,441.00 0.5% $157,670,850.00 12.3% $26,330,431.00 2.0% TOBACCO SETTLEMENT FUNDS AND PROVIDER REFUNDS.      
South Dakota $217,009,642.00 $216,158,942.00 99.6% $0.00 0.0% $850,700.00 0.4% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0%        
Tennessee $2,189,554,874.00 $1,621,466,848.00 74.1% $0.00 0.0% $201,071,026.00 9.2% $0.00 0.0% $0.00 0.0% $105,243,900.00 4.8% $261,773,100.00 12.0% DRUG REBATES FROM PHARMACEUTICAL COMPANIES      
Texas $7,289,507,274.00 $5,664,892,533.00 77.7% $322,087,225.00 4.4% $58,146,512.00 0.8% $0.00 0.0% $1,244,381,004.00 17.1% $0.00 0.0% $0.00 0.0%        
Utah $356,713,300.00 $267,520,300.00 75.0% $36,373,700.00 10.2% $23,580,600.00 6.6% $0.00 0.0% $29,238,700.00 8.2% $0.00 0.0% $0.00 0.0%        
Vermont $391,242,881.00 $162,370,210.00 41.5% $28,079,069.00 7.2% $85,065,439.00 21.7% $0.00 0.0% $10,572,481.00 2.7% $0.00 0.0% $105,155,682.00 26.9%   THE LARGEST REVENUE SOURCES IN THE OTHER FINANCING METHODS BOX INCLUDE TOBACCO LITIGATION SETTLEMENT MONIES, CIGARETTE AND TOBACCO TAX REVENUES, AND THE STATE'S SHARE OF BENEFICIARY PREMIUMS. SMALLER AMOUNTS ASSOCIATED WITH VARIOUS STATE SPECIAL FUNDS AND REVENUES IN ACCORDANCE WITH APPLICABLE STATUTES ARE ALSO INCLUDED.    
Virginia $2,596,637,553.00 $2,594,129,489.00 99.9% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $2,508,064.00 0.1% $0.00 0.0%        
Washington $1,496,199,042.00 $1,348,633,656.00 90.1% $0.00 0.0% $0.00 0.0% $0.00 0.0% $0.00 0.0% $140,107,386.00 9.4% $7,458,000.00 0.5%       LEGISLATIVE APPROPRIATION FROM DEDICATED TRUST ACCOUNT FOR TRAUMA CARE SERVICES.
West Virginia $665,580,594.00 $505,981,197.00 76.0% $0.00 0.0% $140,199,675.00 21.1% $0.00 0.0% $0.00 0.0% $19,399,722.00 2.9% $0.00 0.0%        
Wisconsin $1,955,211,878.00 $1,257,379,198.00 64.3% $10,784,548.00 0.6% $382,928,236.00 19.6% $0.00 0.0% $46,174,600.00 2.4% $257,945,296.00 13.2% $0.00 0.0%        
Wyoming $243,783,065.00 $234,980,130.00 96.4% $0.00 0.0% $0.00 0.0% $0.00 0.0% $8,797,392.00 3.6% $0.00 0.0% $5,543.00 0.0%     ARRA INCLUDED - 2.5%. DSH PAYMENTS MADE BASED ON FFY (OCT. 1 - SEPT. 30)  
Total $134,456,747,826.70 $86,467,135,022.25 64.3% $9,499,568,670.00 7.1% $11,488,304,638.30 8.5% $16,109,406.00 0.0% $13,613,985,289.00 10.1% $7,512,469,037.15 5.6% $5,859,175,764.00 4.4%        

Source: GAO analysis of state-reported data. | GAO-15-227SP

 

Refer to the following for the definitions of the Medicaid payments and sources of funds for which states were requested to provide information in responding to our questionnaire

Definitions
 
MEDICAID PAYMENTS:
 
Fee-for-service Medicaid payments are Medicaid payments made by the state at the state's regular Medicaid rates for services provided.
Capitation payments to managed care organizations are fixed, predetermined payments made by the state to Medicaid managed care organizations for providing comprehensive medical services to Medicaid-eligible individuals enrolled in managed care plans.
Medicaid Disproportionate Share Hospital supplemental payments are Medicaid payments to hospitals that serve a disproportionate share of low-income and Medicaid patients to help offset hospitals' uncompensated costs for serving these individuals.
Medicaid non-Disproportionate Share Hospital supplemental payments and other Medicaid payments are Medicaid upper payment limit (UPL) supplemental payments; payments made from funding pools created under Medicaid demonstrations, such as payments from low-income pools, uncompensated care pools, and similar special funding pools established and paid under Medicaid waiver authority; Medicaid Graduate Medical Education (GME) payments; and other payments, such as enhanced payment rates or bonus payments made to certain health care providers. In addition, this payment category included bundled payments, i.e., episodic Medicaid payments in which payments are based on a predetermined cost for a clinically defined bundle or episode of care.
 
SOURCES OF FUNDS FOR NONFEDERAL SHARE:
 
State funds include state general funds and intra-agency funds, which included intra-agency payments, intra-agency transfers, and intra-agency certified public expenditures, which are defined as follows:
State general funds are dollars appropriated from a state's general fund to the state Medicaid agency.
Intra-agency funds are contributions from other state agencies, such as state departments of mental health, that pay Medicaid providers, for example, through intra-agency agreement; a transfer of funds to the state Medicaid agency from a state government entity that has been appropriated state general funds; or a certification of expenditures for Medicaid-covered services provided to a Medicaid beneficiary from a state government entity that has been appropriated state general funds.
Health care provider funds include health care provider taxes and provider donations, which are defined as follows:
Health care provider taxes are taxes, licensures or other fees, assessments, or other mandatory payments, imposed on health care services or providers, as defined in Section 1903 of the Social Security Act and in 42 C.F.R. § 433.55 - Health Care-Related Taxes Defined.
Provider donations are funds donated by providers to contribute to the nonfederal share of a state's Medicaid program, as stated in 42 C.F.R. § 433.66 - Permissible Provider-Related Donations.
Local government funds include intergovernmental transfers and certified public expenditures. These funds can come from local government entities, such as counties, cities, and local hospital districts, as well as directly from local-government-owned or -operated providers, such as county hospitals. Intergovernmental transfers and certified public expenditures are defined as follows:
Intergovernmental transfer is a transfer of funds from a local or county government entity, including a provider operated by local or county government, to the state Medicaid agency.
Certified public expenditure is an expenditure made by a local or county government entity, including a provider operated by local or county government, under the state's approved Medicaid state plan, for a Medicaid-covered service provided to a Medicaid beneficiary.
Other sources include funds, such as tobacco settlement funds, that are used to fund the state's nonfederal share of Medicaid expenditures and are not considered state general funds; health care provider taxes, fees, and/or assessments; provider donations; intergovernmental transfers; certified public expenditures or intra-state agency payments/transfers/ certified public expenditures.