| Nonfederal share separated into state funds and all other sources of funds for fee-for-service Medicaid payments in state fiscal year 2011 |
| Total amount of nonfederal share | State funds | All other sources of funds | |||
|---|---|---|---|---|---|
| State | Dollar amount | Dollar amount | Percentage | Dollar amount | Percentage |
| Alabama | $1,240,469,090.00 | $664,138,083.00 | 53.5% | $576,331,007.00 | 46.5% |
| Alaska | $461,198,210.00 | $461,198,210.00 | 100% | $0.00 | 0.0% |
| Arizona | $112,831,259.00 | $88,460,943.41 | 78.4% | $24,370,315.59 | 21.6% |
| Arkansas | $943,784,139.00 | $690,292,288.00 | 73.1% | $253,491,851.00 | 26.9% |
| California | $13,856,782,221.23 | $9,548,690,077.03 | 68.9% | $4,308,092,144.20 | 31.1% |
| Colorado | $1,209,454,261.00 | $989,602,162.00 | 81.8% | $219,852,099.00 | 18.2% |
| Connecticut | $2,101,493,514.00 | $1,994,378,355.31 | 94.9% | $107,115,158.69 | 5.1% |
| Delaware | $252,237,036.00 | $250,823,304.00 | 99.4% | $1,413,732.00 | 0.6% |
| District of Columbia | $205,819,067.00 | $179,293,096.00 | 87.1% | $26,525,971.00 | 12.9% |
| Florida | $6,295,061,764.00 | $3,905,209,256.00 | 62.0% | $2,389,852,508.00 | 38.0% |
| Georgia | $1,333,909,867.00 | $991,685,999.00 | 74.3% | $342,223,868.00 | 25.7% |
| Hawaii | $146,823,551.00 | $146,823,551.00 | 100% | $0.00 | 0.0% |
| Idaho | $333,841,000.00 | $277,755,500.00 | 83.2% | $56,085,500.00 | 16.8% |
| Illinois | $4,605,570,714.00 | $3,532,542,295.00 | 76.7% | $1,073,028,419.00 | 23.3% |
| Indiana | $1,149,849,001.00 | $971,491,079.00 | 84.5% | $178,357,922.00 | 15.5% |
| Iowa | $885,401,711.00 | $276,269,543.00 | 31.2% | $609,132,168.00 | 68.8% |
| Kansas | $595,260,399.00 | $567,602,136.00 | 95.4% | $27,658,263.00 | 4.6% |
| Kentucky | $970,779,705.00 | $741,419,988.00 | 76.4% | $229,359,717.00 | 23.6% |
| Louisiana | $1,205,662,596.00 | $260,739,594.00 | 21.6% | $944,923,002.00 | 78.4% |
| Maine | $619,575,713.00 | $430,759,169.00 | 69.5% | $188,816,544.00 | 30.5% |
| Maryland | $2,085,223,503.00 | $1,709,785,884.00 | 82.0% | $375,437,619.00 | 18.0% |
| Massachusetts | $2,822,789,307.00 | $2,586,326,827.36 | 91.6% | $236,462,479.64 | 8.4% |
| Michigan | $1,207,900,000.00 | $787,900,000.00 | 65.2% | $420,000,000.00 | 34.8% |
| Minnesota | $1,981,616,318.00 | $1,701,357,970.04 | 85.9% | $280,258,347.96 | 14.1% |
| Mississippi | $586,201,341.00 | $241,432,910.00 | 41.2% | $344,768,431.00 | 58.8% |
| Missouri | $2,675,808,294.00 | $1,043,030,072.00 | 39.0% | $1,632,778,222.00 | 61.0% |
| Montana | $204,378,238.00 | $147,950,378.00 | 72.4% | $56,427,860.00 | 27.6% |
| Nebraska | $461,082,834.00 | $454,945,569.00 | 98.7% | $6,137,265.00 | 1.3% |
| Nevada | $418,375,953.00 | $326,751,859.00 | 78.1% | $91,624,094.00 | 21.9% |
| New Hampshire | $626,667,904.00 | $411,399,891.00 | 65.6% | $215,268,013.00 | 34.4% |
| New Jersey | $3,694,379,485.00 | $3,486,302,028.00 | 94.4% | $208,077,457.00 | 5.6% |
| New Mexico | $156,278,501.00 | $136,439,207.00 | 87.3% | $19,839,294.00 | 12.7% |
| New York | $19,519,976,293.00 | $13,434,559,020.75 | 68.8% | $6,085,417,272.25 | 31.2% |
| North Carolina | $2,229,116,847.00 | $2,093,380,126.00 | 93.9% | $135,736,721.00 | 6.1% |
| North Dakota | $226,177,125.00 | $217,494,593.00 | 96.2% | $8,682,532.00 | 3.8% |
| Ohio | $2,935,076,412.00 | $2,089,374,577.00 | 71.2% | $845,701,835.00 | 28.8% |
| Oklahoma | $935,642,390.00 | $762,058,901.00 | 81.4% | $173,583,489.00 | 18.6% |
| Oregon | $558,000,000.00 | $402,000,000.00 | 72.0% | $156,000,000.00 | 28.0% |
| Pennsylvania | $3,404,595,000.00 | $2,234,889,000.00 | 65.6% | $1,169,706,000.00 | 34.4% |
| Rhode Island | $488,066,000.00 | $369,164,072.03 | 75.6% | $118,901,927.97 | 24.4% |
| South Carolina | $802,725,437.00 | $536,277,458.00 | 66.8% | $266,447,979.00 | 33.2% |
| South Dakota | $217,762,212.00 | $216,888,567.96 | 99.6% | $873,644.04 | 0.4% |
| Tennessee | $751,525,910.00 | $324,109,754.00 | 43.1% | $427,416,156.00 | 56.9% |
| Texas | $5,812,052,503.00 | $5,750,721,723.00 | 98.9% | $61,330,780.00 | 1.1% |
| Utah | $360,390,200.00 | $329,483,900.00 | 91.4% | $30,906,300.00 | 8.6% |
| Vermont | $61,077,356.00 | $61,077,356.00 | 100% | $0.00 | 0.0% |
| Virginia | $2,096,264,741.00 | $2,096,264,741.00 | 100% | $0.00 | 0.0% |
| Washington | $1,262,141,267.00 | $1,169,857,025.00 | 92.7% | $92,284,242.00 | 7.3% |
| West Virginia | $402,011,622.00 | $305,578,544.00 | 76.0% | $96,433,078.00 | 24.0% |
| Wisconsin | $1,086,720,728.00 | $531,020,295.00 | 48.9% | $555,700,433.00 | 51.1% |
| Wyoming | $248,333,196.00 | $248,333,196.00 | 100% | $0.00 | 0.0% |
| Total | $98,844,161,735.23 | $73,175,330,073.89 | 74.0% | $25,668,831,661.34 | 26.0% |
| 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. |