State Health Care Spending Project

State Health Care Spending Project



The State Health Care Spending Project is an initiative of The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation. We help policy makers better understand how much states spend on health care, how this amount is changing over time, and how states can manage costs while improving health outcomes. Learn more about the challenges states face and our work (PDF).

Why State Health Care Spending Matters

When it comes to health care spending, the bill just keeps getting bigger. Health care’s growing claim on state budgets is competing with other important priorities, including education, public safety, and transportation.

States felt this acutely during the Great Recession, when the number of people on Medicaid expanded dramatically. Medicaid is now the top budget item for states, comprising more than 22 percent of their total spending in fiscal year 2010, and that figure is projected to rise in coming years. Many states will spend more money on Medicaid as the Affordable Care Act (ACA) begins to expand in 2014—and that amount will grow in 2019, when federal funds begin to taper.

The implementation of ACA has heightened the focus on Medicaid. But states have many other health care costs—such as public sector employee and retiree benefits, public health, state-run hospitals, and corrections—that account for a significant share of their overall health care spending. These, too, will likely escalate. Containing all of these costs in ways that deliver better outcomes will be critical to states’ fiscal health now and in the future. 

How We Conduct Our Work

The State Health Care Spending Project conducts original research, convenes policy makers, and works with experts in the field to help states understand how much they spend on health care overall, how that amount has changed over time, what is driving it higher, and which policy approaches are containing costs while improving health outcomes. Our rigorous, nonpartisan 50-state data and analysis enable stakeholders to compare and contrast states’ experiences, and our case studies showcase innovative efforts to manage costs. By bringing together lawmakers from across the states, we offer opportunities for them to share both lessons learned and ideas for change. And Stateline, Pew's daily news service, provides regular reporting and analysis on states' health care issues.


October 29, 2013

Managing Prison Health Care Spending

This report examines state spending on inmate health care and the factors driving costs higher. It also reviews strategies that some states have used to control these expenses while protecting public safety and maintaining or improving the quality of care that prisoners receive. More
HEALTH medicaid database
March 6, 2013

Combating Medicaid Fraud and Abuse

States are targeting Medicaid fraud and abuse with an array of policies and tools. To help policy makers learn about steps taken in their state and across the country, the State Health Care Spending Project created an online database containing hundreds of practices found to be promising by state and federal Medicaid agencies. More
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