{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T16:33:45Z","timestamp":1781282025504,"version":"3.54.1"},"reference-count":21,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Medicaid is a vital public health program, serving over 70 million Americans from many backgrounds. Understanding how Medicaid spending varies by political leadership and demographic factors can inform policy discussions and advocacy efforts. We conducted a cross-sectional descriptive analysis of state Medicaid spending using publicly available data. Our findings show that individuals identifying as White comprise the largest single racial group of Medicaid beneficiaries both nationally and in most states. While the 2020 Census Diversity Index correlated strongly with total Medicaid spending, no significant association was found with per enrollee spending or the federal share of Medicaid funding. States led by Democrats had higher total Medicaid spending when compared to Republican-led states. However, Republican-led states received a larger proportion of federal Medicaid funding. Among political leadership levels, Senate representation showed the strongest relationship with Medicaid spending trends compared to gubernatorial leadership and presidential voting history. In conclusion, we demonstrate that Medicaid spending impacts all racial groups and both major political parties. However, funding structures and political representation reflect distinct spending patterns. Given the evolving demographic and political landscape, ongoing policy discussions should ensure that Medicaid remains a public health program that remains effective at safeguarding human health.<\/jats:p>","DOI":"10.3390\/ijerph22071074","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T11:20:11Z","timestamp":1751628011000},"page":"1074","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["U.S. Federal and State Medicaid Spending: Health Policy Patterns by Political Party Leadership and Census Demographics"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0356-4867","authenticated-orcid":false,"given":"Jamaji C.","family":"Nwanaji-Enwerem","sequence":"first","affiliation":[{"name":"Center for Health Justice, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"Center of Excellence in Environmental Toxicology, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamaji","family":"Nwanaji-Enwerem","sequence":"additional","affiliation":[{"name":"Department of Business and Entrepreneurship, Barber-Scotia College, Concord, NC 28025, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1001\/jama.2022.14791","article-title":"The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity","volume":"328","author":"Donohue","year":"2022","journal-title":"JAMA"},{"key":"ref_2","unstructured":"(2025, March 20). Eligibility Policy|Medicaid, Available online: https:\/\/www.medicaid.gov\/medicaid\/eligibility-policy."},{"key":"ref_3","unstructured":"(2025, March 19). Mandatory & Optional Medicaid Benefits|Medicaid, Available online: https:\/\/www.medicaid.gov\/medicaid\/benefits\/mandatory-optional-medicaid-benefits\/index.html."},{"key":"ref_4","unstructured":"(2024). Budget Basics: Medicaid, Peterson Foundation."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e245140","DOI":"10.1001\/jamahealthforum.2024.5140","article-title":"With or Without ACA Repeal, ACA and Medicaid Cuts Are Looming","volume":"5","author":"Levitt","year":"2024","journal-title":"JAMA Health Forum"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1056\/NEJM198408163110735","article-title":"Termination from Medi-Cal\u2014Does It Affect Health?","volume":"311","author":"Lurie","year":"1984","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1056\/NEJM198605083141934","article-title":"Termination of Medi-Cal Benefits. A Follow-up Study One Year Later","volume":"314","author":"Lurie","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_8","unstructured":"Altman, D. (2025, May 27). The Collision of Medicaid World Views. KFF. Available online: https:\/\/www.kff.org\/from-drew-altman\/the-collision-of-medicaid-world-views."},{"key":"ref_9","unstructured":"Bureau, U.C. (2025, March 19). Racial and Ethnic Diversity in the United States: 2010 Census and 2020 Census, Available online: https:\/\/www.census.gov\/library\/visualizations\/interactive\/racial-and-ethnic-diversity-in-the-united-states-2010-and-2020-census.html."},{"key":"ref_10","unstructured":"EXHIBIT 16 (2025, March 19). Medicaid Spending by State, Category, and Source of Funds, Available online: https:\/\/www.macpac.gov\/publication\/medicaid-spending-by-state-category-and-source-of-funds\/."},{"key":"ref_11","unstructured":"EXHIBIT 22 (2025, March 19). Medicaid Benefit Spending Per Full-Year Equivalent (FYE) Enrollee by State and Eligibility Group, Available online: https:\/\/www.macpac.gov\/publication\/medicaid-benefit-spending-per-full-year-equivalent-fye-enrollee-by-state-and-eligibility-group\/."},{"key":"ref_12","unstructured":"Kaiser Family Foundation (2023). Distribution of People Ages 0\u201364 with Medicaid by Race\/Ethnicity, KFF."},{"key":"ref_13","unstructured":"(2025, March 19). MultiState 2024 Governors and Legislatures. Available online: https:\/\/www.multistate.us\/resources\/2024-governors-and-legislatures."},{"key":"ref_14","unstructured":"(2025, March 19). MultiState 2025 Governors and Legislatures. Available online: https:\/\/www.multistate.us\/resources\/2025-governors-and-legislatures."},{"key":"ref_15","unstructured":"Council of State Governments (2025, March 19). Book of the States 2023. Council of State Governments, Available online: https:\/\/bookofthestates.org\/tables\/2023-4-1\/."},{"key":"ref_16","unstructured":"(2025, March 19). Electoral College Results, Available online: https:\/\/www.archives.gov\/electoral-college\/results."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1561\/100.00006026","article-title":"Rich State, Poor State, Red State, Blue State: What\u2019s the Matter with Connecticut?","volume":"2","author":"Gelman","year":"2005","journal-title":"Q. J. Political Sci."},{"key":"ref_18","unstructured":"Jacobson, L. (2025, March 20). Population-Growth Patterns Paint Grim Picture for Democrats|Politics|U.S. News. Available online: https:\/\/www.usnews.com\/news\/politics\/articles\/2024-01-16\/population-growth-patterns-paint-grim-picture-for-democrats."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1215\/03616878-2334889","article-title":"Why States Expand Medicaid: Party, Resources, and History","volume":"38","author":"Jacobs","year":"2013","journal-title":"J. Health Politics Policy Law"},{"key":"ref_20","unstructured":"Choi, J.H., and Lim, C.S.H. The Political Economy of Medicaid: Partisanship, Eligibility, and the Unintended Consequences of Cost-Saving Measures; Presented at the Empirical Micro Lunch seminar, Department of Economics, University of Pennsylvania, Philadelphia, PA, USA, 21 September 2021, (working paper)."},{"key":"ref_21","unstructured":"Euhus, R., Burns, A., and Published, R.R. (2025). Map: Medicaid Enrollment by Eligibility Group, KFF."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/7\/1074\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:04:34Z","timestamp":1760033074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/7\/1074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":21,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["ijerph22071074"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22071074","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]}}}