Expenditures by Government Payers

New York’s Medicaid program is funded through a combination of federal, state, and local dollars. The federal government reimburses 50% of most New York Medicaid costs, with higher matching rates for ACA Medicaid expansion costs and other special circumstances, which is why the visualizations show the federal proportion as greater than 50 percent.¹

New York Medicaid Expenditures by Local, State, and Federal Share: State Fiscal Years (SFY) 2016-17 through 2021-22

Where the Money Goes

Medicaid members' care is either administered through a Medicaid managed care (MMC) plan or directly through the State in fee-for-service (FFS). MMC plans (mainstream managed care, managed long-term care, etc.) receive risk-adjusted monthly payments from the state to manage and administer services members receive. Care for specific subpopulations (older adults, people with disabilities, etc.) is administered through FFS. Both MMC and FFS cover the same comprehensive services for members.

New York Medicaid Expenditures by Service Category: Federal Fiscal Years 2013 and 2021²

1. The New York State fiscal year (SFY) runs from April 1 of one year to March 31 of the following year. For example, SFY 2016-17 is between April 1, 2016 and March 31, 2017.

Congressional Research Service. April 2018. Medicaid’s Federal Medical Assistance Percentage (FMAP).

New York State. November 2017. Fiscal Year 2018 Mid-Year Update.

August 2018. Fiscal Year 2019 First Quarterly Update.

November 2019. Fiscal Year 2020 Mid-Year Update.

November 2020. Fiscal Year 2021 Mid-Year Update.

April 2022. Fiscal Year 2023 Enacted Financial Plan

To offset the growing financial burden on local districts due to the growth in Medicaid spending, the local Medicaid share was frozen. Beginning in 2012, Governor Andrew Cuomo and the Legislature enacted a phaseout of the growth in local Medicaid funding. This meant that each local district's Medicaid local share cannot exceed the 2015 level. All non-federal costs beyond those amounts are paid for by the State. This is why the dollar amount paid by localities has been stable for the graphed fiscal years.

New York State Department of Health. November 2010. New York State Medicaid Administration November 2010 Report.

2. The federal fiscal year (FFY) runs from October 1 of one year to September 30 of the following year. For example, FFY 2013 is between October 1, 2012 and September 30, 2013.

The service category expenditures and percentages displayed in these charts may be inconsistent with NYS Medicaid spending reported from other sources for several reasons:

The federal CMS-64 data displayed in these charts may include certain prior period adjustments for services and expenditures incurred in earlier years.
The displayed percentages of expenditures by service category do not include the offsetting Medicaid fee-for-service and managed care rebates, which had net totals of $2.032 billion in FFY 2013 and $3.148 billion in FFY 2019. The displayed percentages only reflect unadjusted expenditures on fee-for-service prescribed drugs and managed care and premium assistance as listed in the state CMS-64 reports.

Medicaid and CHIP Payment and Access Commission. MACStats Medicaid and CHIP Data Book. June 2014 and December 2021.

New York State Department of Health. May 6, 2022. Medicaid Program Enrollment by Month: Beginning 2009.

3. Certain services are covered by fee for service (FFS) for all members (i.e., carved out from MMC). These services include non-emergency medical transportation and pharmacy benefits. Also, FFS will cover any benefits available to Medicaid-eligible New Yorkers who are enrolled in Essential Plan or Child Health Plus that are not covered by Essential Plan or Child Health Plus.

Last updated 3/23/2023