Heartland Institute Evaluated State Medicaid Systems
A new study compared performance across all 50 states, ranking Kansas first and California last.
Updated on Sept. 27, 2026 in Healthcare
Live Poll
Should states restrict Medicaid eligibility to ensure greater fiscal sustainability of the program?
The Heartland Institute has released a new report card evaluating Medicaid programs across all 50 states. Kansas earned the top ranking with 74 points, while California finished last with 22 points.
Why it matters
The report aims to provide state policymakers with a clearer understanding of how their specific systems perform. It highlights significant disparities in Medicaid efficiency and sustainability across the country.
The study evaluated states across 16 benchmarks, revealing that non-expansion states averaged 57.7 points compared to 42.4 points for expansion states. Nationally, Medicaid programs provide coverage to 75 million people.
The players
The Heartland Institute
This is a Chicago-based public policy research organization that conducts studies on government programs and fiscal policy.
Centers for Medicare & Medicaid Services
This federal agency oversees the administration of Medicare and Medicaid programs in the United States.
The details
Researchers compiled the rankings using 16 benchmarks organized into four categories, drawing on public records from the U.S. Census Bureau and federal health agencies. The report highlighted fiscal sustainability as a key differentiator, with Wyoming and Mississippi earning 26 points in that metric, while New York received zero.
Timeline
September 27, 2026: The Medicaid Report Card study was officially released.
Market Landscape
This report follows a pattern set by the Medicaid and CHIP Payment and Access Commission reporting standards to evaluate health program efficacy. It underscores the ongoing competition among states to balance fiscal sustainability with access to coverage.
Patients may see shifts in their local program management as state policymakers use these metrics to identify reform opportunities. Those covered by the program should monitor local health department communications for potential administrative changes.
The takeaway
Understanding how state programs rank can help citizens engage more effectively with local health policy debates. The performance gap between expansion and non-expansion states indicates that structural differences continue to drive major health care outcomes.
Further reading
For more context on the national healthcare environment, visit the Healthcare section.
Live Poll
Should states restrict Medicaid eligibility to ensure greater fiscal sustainability of the program?
