From $109B to $199B: How Medicaid Spending Nearly Doubled in 6 Years
Medicaid spending grew from $108.67B in 2018 to $198.79B in 2023 — an 83% increase. The COVID pandemic was the turning point: 2020 saw a modest jump, then 2021 exploded with $30.5B in additional spending. With 2024 partial-year data already at $184.98B, the full year will likely set another record.
$1.09T
Total 7-Year Spending
$198.79B
Peak Year (2023)
+83%
Growth 2018–2023
+35K
Provider Growth
Medicaid Spending by Year
Total payments in billions of dollars. 2024 is partial-year data.
Year-by-Year Breakdown
| Year | Total Paid | Claims | Providers | YoY Change | YoY % |
|---|---|---|---|---|---|
| 2018 | $108.67B | 2.1B | 325K | — | — |
| 2019 | $126.91B | 2.4B | 328K | +$18.24B | +16.8% |
| 2020 | $132.09B | 2.3B | 344K | +$5.18B | +4.1% |
| 2021 | $162.56B | 2.9B | 359K | +$30.47B | +23.1% |
| 2022 | $179.56B | 3.1B | 356K | +$17.01B | +10.5% |
| 2023 | $198.79B | 3.2B | 360K | +$19.23B | +10.7% |
| 2024* | $184.98B | 2.8B | 340K | -$13.81B | -6.9% |
* 2024 data is partial year (not all months reported).
The Story Behind the Numbers
Between 2018 and 2023, Medicaid spending grew every single year. But not all growth was equal. From 2018 to 2019, spending jumped $18.2B (+16.8%), driven partly by state Medicaid expansion under the ACA. Then 2020 hit.
The COVID Inflection Point
The Families First Coronavirus Response Act (FFCRA) in March 2020 included a continuous enrollment requirement: states couldn’t disenroll Medicaid beneficiaries during the public health emergency. Enrollment surged from roughly 71 million to over 90 million. This single policy change rippled through every spending category for three years.
The effect wasn’t immediate. In 2020, total spending rose by $5.18B — a modest 4.1% increase. Many in-person services dropped as lockdowns took hold and elective procedures were postponed. But by 2021, deferred care came roaring back. Spending exploded by $30.47B in a single year — a 23.1% jump, the largest absolute increase in our dataset.
What Drove the Growth?
Continuous Enrollment
The FFCRA enrollment freeze added 20+ million beneficiaries who couldn’t be disenrolled, even if they no longer qualified. States received enhanced federal matching in exchange.
Telehealth Expansion
Medicaid rapidly expanded telehealth coverage during COVID. Many states made temporary expansions permanent, adding new billing codes and reimbursement pathways.
Rising Drug Costs
New specialty drugs, gene therapies, and provider-administered biologics entered the market at price points exceeding $100K per treatment. Medicaid absorbed these costs for a growing beneficiary population.
State Expansion
Several states expanded Medicaid eligibility between 2018 and 2023, including Nebraska (2020), Oklahoma (2021), Missouri (2021), and South Dakota (2023), adding hundreds of thousands of new enrollees.
The growth continued in 2022 (+10.5%) and 2023 (+10.7%), pushing total annual spending to nearly $198.79B. The provider ecosystem grew too: from 325K active providers in 2018 to 360K in 2023 — a net increase of 35K billing entities.
2024: Partial Data, But Telling
The 2024 figures in our dataset ($184.98B) reflect an incomplete reporting year. Not all states have submitted their full 2024 data. Despite this, the partial total already exceeds every full year before 2022. If the remaining months follow historical patterns, 2024 will almost certainly surpass 2023’s record $198.79B.
The numbers tell a clear story: Medicaid is on a trajectory that shows no sign of slowing. Over seven years, the program paid out a combined $1.09T across 18.8B claims. Understanding where this money goes — and whether it’s being spent effectively — is the central question behind every investigation on this site.
Key Takeaways
- ▸Medicaid spending grew 83% from 2018 to 2023, from $108.67B to $198.79B annually.
- ▸2021 was the inflection year: $30.47B in additional spending (+23.1%), the largest single-year jump in the dataset.
- ▸The provider ecosystem expanded by 35K providers (325K to 360K) over six years.
- ▸2024 partial data ($184.98B) already exceeds pre-2022 full-year totals, suggesting another record when complete.
Source: HHS T-MSIS Other Services File (2018–2024) · 227M records