A comprehensive, data-driven evaluation of all 50 states across program design, fiscal sustainability, program integrity, and market structure.
Click any state to view its full report card
Lower score
Higher score
Top 10 states
Each state is evaluated across 16 metrics grouped into four pillars. Metrics are scored based on quintile rankings relative to peer states, rewarding fiscal discipline, program integrity, and market-friendly policies.
A higher score reflects better Medicaid program management — not necessarily more spending or broader coverage. Scores range from 0 to 100.
Pillar 1 — Program design & enrollment
Expansion status, work requirements, redetermination rates, MCO presence, coverage ratio. Max 36 pts.
Pillar 2 — Fiscal sustainability & cost growth
5-year spending growth, per-enrollee cost growth, Medicaid budget share. Max 26 pts.
Pillar 3 — Program integrity & oversight
Improper payment rate, MFCU enforcement strength, APCD presence. Max 24 pts.
Pillar 4 — Market structure & provider environment
CON laws, PCP supply, NP & PA scope of practice, IMLC membership. Max 14 pts.
