States that have not adopted Medicaid expansion under the ACA significantly outperformed expansion states in a new 50-state Medicaid governance ranking from the Heartland Institute.
The report scores states on 16 measures spanning program design, fiscal sustainability, program integrity and provider-market structure. Non-expansion states averaged 57.7 points out of 100, compared with 42.4 among expansion states, and every non-expansion state placed in the top 18, according to a Sept. 9 news release.
Kansas ranked first overall with 74 points, while California ranked last with 22. Six expansion states — Nebraska, South Dakota, Arkansas, Iowa, North Dakota and Utah — still ranked in the top 10 based on strong fiscal and program-integrity scores.
“The states that rise to the top generally do several things well at once, while the states at the bottom tend to accumulate problems across several areas,” said Jack McPherrin, the report’s author and a senior policy analyst and research fellow at the Heartland Institute.
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