Best and Worst States for Healthcare for Low-Income Individuals

Having affordable and reliable healthcare is more critical to Americans as the country attempts to navigate past the COVID-19 pandemic. 

Over 78.5 million are currently enrolled in publicly-funded health insurance for low-income individuals. 

Paid for by state and federal governments, Medicaid and the Children’s Health Insurance Program (CHIP) were created to provide health insurance to people who lacked the money or resources to buy it. Each state has its own eligibility requirements and policies.

Generally, you qualify for Medicaid or CHIP depending on how your annual household income compares to the Federal Poverty Level. Other criteria such as residency, legal status and age could apply.  

The Affordable Care Act also offered funding to states to expand Medicaid eligibility. To date, 39 states and Washington, D.C. have done so. 

Given how important Medicaid and CHIP are to the populations they serve, we sought to gauge the states with the best and worst healthcare coverage.

HealthCareInsider compared the 50 states and Washington, D.C. across 13 key metrics in three categories: Cost, Access and Quality.  

Read our findings below along with a full description of our methodology.

Rank	State	Total Score	Cost	Quality	Access
1	Connecticut	76.86	19.11	27.28	30.47
2	New York	75.99	24.34	24.66	26.99
3	California	74.79	20.42	26.62	27.75
4	Massachusetts	74.74	21.72	26.46	26.55
5	Minnesota	73.48	21.89	23.52	28.08
6	District of Columbia	71.63	16.82	21.72	33.08
7	New Mexico	69.51	20.58	19.76	29.16
8	Vermont	69.35	21.56	20.91	26.88
9	Washington	65.10	16.66	25.48	22.96
10	Hawaii	64.12	14.05	27.44	22.64
11	Rhode Island	62.98	22.05	23.52	17.41
12	Maryland	62.65	17.80	20.91	23.94
13	Colorado	61.78	14.37	21.40	26.01
14	Delaware	61.72	17.31	19.27	25.14
15	Pennsylvania	61.51	22.87	18.29	20.35
16	Arkansas	61.40	19.27	13.72	28.40
17	Maine	59.44	22.21	10.13	27.10
18	West Virginia	58.57	17.97	17.97	22.64
19	Illinois	58.19	18.46	19.27	20.46
20	Ohio	57.70	22.70	10.62	24.38
21	Oregon	57.10	16.66	25.97	14.47
22	Kentucky	54.71	20.58	15.52	18.61
23	New Jersey	54.70	15.35	18.13	21.22
24	Louisiana	51.71	20.42	13.56	17.74
25	New Hampshire	50.25	17.64	21.72	10.88
26	Michigan	49.92	18.78	17.31	13.82
27	Wisconsin	49.37	13.88	14.05	21.44
28	Iowa	49.26	14.54	12.41	22.31
29	Florida	48.88	16.50	19.76	12.62
30	Virginia	48.71	10.13	17.15	21.44
31	Alaska	46.87	16.82	15.35	14.69
32	Nevada	45.51	12.90	19.44	13.17
33	North Carolina	44.47	16.17	10.13	18.17
34	Indiana	44.04	20.58	9.96	13.49
35	Arizona	43.77	18.46	13.56	11.75
36	Montana	41.53	14.70	14.21	12.62
37	South Carolina	39.79	14.37	6.04	19.37
38	Utah	39.41	9.47	20.91	9.03
39	Nebraska	37.50	10.45	8.66	18.39
40	Tennessee	37.40	20.25	10.29	6.86
41	Missouri	36.74	21.40	5.23	10.12
42	North Dakota	36.42	13.56	17.97	4.90
43	Mississippi	36.15	17.80	9.96	8.38
44	Texas	35.87	16.50	9.15	10.23
45	Alabama	35.71	13.23	15.19	7.29
46	Wyoming	31.79	10.78	12.74	8.27
47	Idaho	31.46	13.88	9.31	8.27
48	Kansas	28.91	11.92	12.09	4.90
49	Georgia	28.47	10.62	8.82	9.03
50	Oklahoma	27.38	14.86	2.94	9.58
51	South Dakota	26.51	10.78	8.98	6.75

*Excluding states that did not participate in the Medicaid Expansion program. 

Best States for Low-Income Healthcare: Countdown

Methodology

In order to determine the best and worst states for low-income healthcare, HealthCareInsider compared the 50 states and the District of Columbia across three key categories: 1) Cost, 2) Access and 3) Quality.

We evaluated those categories using 13 relevant metrics, which are detailed below. Each metric was graded on a 100-point scale. A  score of 100 represented the best healthcare for low-income individuals at the most affordable cost.

Lastly, we determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Cost – Total Points: 33.33

• Total Medicaid Spending Per Low-income Population: Full Weight
• Federal Medicaid Contribution as a Percentage: Full Weight
• State Medicaid Contribution as a Percentage: Full Weight
• State Medicaid Spending as Share of State Budget: Full Weight
  • Note: This metric measures the total Medicaid & state-funded Medicaid spending as share of total state budget.

Quality – Total Points: 33.33

• Life Expectancy for Low-Income Individuals: Full Weight
• Quality of Public Hospital System: Full Weight
  • Note: This metric measures performance rates on frequently reported health care quality measures in the CMS Medicaid Adult Core Set.
• Medicaid Expansion Enrollment Per Capita: Full Weight
• Child Immunization Quality: Full Weight
  • Note: This metric measures the share of voluntarily reported sets of core measures showing the quality of care and health outcomes for adults participating in Medicaid, and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

Access – Total Points: 33.33

• Children Medicaid Eligibility Level: Full Weight
  • Note: This metric is expressed as a percentage of the Federal Poverty Level.
• Pregnant Women Medicaid Eligibility Level: Full Weight
  • Note: This metric is expressed as a percentage of the Federal Poverty Level.
• Adults Medicaid Eligibility Level: Full Weight
  • Note: This metric is expressed as a percentage of the Federal Poverty Level.
• Total Medicaid Enrollment Per Capita: Full Weight
• Medicaid/CHIP Coverage of Lawfully-Residing Immigrant Children: Full Weight
• Medicaid/CHIP Coverage of Lawfully-Residing Pregnant Women: Full Weight

Sources: Data used to create this ranking were collected from Centers for Medicare & Medicaid Services (CDC), Kaiser Family Foundation, Medicaid and CHIP Payment and Access Commission (MACPAC) and Opportunity Insights (formally the Equality of Opportunity Project).