Best and Worst States for Healthcare for Low-Income Individuals

HealthCare Insider ranked all 50 states and Washington, D.C. on cost, access, and quality of Medicaid and CHIP coverage for low-income individuals. Our analysis highlights where affordable healthcare is most accessible—and where it still falls short.

Why the State You Live in Matters for Affordable Healthcare

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. 

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.

The Best and Worst States For Healthcare in The U.S.

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

The following is a ranking of states from best to worst for overall healthcare:

1. Connecticut
2. New York
3. California
4. Massachusetts
5. Minnesota
6. District of Columbia
7. New Mexico
8. Vermont
9. Washington
10. Hawaii
11. Rhode Island
12. Maryland
13. Colorado
14. Delaware
15. Pennsylvania
16. Arkansas
17. Maine
18. West Virginia
19. Illinois
20. Ohio
21. Oregon
22. Kentucky
23. New Jersey
24. Louisiana
25. New Hampshire
26. Michigan
27. Wisconsin
28. Iowa
29. Florida
30. Virginia
31. Alaska
32. Nevada
33. North Carolina
34. Indiana
35. Arizona
36. Montana
37. South Carolina
38. Utah
39. Nebraska
40. Tennessee
41. Missouri
42. North Dakota
43. Mississippi
44. Texas
45. Alabama
46. Wyoming
47. Idaho
48. Kansas
49. Georgia
50. Oklahoma
51. South Dakota

Best and Worst States By Cost

Medicaid Spending Per Capita

• Best: District of Columbia
• Worst: Utah

Federal Medicaid Contribution

• Best: New Mexico
• Worst: Wyoming

State Medicaid Contribution

• Best: Wyoming
• Worst: New Mexico

Best and Worst States By Quality

Child Immunization Quality

• Best: Connecticut
• Worst: Wyoming

Public Hospital System Quality

• Best: Hawaii
• Worst: Louisiana

Medicaid Expansion Enrollment Per Capita

• Best: Washington, D.C.
• Worst: Maine*

Best and Worst States By Access

Pregnant Women Medicaid Eligibility Level

• Best: Iowa
• Worst: South Dakota

Adult Medicaid Eligibility Level

• Best: Washington, D.C.
• Worst: Texas

Children Medicaid Eligibility Level

• Best: Washington, D.C.
• Worst: Wyoming

Total Medicaid Enrollment Per Capita

• Best: New Mexico
• Worst: North Dakota

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

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).