Spending Trends
Medicaid spending grew 70% from $108.67B in 2018 to $184.98B in 2024.
Total (7 Years)
$1.09T
Peak Year
2023
$198.79B
Total Growth
+70%
2018 to 2024
2024 Providers
340K
Total Payments by Year
2020–2021: COVID-19 Pandemic Impact
Federal continuous enrollment provisions and emergency funding dramatically expanded Medicaid during the pandemic. The $0 jump from 2020 to 2021 was the largest single-year increase in the dataset, driven by surging enrollment and pandemic-related healthcare spending.
2024: Medicaid Unwinding
The end of pandemic-era continuous enrollment protections led to millions of disenrollments nationwide, contributing to the first spending decline since the dataset began. States resumed eligibility redeterminations, removing beneficiaries who no longer qualified or failed to complete paperwork.
Total Claims by Year
Year-by-Year Breakdown
| Year | Payments | YoY Growth |
|---|---|---|
| 2018 | $108.67B | — |
| 2019 | $126.91B | +16.8% |
| 2020 | $132.09B | +4.1% |
| 2021 | $162.56B | +23.1% |
| 2022 | $179.56B | +10.5% |
| 2023 | $198.79B | +10.7% |
| 2024 | $184.98B | -6.9% |
Key Observations
Medicaid spending grew steadily from 2018 through 2023, accelerating during the COVID-19 pandemic era (2020–2021). The peak in 2023 at $198.79B represents the highest spending year in the dataset.
The slight decline in 2024 ($184.98B) may reflect the Medicaid unwinding — the end of continuous enrollment protections enacted during the pandemic, which led to millions of beneficiaries being disenrolled.
Provider counts peaked at 360K in 2023, suggesting the growth in spending is driven by both more providers entering the system and existing providers billing more.
Key Takeaways
- •Medicaid spending grew 70% over seven years, from $108.67B (2018) to a peak of $198.79B (2023) — far outpacing inflation.
- •The COVID-19 pandemic was the single biggest accelerant, with federal continuous enrollment provisions and emergency funding driving the largest year-over-year increases in the dataset.
- •The 2024 decline marks the first spending drop since the dataset began, coinciding with Medicaid unwinding and millions of disenrollments as states resumed eligibility checks.
- •Rapid spending growth created opportunities for fraud — our analysis identifies 1,860 providers with suspicious billing patterns that emerged during this expansion.
What This Means
Medicaid spending nearly doubled in seven years, driven by pandemic emergency measures that expanded enrollment and suspended eligibility checks. This rapid growth created an environment where fraudulent billing could more easily go undetected — more money flowing through the system with fewer guardrails.
The 2024 decline signals a correction as states resume normal operations, but spending remains 70% above 2018 levels. The providers, procedures, and billing patterns that emerged during this expansion period deserve the closest scrutiny.
Our analysis flagged 1,860 providers whose billing patterns deviate significantly from their peers — many of whom saw their largest billing increases during the 2020–2023 growth period. Understanding when anomalies appeared matters as much as understanding what the anomalies are.