Heartland Institute Study Ranked U.S. Medicaid Systems

The study offers operators a view of state program performance as policy shifts influence healthcare costs and regional access.

Updated on Sept. 27, 2026 in Healthcare

Bold flat-color editorial illustration showing stylized medical vials and a clinic model, representing state healthcare policy analysis. — The Heartland Institute's new Medicaid report card evaluates state systems across 16 benchmarks, revealing fiscal and administrative variations among all 50 states. AI Illustration. Upload story photo >

Live Poll

Should states restrict Medicaid eligibility to ensure greater fiscal sustainability of the program?

The Heartland Institute released "The Medicaid Report Card," an evaluation of state programs across 50 states using 16 distinct benchmarks. The study analyzed how various state policies affect the 75 million people covered by Medicaid nationwide.

Why it matters

The report provides state policymakers and healthcare stakeholders with a standardized view of program sustainability and reform opportunities. For operators, these rankings highlight significant geographic variations in fiscal sustainability and program administration that impact regional healthcare markets.

Kansas led the rankings with 74 points, while California ranked last with 22 points, falling below the 45.5 national average. The analysis measured 16 benchmarks against a potential 100 points, with 26 points specifically allocated to fiscal sustainability metrics.

The players

The Heartland Institute

A Chicago-based public policy think tank that produces research and analysis on state and federal government programs.

The details

Researchers evaluated state performance using public records from the U.S. Census Bureau, the Centers for Medicare & Medicaid Services, and the Medicaid and CHIP Payment and Access Commission. The assessment grouped benchmarks into four categories to quantify how state-level decisions influence program efficiency and long-term sustainability. Non-expansion states averaged 57.7 points in the rankings, while expansion states averaged 42.4 points.

The Medicaid Report Card study was released on September 27, 2026.

Market Landscape

This study extends the ongoing analysis of state-level program administration under the Social Security Act's Medicaid provisions. It follows established trends in evaluating how state-specific implementation impacts the fiscal sustainability of government-funded healthcare.

Operators in the healthcare sector should monitor state-level fiscal sustainability scores to anticipate potential changes in reimbursement policies or administrative requirements. These rankings serve as a baseline for assessing regional regulatory risk and potential future reform measures in specific state markets.

The takeaway

The study suggests that state-level policy choices create measurable differences in Medicaid program viability. Healthcare operators should track their home state's fiscal sustainability performance as a leading indicator for potential policy shifts or adjustments to provider reimbursement structures.