Medicaid is a health insurance program jointly funded by the federal government and the states; in New York, counties and the City of New York also make contributions to the program. While the federal government sets some requirements for coverage and other aspects of the program, states have considerable flexibility to shape their programs, including eligibility and scope of service.
The federal government’s contribution is based on the federal medical assistance percentage (FMAP), which is a ratio determined by comparing a state’s per capita income to the U.S. average. Since New York is a relatively wealthier state, it receives a statutory minimum FMAP of 50 percent reimbursement of certain state Medicaid expenditures. Medicaid expansion authorized under the Affordable Care Act for non-elderly adults with incomes up to 138 percent of the federal poverty level also provided the state with a 90 percent FMAP for these individuals.
In SFY 2025, federal Medicaid spending totaled $69.2 billion out of a total of $115.6 billion. Total Medicaid spending is projected by the Division of the Budget (DOB) to grow to $133.7 billion in SFY 2029, of which $73.1 billion is expected to be federally funded.
New York has defined eligibility for Medicaid more broadly than many other states, and enrollment in Medicaid is second only to California. In February 2025, enrollment in Medicaid totaled 6.9 million, and is projected by DOB to remain at around 7 million in the outyears of DOB’s Financial Plan. About 35 percent of the State’s residents were enrolled in Medicaid.
In February 2025, New York City residents constituted 57.8 percent of Medicaid enrollment in the state; however, Medicaid covers a significant share of residents in counties around the state. Medicaid covered at least 25 percent of residents in 36 counties, with a low of 13.7 percent in Hamilton County to a high of 68.2 percent in the Bronx.
New York Medicaid Spending by Level of Government, SFY 2016 – SFY 2025
Note: Pursuant to State law, the amount of county contributions has remained capped at calendar year 2015 levels. SFY 2025 amounts are estimates; all other years are actual.
Source: NYS Division of the Budget
New York Medicaid Enrollment, Month of February, CY 2016 – CY 2025
Note: Medicaid enrollment hit a high of a little over 8 million in June 2023 because federal legislation enacted during the pandemic prohibited states from disenrolling people from Medicaid for the duration of the public health emergency.
Source: NYS Department of Health