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
Medicaid Enrollment by County
- Data Table
District Enrollment Percent Enrolled Albany 71,045 22.4% Allegany 12,538 26.9% Bronx 924,530 68.2% Broome 56,290 28.7% Cattaraugus 21,402 28.3% Cayuga 19,893 26.7% Chautauqua 38,794 31.1% Chemung 29,303 36.0% Chenango 14,177 30.9% Clinton 19,773 25.3% Columbia 14,453 23.9% Cortland 11,995 26.2% Delaware 10,255 23.1% Dutchess 62,580 21.1% Erie 253,616 26.8% Essex 8,084 22.0% Franklin 14,480 31.1% Fulton 14,664 28.1% Genesee 12,941 22.5% Greene 12,167 25.9% Hamilton 698 13.7% Herkimer 16,352 27.5% Jefferson 28,886 25.2% Kings (Brooklyn) 1,294,232 50.5% Lewis 5,191 19.6% Livingston 11,770 19.2% Madison 15,650 23.4% Monroe 199,607 26.7% Montgomery 18,522 37.5% Nassau 308,393 22.3% New York (Manhattan) 480,783 30.1% Niagara 53,908 25.7% Oneida 70,591 31.0% Onondaga 119,079 25.5% Ontario 22,594 20.1% Orange 127,170 31.2% Orleans 10,970 28.0% Oswego 33,283 28.2% Otsego 13,146 21.9% Putnam 17,815 18.2% Queens 1,110,863 49.3% Rensselaer 35,670 22.4% Richmond (Staten Island) 181,942 37.1% Rockland 151,661 44.5% Saint Lawrence 28,375 26.5% Saratoga 36,632 15.3% Schenectady 47,439 29.7% Schoharie 7,093 23.6% Schuyler 3,498 20.0% Seneca 7,660 23.7% Steuben 26,202 28.4% Suffolk 366,980 24.1% Sullivan 28,276 35.4% Tioga 11,984 25.1% Tompkins 16,443 15.9% Ulster 48,678 26.7% Warren 15,621 23.9% Washington 16,348 27.2% Wayne 21,397 23.6% Westchester 239,949 24.2% Wyoming 8,849 22.4% Yates 4,962 20.3%