This edition looks at state-level and national Medicaid spending trends, first overall and then by the share of Medicaid spending that is paid via capitation. Some of the key findings include:

• National Medicaid spending was 76% higher in FFY2021 than during FFY2011.  However, most of these spending increases are attributable to the enrollment growth that has occurred, driven by widespread adoption of Medicaid expansion and then by COVID’s economic impacts.  Per enrollee Medicaid spending was nearly flat nationwide from 2011 to 2021, increasing at an average annual rate of only 1.0%.

• The use of the capitation model in Medicaid has exploded upwards during the past ten years.  Capitation accounted for 25.0% of all Medicaid spending during FFY2011; this percentage reached 56.1% in FFY2021.  Capitation represented the majority of FFY2021 Medicaid spending in 25 states, as well as nationwide.