(The Center Square) – New analysis of Medicaid programs in each state in the U.S. ranked Illinois a few spots below the middle, based on criteria like how the state has expanded the program’s scope and spending growth.
The Heartland Institute, a self-described nonprofit think tank focused on “free-market solutions to social and economic problems,” produced an evaluation of each state’s Medicaid program, ranking Illinois’ program implementation 31st.
Jack McPherrin, a senior policy analyst and research fellow with the institute, co-authored the report, which he said focuses on the structure, integrity and fiscal sustainability of state-implemented Medicaid programs.
“The purpose of the scorecard isn't necessarily to say that, for instance, Kansas has the best health care system in America or that California has the worst,” McPherrin said. “The scorecard itself is a much narrower assessment.”
McPherrin said the middling score is due to a combination of aspects ranging from implementation and program expansion to fiscal sustainability.
“Illinois has decided to expand Medicaid, along with 39 other states. It has no meaningful early work requirement activity in accordance with the federal statute passed last year. It has rapid Medicaid spending and per annually cost growth. It has no all payer claims database and its provider market is generally fairly restricted,” McPherrin said.
The category Illinois performed worst in was fiscal sustainability, which the researcher attributed to increased spending.
“In terms of fiscal sustainability, of course, that's more of a long-term measure.It's not something that can be fixed immediately, but the more that's being spent on Medicaid, the less that can go towards other policy areas and other things that might be important to consumers,” McPherrin said.
The state spent about $43.17 billion during the 2026 fiscal year that ended July 31. Spending was up $6.11 billion from FY 2024, according to state comptroller data.
For every dollar spent by the state on Medicaid, the federal government reimburses about 51.82%.
Illinois tied Indiana in overall score, while Iowa ranked well ahead.
“[Iowa] has very strong performance on program design, administrative oversight, provider market indicators. It has early work requirement activity, which is one of the things that really distinguishes it from Illinois,” McPherrin said.
He said the key takeaways from the research for Illinois, at least legislatively, is that the program in Illinois could improve fiscally by rolling back expansion beyond the initially created program, though he acknowledged that would be politically difficult.
“I understand that that's politically – might be a little bit difficult, especially in a state like Illinois, but there are a lot of downstream effects of that that create the problems that that Illinois is facing here,” McPherrin said.
He pointed to low-ranking Kentucky, which has a conservative legislature, to note that the program’s size and sustainability aren’t strictly tied to politics.
He said that the rankings are focused on "rigorous" methodology to assess the program in each state, and the study is made to be replicable and transparent.
