Most people like Medicaid but don’t know about this quirk in the system that allows states to make money on it—at the expense of federal taxpayers.
Uncle Sam reimburses states a percentage of what they spend on Medicaid. That ranges from 50 to 76.9 percent in 2025, depending on several factors. For people who enrolled through the Medicaid expansion under the Affordable Care Act, the reimbursement rate is 90 percent.
