http://www.statecoverage.org/files/Disparities%20in%20State%20Health%20Coverage%20A%20Matter%20of%20Policy%20or%20Fortune.pdf

The paper explores the reasons why states differ in their Medicaid coverage of the at-risk population, focusing in particular on the large disparities in Medicaid spending associated with these differences.Two distinct sources for these disparities in spending are examined. First, they may be the result of two factors largely beyond state control: differences in state wealth (or "fiscal capacity"), and differences in the generosity of federal funding. Second, they may be the result of differences in state "fiscal effort," as measured by the ratio of state Medicaid spending to capacity.