Medicaid is a cornerstone of New York's health insurance system, providing coverage for more than four million of the state's residents, including more than two million in New York City. Accounting for about $50 billion in annual health care spending, Medicaid provides a broad range of health care services to diverse groups of New Yorkers. The program's responsibilities include four main roles:

• Providing health insurance to low-income families;
• Covering disabled individuals with no other access to services;
• Supplementing Medicare for low-income elderly and disabled persons;
• Providing subsidies directly to health care providers.

As of September 2009, 4.5 million New Yorkers were enrolled in Medicaid, including:

• 1.7 million children who are not disabled (not including 0.4 million enrolled in CHIP)
• 1.7 million adults who are neither elderly nor disabled
• 1.1 million individuals who are elderly, disabled, or both

Medicaid spending on health care services in New York totaled $49.4 billion in federal fiscal year 2009. Acute care services accounted for 47 percent of costs and long-term care accounted for 47 percent; direct payments to Disproportionate Share Hospitals (DSH), those serving high concentrations of Medicaid patients and the uninsured, made up the balance. (An additional $1.4 billion was spent on administrative costs.)  

Although elderly and disabled beneficiaries make up less than one-fourth of Medicaid enrollment, services provided to them account for about two-thirds of spending, most of which fills coverage gaps for beneficiaries also enrolled in Medicare. Children and adults who are neither elderly nor disabled make up more than three-quarters of enrollment, yet account for about one-quarter of Medicaid spending.