Using a state-culture conceptual framework, this 50-state study of the United States identifies factors affecting state-level variance in Medicaid expenditures in 2004. Path analysis is applied to depict a structural model measured by political and socioeconomic predictors of state-level Medicaid expenditures. Findings show Democratic political party control, and a state's financial capacity predicts higher Medicaid expenditures. Medicaid need demographics have a significant, but negative, effect on Medicaid expenditures. Maintaining political neutrality may constrain our ability to advocate for vulnerable populations. Establishing a uniform standard for indigent health care through a federally financed and administered universal health insurance structure is discussed.