Note also that VA and MD are in this category for very different reasons than KY, AL and WV. Virginia and Maryland are extensions of the Washington, DC government complex (the Pentagon is in Virginia). A large portion of the Federal spending that goes to these states is direct expenditure (salaries, rents, purchasing) for goods and services, while for WV it's much more biased towards entitlement spending (social security, disability, Medicaid, Medicare).