Though a high proportion of Medicaid population in Alabama are women, little is known about their economic burdens of diabetes and hypertension. We used Alabama Medicaid claims data of 16,107 female enrollees aged 19-64 years to estimate per-capita total annual medical costs of hypertension by diabetes status. Hypertension prevalence was 60.0% and 17.3% among those with and without diabetes. The estimated annual medical cost for enrollees with hypertension was $6,689 (in 2017 $), of which $2,369 was associated with having hypertension. The hypertension-associated excess costs were $2,646 and $2,378 for enrollees with and without diabetes. All subgroups such as Blacks and those with Charlson Comorbidity Index ≥ 1, had higher medical costs when they had a combination of hypertension and diabetes compared with having diabetes without hypertension. Hypertension and diabetes increased medical costs substantially, and the findings can inform decision makers about effective resource utilizations for prevention and treatment strategies.