Equitable distribution of public spending has been argued to be an effective tool for enhancing access to health care and moving towards Universal Health Coverage. In India, much of the existing evidence on equity in public spending has been confined to state-level aggregates, and intra-state distribution of public spending has received limited attention. This paper focuses on the distribution of public spending on health within two Indian States (Bihar and Tamil Nadu) to provide insights on differential access to health care within each state. The analysis suggests that public spending on health is pro-rich in Bihar, and plays a relatively weak redistributive role. In contrast, the distribution of public spending on health in Tamil Nadu is strikingly pro-poor, particularly at lower levels of care. In both horizontal and vertical dimensions (across districts and levels of health care), inequity in public spending is significantly higher in Bihar than in Tamil Nadu.