Medicaid is the primary program providing comprehensive coverage of health and long-term care to 83 million low-income people in the United States and accounts for one-fifth of health care spending. Medicaid is jointly financed by states and the federal government but administered by states within federal rules. The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade. While several options appear to be under consideration to significantly reduce Medicaid spending, President Trump publicly said recently about Medicaid, “We are not going to touch it. Now, we are going to look for fraud.” Speaker Johnson has said, “Medicaid is hugely problematic because it has a lot of fraud, waste, and abuse.” Although fraud, waste, and abuse can be related concepts (and all fall under a broader “program integrity” umbrella), they are also distinct in important ways (Box 1). These terms apply to other government health care programs, private health insurance, and other government programs more broadly.¹  On March 11, 2025, the White House released a statement saying most federal spending lost to fraud is from entitlement programs such as Medicaid and Medicare, citing “improper payment” estimates, without clarifying (as GAO does) that “improper payments” are not a measure of fraud or abuse and most improper payments are the result of missing documentation or missing administrative steps, and are not necessarily payments made for ineligible enrollees, providers, or services.

Speaker Johnson has referenced $50 billion in annual fraudulent payments (a figure that may reflect improper payments rather than fraud). In debates about broader Medicaid spending reductions, Republicans may try to recast policy changes such as adding work requirements to Medicaid and restricting the use of provider taxes as addressing fraud, waste, and abuse. Despite talk about eliminating fraud, the President’s recent order to remove Inspectors General (IGs), who are responsible for providing independent oversight of federal programs, from at least 17 government agencies—including HHS—appears to run counter to the stated focus on fraud, waste, and abuse. Recent KFF polling shows, while the public thinks that reducing fraud and waste in government health programs could lead to reductions in overall federal spending, many (60% of Republicans, 55% of Democrats, and 51% of independents) also think reducing fraud and waste in government programs could result in a reduction of benefits. Overall, most Americans (77%) hold favorable views of Medicaid, including six in ten Republicans (63%), and at least eight in ten independents (81%) and Democrats (87%).

This brief explains what is known about improper payments and fraud and abuse in Medicaid and describes ongoing state and federal actions to address program integrity.

1. Both the federal government and states are responsible for ensuring program integrity.

Program integrity refers to the proper management and functioning of the Medicaid program to ensure it is providing quality and efficient care while using funds–taxpayer dollars–appropriately with minimal waste. Medicaid is a very complex program that involves millions of beneficiaries, hundreds of thousands of providers, and significant federal and state expenditures. Program integrity efforts work to prevent and detect waste, fraud, and abuse, to increase program transparency and accountability, and to recover improperly used funds. Program integrity activities help ensure that eligibility decisions are made correctly; prospective and enrolled providers meet federal and state participation requirements; services provided to enrollees are medically necessary and appropriate; and provider payments are made in the correct amount and for appropriate services. Program integrity also includes routine oversight to ensure compliance with state and federal law.

State Medicaid agencies administer Medicaid on a day-to-day basis and have the primary responsibility for program integrity. Program integrity includes specific, dedicated activities, as well as activities that are built into program functions (e.g., beneficiary and provider enrollment, service delivery, payment). Federal laws and regulations include requirements for states to reduce fraud, waste, and abuse. Each state must have a Medicaid Fraud Control Unit (MFCU) to investigate fraud and prosecute or refer to prosecution individuals or entities defrauding Medicaid. Other state agencies and fiscal officers may be involved, including state auditors. Comprehensive managed care is the primary Medicaid delivery system (accounting for 75% of beneficiaries and over 50% of total Medicaid spending) which creates different risks, as the state is delegating provider contracting, utilization management, and claims processing to a managed care organization (MCO). States with managed care programs have additional program integrity responsibilities.

The federal government’s responsibility is to provide “effective support and assistance to states to combat provider fraud and abuse.” CMS supports states through funding, training, and defining in regulation how states must comply with Medicaid program integrity requirements. Three federal agencies – the HHS Office of Inspector General (OIG), U.S. Department of Justice (DOJ), and Government Accountability Office (GAO) – are also involved in this work, each with different roles and responsibilities. Federal agencies regularly report on Medicaid program integrity performance, including:

• The CMS Improper Payments Fact Sheet, which summarizes and explains annual statistics on HHS improper payment measurements
• The HHS Agency Financial Report, which includes Medicaid payment integrity statistics
• The Payment Error Rate (PERM) Findings and Reports, Supplemental Improper Payment Data Reports²  include state specific data
• The HHS-OIG Healthcare Fraud and Abuse Control (HCFAC) report and the Medicaid Fraud Control Units (MFCU) report, which summarize program integrity oversight and enforcement activities
• GAO’s High-Risk Series identifies government operations with vulnerabilities to fraud, waste, abuse

2. There is no comprehensive or reliable measure of fraud in Medicaid.

Fraud is not unique to Medicaid. Fraud occurs in Medicaid, Medicare, and private health insurance. Most monetary loss from fraud is by providers. Fraud includes obtaining a thing of value through willful misrepresentation. Measuring fraud is difficult, in part, because it can only be determined with certainty after the fact and if it is identified. There are no reliable measures of fraud against Medicaid. DOJ and HHS-OIG operate a Health Care Fraud and Abuse Control (HCFAC) program, designed to coordinate federal, state, and local health care fraud and abuse law enforcement activities. A HCFAC report is published annually, describing health care fraud enforcement actions. Recent analysis of the FY 2023 HCFAC report found no beneficiary fraud in the listing. Providers convicted (of different kinds of fraud against Medicaid and Medicare) included ambulance service providers, durable medical equipment suppliers, diagnostic labs, nursing homes, pain clinics, pharmacies, physical therapists, physicians, and substance use treatment providers. Examples of successful criminal and civil investigations highlighted in the report include:

• Sentencing of an EMT supervisor for an ambulance company who wrote and signed hundreds of false ambulance run sheets that were used to send fraudulent bills to the Texas Medicaid program;
• Sentencing of a pharmacy owner in a scheme to bill Kentucky Medicaid (and other health benefit programs) for drug prescriptions that were never filled; and
• Sentencing of a Michigan physician for his role in a health care fraud scheme that exploited patients suffering from addiction by administering unnecessary back injections and illegally distributing millions of medically unnecessary opioids.

In FY 2023, total HCFAC recoveries reached $3.4 billion (across Medicaid and Medicare). The reported return on investment for the HCFAC program (2021-2023) was $2.80 for every $1 spent. HHS-OIG also publishes an annual summary of the cases brought by state Medicaid Fraud Control Units (MFCUs). The report identifies criminal convictions and civil settlements and judgments by provider type. In FY 2024, MFCUs reported 1,151 convictions and $1.4 billion in recoveries (or $3.46 for every $1 spent).

3. Improper payments are not a measure of fraud.

The Improper Payments Information Act (IPIA) of 2002 (replaced by the Payment Integrity Information Act (PIIA) of 2019) requires the heads of federal agencies to annually review programs they administer and identify those that may be susceptible to significant improper payments, to estimate the amount of improper payments, to submit those estimates to Congress, and to submit a report on actions the agency is taking to reduce the improper payments. The Office of Management and Budget (OMB) has identified Medicaid and CHIP as programs at risk for significant improper payments. As a result, CMS developed the Payment Error Rate Measurement (PERM) program to comply with the IPIA / PIIA and related guidance issued by OMB.

The PERM program measures improper payments in Medicaid and produces a national improper payment rate, which is not a fraud rate. Improper payments, which are often cited when discussing program integrity, are payments that do not meet CMS program requirements. PERM is based on reviews of fee-for-service (FFS), managed care, and eligibility components of a state’s Medicaid program in the year under review. The error rate is not a “fraud rate” (or a waste or abuse rate) but a measurement of payments made that did not meet statutory, regulatory, or administrative requirements or are made in an incorrect amount (including overpayments and underpayments). While fraud and abuse may be one cause of improper payments, not all improper payments represent fraud or abuse. PERM is not designed to detect or measure fraud. States are audited on a rolling three-year basis, meaning each PERM cycle measurement includes one-third of states. Annually, the most recent three cycles are combined to produce a national improper payment rate (weighted by state size). (CMS also produces improper payment rates for CHIP, Medicare, and advanced premium tax credits (APTCs) for the federally facilitated exchange.) As with variation in all aspects of Medicaid operations, PERM rates vary across states ranging from under 1% in Alabama, South Dakota, and Washington to over 20% in South Carolina and Wyoming.

In 2024, Medicaid paid an estimated 94.9% of total outlays properly, representing $579.73 billion in proper federal payments (Figure 1). The overall Medicaid improper payment rate was 5.1% (or $31.10 billion in federal payments). However, 79.1% of the improper Medicaid payments were the result of insufficient documentation or missing administrative steps (Figure 1). These payments were not necessarily for ineligible enrollees, providers, or services (i.e., since they may have been payable if the missing information had been on the claim and/or the state had complied with requirements). Examples include state failure to document beneficiary eligibility or to appropriately screen enrolled providers, or medical records not submitted or missing required documentation to support the medical necessity of a claim. Other improper payments include payments for beneficiaries who were ineligible or were eligible but received a service that was not covered (15.6%), for providers not enrolled in the program (2.0%), and other monetary losses (3.3%) (Figure 1). States are often required to develop and implement corrective action plans for errors and deficiencies.

The 2024 improper payment rate was the lowest rate since the COVID-19 pandemic began due, in part, to flexibilities granted during the public health emergency (e.g., suspended eligibility renewal determinations and reduced requirements for provider enrollment and revalidations) and to improved state compliance with program rules. Prior to the pandemic, the improper payment rate increased following the reintegration of the PERM eligibility component in 2019, which was suspended from 2015 – 2018 to provide states with time to adjust to eligibility process changes in the Affordable Care Act.³  (In its place, CMS required states to implement pilots to assess the accuracy of their eligibility determinations.) While the national improper payment rate increased notably in 2019, 2020, and 2021 (to 21.7%), more than three quarters of improper payments (in each year) were due to insufficient documentation or missing administrative steps (data not shown). In 2024, CMS finalized rules related to eligibility and enrollment that included guidance for states on eligibility documentation procedures to reduce “paperwork” errors that lead to the majority of eligibility-related improper payments. Specifically, the rule requires records to be kept in electronic format for the entire period the case is active and for at least three years after and identifies the information that must be included in all case records; however, Congress may repeal these rules.

4. HHS and CMS identify key areas of program integrity focus, informed in part by recommendations made by other federal agencies.

HHS works with all states to develop strategies to address the root causes of improper payments. States are responsible for implementing, overseeing, and assessing the impact of these strategies and actions. Efforts include systems and process improvements (e.g., adding new claims processing checks, upgrading claims processing systems, and enhancing procedures for provider and beneficiary enrollment).

Every five years, HHS and CMS must issue a comprehensive Medicaid program integrity plan that outlines the agency’s strategy for working with states on program integrity. Historically, program integrity efforts focused on the recovery of misspent funds, but more recent initiatives move beyond “pay and chase” models to focus more heavily on prevention and early detection of fraud and abuse and other improper payments. The FY 2024-2028 CMS plan highlights key areas of focus including Medicaid managed care oversight, eligibility determination processes, systems improvements, data analytics and data sharing, and federal training and technical assistance. To help target oversight activities, CMS will continue to use a risk-based approach to focus efforts on high-risk states, providers, managed care plans, and program areas to maximize return on investment. CMS identified Medicaid managed care, non-emergency medical transport (NEMT), dental benefits, nursing facilities, and home- and community- based services as areas where there may be high-risk program integrity vulnerabilities.

Independent agencies like MACPAC and GAO regularly make recommendations to reduce fraud, waste, and abuse in Medicaid. In 2024, GAO indicated CMS had taken steps to address improper Medicaid payments (consistent with their recommendations) including improving managed care oversight (e.g., increasing audits), assessing fraud risks (including documenting vulnerabilities and identifying mitigation strategies), and improving state compliance with provider screening and enrollment requirements. GAO notes, however, actions on recommendations that remain unimplemented could further enhance program integrity—including additional CMS oversight/action to improve state compliance with provider enrollment and screening requirements, ensure timely state eligibility determinations, and improve collaboration with state auditors. Additionally, GAO made recommendations to CMS about other areas where program oversight and transparency could be improved including managed care, demonstration waivers, and other financing. MACPAC recommendations include simplifying and streamlining program integrity regulatory requirements, improving state-federal coordination, and identifying the most effective program integrity activities.

5. “Fraud, waste, and abuse” are at the forefront of current debates as a basis for making changes in Medicaid and more broadly.

Medicaid is a very complex program that involves millions of beneficiaries, hundreds of thousands of providers, 51 state agencies (including DC), different delivery systems, complicated eligibility rules, and significant federal and state expenditures—all of which together create vulnerabilities and opportunities for error. Since the enactment of Medicaid in 1965, the statute has evolved to promote program integrity. The focus of program integrity efforts has also evolved at CMS in response to changing legislation, policy developments, and priorities. Each administration may approach program integrity differently, with different goals and a willingness to accept different tradeoffs. Republicans in Congress and the Trump Administration state they are not aiming to cut Social Security, Medicare, or Medicaid benefits but aiming to root out fraud, waste and abuse—often citing improper payment estimates as evidence of extensive fraud in Medicaid and Medicare, despite GAO stating improper payments are not designed to identify fraud and are not a measure of fraud or abuse. While policy makers and the public support efforts to root out fraud and make government more efficient, there is little support for broad reductions in federal spending on Medicaid that could affect coverage, benefits, or access to care.

What is known about fraud in Medicaid is that it’s not unique to Medicaid (fraud also occurs in Medicare and private health insurance) and is mostly committed by providers. There are checks on fraud, waste, and abuse at both the federal and the state levels, as described in the sections above. GAO and MACPAC recommendations to reduce fraud and abuse may involve additional investments in oversight and transparency but not reductions in federal funding. As the budget debate continues, there may be efforts to recast certain Medicaid policy changes such as adding work requirements to Medicaid and restricting the use of provider taxes as addressing fraud, waste, and abuse. There are proponents and opponents of such policies, and these policies may come with tradeoffs (e.g., decreasing federal funding while shifting costs to the states and reducing coverage), but they are not about rooting out fraud in Medicaid.

1. GAO has issued separate overviews that apply government-wide of fraud and improper payments,  waste, and abuse. ↩︎
2. A subset of states are audited each year; CMS publishes an improper payment rate for the states measured in each cycle – most recently available in 2024 (p. 52), 2023 (p. 52), and 2022 (p. 53). ↩︎
3. CMS continued to report the 2014 improper payment rate for eligibility errors as part of its overall PERM improper payment rate calculation. ↩︎

Note: This piece was updated on March 14th to reflect the latest data from MedPAC.

The privatization of Medicare has been taking place without much public debate – a trend that has implications for the 68 million people covered by Medicare, health care providers, Medicare spending, and taxpayers. Since 2010, the share of Medicare beneficiaries receiving their Medicare benefits from private Medicare Advantage insurers has more than doubled (Figure 1). The Congressional Budget Office (CBO) projects nearly two-thirds of all Medicare beneficiaries will be in private plans by 2033, though data released in the early part of 2025 show enrollment growth in 2025 has been somewhat lower than CBO projected. The Trump administration has the opportunity to weigh in on the pace of growth in private Medicare Advantage enrollment and the future of traditional Medicare, which remains the source of coverage for close to half of the Medicare population.

Questions about Medicare Advantage are likely to come up at the forthcoming confirmation hearing of Dr. Mehmet Oz, President Trump’s nominee to head up the Centers for Medicare & Medicaid Services (CMS). In the past, Dr. Oz has promoted Medicare Advantage in co-authored papers, interviews and on his television show. His support for Medicare Advantage aligns with general preferences among Republicans to maximize the role of the private sector, including Medicare Advantage, over government-run public programs, such as traditional Medicare.

The growth in Medicare Advantage is due to a number of factors, but none may be greater than the appeal of potentially lower costs and extra benefits like dental coverage and debit cards, offered by Medicare Advantage plans and aggressively marketed by brokers and insurers. Insurers are required to offer extra benefits when they estimate that their costs for Medicare-covered (Part A and Part B) benefits will be lower than the maximum amount the government is willing to pay in an area. They are able to offer additional extra benefits, in part, due to a payment system that, on average, sets maximum payments well above the costs of similar people in traditional Medicare and adjusts payments for health status in a way that overestimates costs for Medicare Advantage enrollees.

According to MedPAC, an independent, non-partisan agency that advises Congress about Medicare payment, the federal government pays insurers 20% more for Medicare Advantage enrollees than it pays for similar people in traditional Medicare, at a cost of $84 billion in 2025. To put the $84 billion in context, that’s more than Medicare paid physicians under the physician fee schedule to treat traditional Medicare patients in 2024. The higher Medicare spending for Medicare Advantage enrollees results in $13 billion in higher Medicare Part B premiums paid by Medicare beneficiaries, including those who are not in Medicare Advantage.

To promote efficiencies and trim federal spending, the administration could, for example, make technical adjustments to the payment system through the annual rate notice that could have the effect of lowering payments to plans. To achieve further savings, the administration could work with Congress to adopt savings proposals, including those that have recently been advanced by the Paragon Health Institute. These include ending the quality bonus program that increases Medicare spending by nearly $12 billion a year or capping Medicare Advantage benchmarks at 100 percent of local traditional Medicare costs except in areas with low Medicare Advantage penetration. Such changes would achieve Medicare savings but could also make it less profitable for insurers and potentially slow growth or even reduce private plan enrollment.

Alternatively, the Trump administration could adopt policies to accelerate the pace of privatization, such as boosting payments to plans through the annual rate notice and adopting other policies to encourage more private plan enrollment. The administration could, for example, make it easier for insurers and brokers to market Medicare Advantage plans to attract new enrollees, by unwinding the requirement that all television ads be approved before they can be aired or easing the requirement that brokers provide certain information to beneficiaries before they can enroll them in a plan.

The administration could also advance policies to make Medicare Advantage the default enrollment option for new beneficiaries – an approach that would likely accelerate the pace of privatization, and potentially increase spending, all other things equal.

The transformation of Medicare into a marketplace of private plans raises a number of questions that are not being debated. Should the payment system for Medicare Advantage plans be modified, and if so, how and to what end? What should be the role of traditional Medicare nationwide and in rural areas, where fewer beneficiaries are enrolled in Medicare Advantage? Should traditional Medicare be strengthened, with additional benefits and an out-of-pocket cap, so beneficiaries have a meaningful choice when comparing Medicare coverage options? What more should be done to help beneficiaries understand the tradeoffs between traditional Medicare and Medicare Advantage including the potential for extra benefits and lower costs in Medicare Advantage versus challenges that may arise due to limited provider networks and prior authorization requirements?

It’s not yet clear whether the administration will promote policies that fast track the privatization of Medicare in a way that may increase federal spending, or focus more on achieving efficiencies and savings within Medicare Advantage. How this plays out will have implications for beneficiaries, health care providers and insurers, and is worthy of serious debate.

As bird flu continues to circulate among animals in the U.S. with some human cases, about six in 10 (58%) people overall have at least “a fair amount” of trust in the Centers for Disease Control and Prevention (CDC) to provide reliable information about bird flu, though only 21% have a “great deal of trust,” the latest KFF Tracking Poll on Health Information and Trust finds.As the White House withdraws the nomination of Dr. David Weldon to lead the CDC, Republican trust in the agency is low, with about six in 10 (58%) Republicans saying they have little to no trust in the CDC to provide reliable information on bird flu. Most Democrats (72%) and independents (61%) have at least a fair amount of trust in the CDC to provide reliable information on bird flu.

The poll also finds that many people are unaware or unsure about current public health recommendations for preventing the spread of bird flu. For instance, about 4 in 10 adults (39%) are aware that public health officials recommend avoiding raw or unpasteurized milk as a precaution against bird flu, while most either are unsure (50%) or incorrectly say that officials do not recommend avoiding raw milk (11%).

A larger share of Democrats (47%) compared with independents (38%) and Republicans (34%) are aware that public health officials recommend avoiding raw milk. At least half of independents (52%) and Republicans (55%) say they are not sure if this is recommended. However, few across partisans say avoiding unpasteurized milk is not recommended.Amid concerns about egg prices and inflation more broadly, the poll finds nearly nine in 10 adults (86%) are concerned that bird flu will increase the cost of food. Fewer, but still around half (51%), are concerned that bird flu will be the next pandemic in the U.S. or will negatively affect their family’s health (50%). Democrats are almost twice as likely as Republicans to worry that bird flu will be the next pandemic (68% and 36%, respectively) or that it will negatively affect their family’s health (64% and 36%, respectively).

The poll is part of KFF’s Health Information and Trust Initiative, which is aimed at tracking health misinformation in the U.S, analyzing its impact on the American people, and mobilizing media to address the problem.Designed and analyzed by public opinion researchers at KFF, this survey was conducted Feb. 18-25, 2025, online and by telephone among a nationally representative sample of 1,322 U.S. adults in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.

In this JAMA Health Forum column, KFF Executive Vice President Larry Levitt recalls the mid-1990s’ public backlash against Health Maintenance Organizations (commonly known as HMOs) – all of which preceded the recent outpouring of health insurance concerns – as well as how consumer protections against coverage restrictions have evolved and fallen short.

This chart collection examines five types of indicators: outcomes of treatment, provision of appropriate treatment, patient safety, preventive services, and health system capacity and workforce shortages.

Measuring quality in health care is complex: a vast number of metrics are used to monitor health system performance since there is no singular definition of quality, and data is often limited and delayed. While no single indicator represents overall quality, identifying common trends can help determine whether the U.S. health care system is improving or declining over time and identify areas for improvement.

The chart collection is part of the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

Introduction

Women’s use of health care services is shaped by a range of factors, including their health needs, health coverage, access and availability of health providers in their communities, and the social determinants of health. This data note presents findings from the KFF Women’s Health Survey on women’s health status, access to health care services, and use of preventive health services. The data are analyzed across different subgroups of women including by age, race/ethnicity, insurance status, poverty level, disability status, and sexual orientation (LGBT+). The KFF Women’s Health Survey is a nationally representative survey of 5,055 women ages 18 to 64, conducted May 15 – June 18, 2024. See the methodology for details.

Key Findings:

Health Status and Ongoing Health Conditions:

• While most women (81%) ages 18 to 64 report being in excellent, very good, or good health, one in five (20%) report being in fair or poor health, with substantial differences by sociodemographic characteristics.
• Half of women report having an ongoing health condition that needs to be monitored regularly or for which they need regular care or medication. Nearly one in five (17%) women say they have an ongoing health condition that keeps them from participating in daily life activities such as school, work or housework.

Site of Care and Access to Services:

• Eight in ten (81%) women report having a regular doctor or health care provider they see when they are sick or need care, but notably, less than half of those who are uninsured have a usual source of care an important access point for health care.
• While the majority of women (59%) rely on a private doctor’s office or HMO when they are sick or in need of health advice, clinics are a key source of care for about four in ten who have lower incomes, Medicaid coverage, are under the age of 25, or are Hispanic.
• Reproductive health care is not universally obtained by all women. Six in ten women between the age of 18 and 64 report having had a gynecological visit in the past two years, but one in 10 (8%) never had a visit, including almost one in five (19%) uninsured women.
• Less than half (47%) of women ages 50 to 64 report that a health care provider has spoken to them about what to expect in menopause.

Use of Preventive Health Services:

• The majority of women (72%) ages 40 to 64 report that they have had a mammogram in the past two years—among uninsured women, the rates are far lower, with less than four in ten (38%) reporting having had a mammogram in the past two years.
• Most women (62%) ages 21-64 report that they had a Pap smear or Pap test in the past two years for cervical cancer screening, with higher screening rates among Black and Hispanic women as well as those with higher incomes and private insurance.
• Almost half (47%) of women ages 45 to 64 report having had a recent colon cancer screening test in the past two years, including higher shares of Black and Hispanic women and women with private or Medicaid coverage.
• Among women ages 18 to 64 who report having sex in the past 12 months, one in three report having had an HIV test (34%) or a test for other STIs such as chlamydia or gonorrhea (37%) in the past two years.

Health Status and Ongoing Health Conditions

The majority of women ages 18 to 64 report being in good or excellent health, but one in five report fair or poor health. Substantial shares of LGBT+ women, women who identify as disabled, those with lower incomes, those with Medicaid coverage, and those without insurance describe their health as fair or poor. Eight in ten women ages 18 to 64 (81%) rate their health as excellent, very good, or good; however, one in five (20%) describe their health as fair or poor (Figure 1). Nearly half (47%) of women who identify as disabled, and over one in four LGBT+ women, women with low incomes, as well as those with Medicaid coverage and without insurance describe their health as fair or poor. Nearly a quarter of mid-life aged (50-64) women, those living in rural areas, and Black and Hispanic women describe their health as fair or poor, which was significantly higher than younger women, those living in urban areas, and White women.

Half of women ages 18 to 64 report that they have an ongoing health condition that needs to be monitored regularly or for which they need regular care or medication (Figure 2). Larger shares of women age 50 to 64 and women with Medicaid coverage report an ongoing health condition compared to women ages 18 to 49 and women with private health care coverage. Rates are also higher among women who are White and Black, compared to those who are Hispanic or Asian or Pacific Islander. Among women who identify as disabled, 86% report having an ongoing health condition that requires regular monitoring, care, or medication.

While half of women report having an ongoing health condition, nearly one in five (17%) say that they have an ongoing health condition that keeps them from participating fully in school, work, housework, or other activities. One in four women with lower incomes (26%), women with Medicaid coverage (26%), women 50 to 64 (23%), and women living in rural areas (24%) report having an ongoing health condition that keeps them from participating fully in daily life. Among women who identify as disabled, two-thirds (65%) report they have an ongoing health condition that keeps them from participating in daily life.

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Site of Care and Access to Services

Most women report having a regular doctor or health care provider they see when they are sick or need care, but less than half of those who were uninsured had a usual source of care. Eight in ten (81%) women ages 18 to 64 say they have a regular doctor or health care provider they usually see when they are sick or need routine care (Figure 3). Larger shares of women ages 50 to 64, Black women, and women who identify as disabled report having a regular doctor or health provider. However, among women who are uninsured, only four in ten (39%) say they have a regular health care provider compared to 85% of women with private insurance or Medicaid.

When they get sick or need advice about their health, the majority (59%) of women go to a private doctor’s office or HMO (Table 1). Three in ten (28%) women go to a clinic, 5% go to an emergency room, and 4% go to some other place for their health care. Overall, four percent of women 18 to 64 report that they do not have a place to go when they are sick or need advice about their health.

While the majority of women go to a private doctor’s office or HMO when they are sick or in need of health advice, women with lower incomes, Medicaid coverage, are under the age of 25, or are Hispanic are more likely to report going to clinics for their usual care (Table 1). Lower shares of Hispanic women, those with lower incomes or Medicaid coverage, those living in rural areas, and LGBT+ women report that their usual place of care is a private doctor’s office or HMO. In contrast, among women who are uninsured, only one in five (19%) say they go to a private doctor’s office for care—four in ten (40%) say they go to a clinic, many of which provide free or reduced cost care thanks to federal and state support, and one in five (18%) report that they do not have a place to go to when they are sick or need advice. Women under the age of 25 are also more likely to rely on clinics for their care and about one-third of women living in rural areas usually get care at a clinic. While only 5% of women report an emergency room as their usual place of care, larger shares of Black (11%) and Hispanic women (6%), women with lower incomes (10%), those with Medicaid coverage (8%) and those who are uninsured (14%) say their usual place of care is an ER.

Almost all women report they have seen a doctor or health provider in the past two years, either in person, over the phone, or virtually. The majority of women report that they have seen a doctor for an in-person visit (93%), while half (48%) report they talked to a provider over the phone or had a virtual visit (considered a telehealth visit) (Figure 4). The share of women who have seen a doctor or health care provider in the past two years either in person or through telehealth does not differ statistically across key demographic groups such as race and ethnicity, income, and age.

Nationally, six in ten (61%) report that they take prescription medications, including birth control pills, on a regular basis (Figure 5). Larger shares of women ages 50 to 64, women with private coverage, and women with higher incomes take prescription medications compared to reproductive age women, women with lower incomes, and women who are uninsured. Use of prescription medications is predicated on access to clinical care which is poorer among many of these groups. White women are more likely to report that they take prescription medications than Asian or Pacific Islander, Black, and Hispanic women. Nine in 10 (88%) women who identify as disabled report that they take prescription medications compared to 57% who do not identify as disabled.

Six in ten (62%) women report having had a gynecological visit in the past two years (Figure 6). Gynecological visits can include pelvic exams, examinations of the female reproductive organs, cervical cancer screenings, discussion and prescriptions of contraceptives, pregnancy planning, and discussions of menopause, among other topics. Twelve percent of women have had a visit in the past two to three years and 18% had a visit more than three years ago. Nearly one in 10 women (8%) have never had a gynecological visit.

Across most subgroups, except for uninsured women, over half of women have had a gynecological visit in the past two years. Among uninsured women, only one in three (35%) have had a gynecological visit in the past two years, and one in five (19%) report that they have never had a gynecological visit. A third of women under the age of 25 report that they have never had a gynecological visit compared to one percent of women ages 50 to 64. One in seven Asian or Pacific Islander women (13%) and LGBT+ women (14%) also report that they have never had a gynecological visit.

Less than half (47%) of women ages 50 to 64 report that a health care provider has spoken to them about what to expect in menopause (Figure 7). A gynecological visit can be an opportune time for providers to discuss menstrual and other changes across the lifespan, but in recent years, there has been an increased recognition that clinicians do not speak often enough about menopause with female patients.

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Use of Preventive Health Services

The Affordable Care Act (ACA) requires most private health insurance plans and ACA Medicaid expansion programs to cover many recommended preventive services for adults without any patient cost-sharing. Some preventive services are specific to women, including annual checkups, prenatal tests, breast and cervical cancer screenings, prescription contraceptive services and supplies, as well as many services recommended for adults regardless of sex or gender identity. Use of preventive services can lead to early identification of conditions when they are more responsive to medical interventions. Despite the policy’s wide reach and popularity with the public, there have been several legal challenges over elements of the preventive services requirement since it initially took effect, including in a pending case, Braidwood Management Inc. v. Becerra.

The majority of women ages 40 to 64 report that they have had a mammogram in the past two years, with higher rates among Black women. Both the United States Preventive Health Services (USPSTF) and the Health Resources and Services Administration (HRSA) recommend that women ages 40 to 74 with average risk for breast cancer get a screening mammogram at least every two years. Seven in ten (72%) women ages 40 to 64 report having had a mammogram in the past two years (Table 2). Larger shares of Black women (81%) compared to White women (71%) report having had a mammogram in the past two years. Prior research has similarly found that higher shares of Black women report having had a screening mammogram compared to White women. Significantly larger shares of women with private coverage (77%) report having had a mammogram compared to those with Medicaid coverage (66%) or who are uninsured (38%). The National Breast and Cervical Cancer Early Detection Program offers free mammograms to those who are uninsured, but many people may not know of it or how to obtain free or low-cost services.

Most women ages 21-64 report that they have had a Pap smear or Pap test in the past two years for cervical cancer screening, with higher rates among Black and Hispanic women and those with higher incomes and private insurance. USPSTF and HRSA both recommend cervical cancer screenings for women ages 21 to 65, either via a pap smear or a high-risk HPV test or a combination of both every 3 to 5 years, depending on the person’s age. Six in ten women (62%) ages 21 to 64 report having had a pap smear or test in the past two years. Higher shares of Black women (71%) and Hispanic women (65%) report having had a cervical cancer screening compared to White women (59%). Women with private insurance are more likely to have had a cervical cancer screening in the past two years than women who are uninsured. Lower shares of LGBT+ women (56%) and women who identify as disabled (54%) report having had a pap smear or pap test in the past two years compared to non-LGBT+ women (63%) and women who do not identify as disabled (64%).

Fewer women ages 45 to 64 have had a recent colon cancer screening/colonoscopy in the past two years, with lower rates among the uninsured. The USPSTF recommends colon cancer screening (which can include colonoscopies, fetal occult testing, Stool DNA-FIT, or sigmoidoscopy) for all adults ages 45 to 75 every one to ten years, depending on the screening test. In 2021 the USPSTF lowered the age recommendation for starting colon cancer screenings from 50 to 45 in part due to the increasing incidence of colon cancer in younger adults. Almost half (47%) of women ages 45 to 64 report having had a recent colon cancer screening test in the past two years. A higher share of Black (58%) and Hispanic (53%) women report having had a colon cancer screening test in the past two years compared to White women (42%). Significantly higher shares of women with private coverage (47%) and women with Medicaid coverage (50%) report having had a colon cancer screening test in the past two years compared to only 16% of women who are uninsured. Because the question in this survey limits the time period to the last two years, it is likely that a larger share of women in this age group have had a colon cancer screening within the recommended timeframe for their screening test.

Despite clinical recommendations and the fact that they are covered without cost-sharing by most private plans and ACA Medicaid expansion pathways, smaller shares of women report having an HIV test or a test for other sexually transmitted infections (STIs) in the past two years (Figure 9). The USPSTF and HRSA recommend HIV testing for adolescents and adults at least once in their lifetimes, with additional screenings for those at increased risk for HIV infections. Pregnant people should also get tested for HIV during their pregnancies. The USPSTF also recommends chlamydia, gonorrhea, and syphilis screenings for sexually active women and those at increased risk of infection. Among women ages 18 to 64 who report having sex in the past 12 months, one in three report having had an HIV test (34%) or a test for other STIs such as chlamydia or gonorrhea (37%) in the past two years. Recent STI and HIV testing rates are higher among women under the age of 50, those who identify as LGBT+, Asian or Pacific Islander, Black and Hispanic women, women with lower incomes, those who identify as disabled, and women with Medicaid.

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Women’s health outcomes are shaped not only by access to care, health insurance, and affordability, but also by the social and economic factors that drive health, discrimination, and experiences within the health care system. When people feel discriminated against or are treated disrespectfully in healthcare settings, they are more likely to avoid medical care, which can lead to worse health outcomes, especially among more at-risk populations.

This data note presents findings from the 2024 KFF Women’s Health Survey on women’s experiences with disrespectful and unfair treatment as well as negative interactions with providers during health care visits in the past two years. The 2024 KFF Women’s Health Survey was fielded from May 15 to June 18, 2024, and was developed and analyzed by KFF staff. It is a nationally representative survey of 5,055 women and 1,191 men ages 18 to 64. See the methodology for detailed definitions, sampling design, and margins of sampling error.

Disrespectful or Unfair Treatment

The majority of women (95%) and men (87%) ages 18 to 64 report having seen a health care provider, either in-person or via telehealth over the past two years (Appendix Figure 1). However, among those who have seen a provider, nearly one in four women ages 18 to 64 (23%) report that a doctor, health provider, or other staff has treated them unfairly or with disrespect in the past two years, a rate that is somewhat higher than the share reported by men (18%) (Figure 1). For both men and women, weight is the most common reason identified as to why they were treated unfairly or with disrespect. Overall, one in seven (15%) women say that they were treated unfairly or with disrespect because of their weight, and one in 10 (9%) identified their age and/or gender as the reason why they were treated poorly. Seven percent of women report they were treated unfairly or with disrespect because of their race.

Overall, somewhat larger shares of Black (26%) and Hispanic (25%) women report that they have been treated unfairly or with disrespect by a doctor, health provider, or other staff in the past 2 years compared to White women (21%) (Figure 2). One in five Black women (19%) report that they have been treated unfairly or with disrespect because of their race. One in 10 (9%) Hispanic women and 7% of Asian or Pacific Islander women also identify their race as the reason why they were treated poorly by a health provider while only 2% of White women identify their race as the reason. Larger shares of Black and Hispanic women report that their accent or ability to speak English was the reason they were treated unfairly or with disrespect compared to White women.

Women of reproductive age (18 to 49), women with lower incomes, LGBT+ women, and women who identify as disabled are more likely to report that they have been treated unfairly or with disrespect compared to women 50 to 64, women with higher incomes, non-LGBT+ women and women who do not identify as disabled. Among women who identify as disabled one in five women (19%) say they were treated poorly due to a disability they have.

Across the majority of subgroups, weight is the most common reason identified by women about why they were treated unfairly or with disrespect. Weight stigma and discrimination can reduce the quality of care patients receive and patient satisfaction. It can also lead to an increase in stress for a patient and affect their short- and long-term health outcomes. Similar shares of White (15%), Hispanic (15%), and Black (13%) women identify their weight as the reason why they were treated poorly by a health provider in the past two years, while only 8% of Asian or Pacific Islander women say the same. Twice as many LGBT+ women (26%) women and women who identify as disabled (24%) compared to non-LGBT+ women (13%) and women who do not identify as disabled (13%) say that weight was the reason they were treated unfairly or with disrespect by a health care provider.

Negative Health Care Experiences

One in three women (34%) who have seen a provider in the past two years report having at least one of several negative experiences (Figure 3). One in five women (20%) said a health provider has ignored a direct request they made or question they asked, and another one in five (19%) report that a provider has assumed something about them without asking. Nearly one in five women say that a provider didn’t believe they were telling the truth, and one in seven (13%) say their provider suggested they were personally to blame for a health problem they were experiencing. One in 10 women say their provider has refused to prescribe them pain medication they thought they needed.

Significantly larger shares of LGBT+ women and women who identify as disabled have had a negative experience with a health care provider in the past two years (Figure 4). About half of LGBT+ women (51%) and women with disabilities (47%) report having had a negative experience with a health provider in the past two years. Across all five of the negative experiences asked about on the survey, larger shares of LGBT+ women and women who identify as disabled say they have experienced each compared to non-LGBT+ women and women who do not identify as disabled. Prior KFF research has found that LGBT+ adults are more likely than non-LGBT+ adults to report adverse consequences because of negative interactions with health providers and are more likely to take steps to mitigate or prepare for unfair treatment when receiving care.

Similarly, larger shares of women with lower incomes report having had a negative experience with a health provider in the past two years compared to women with higher incomes.