Medicaid covers one-fifth of adults with substance use disorders (SUDs), including many with substantial treatment needs. Inpatient and residential care services are part of the American Society of Addiction Medicine (ASAM) continuum of SUD services. However, long-standing federal law has generally prohibited Medicaid payments for inpatient or residential care services that are provided in Institutions for Mental Disease (IMDs) for adults ages 21 to 64. IMDs include certain psychiatric and substance use treatment facilities with more than 16 beds that are primarily engaged in providing diagnosis, treatment or care for people with mental health or substance use disorders.

Section 1115 demonstration waiver authority for SUD, referred to here as “SUD IMD waivers,” was introduced in 2015 and updated in 2017 to allow states to receive federal Medicaid funds for short-term stays in IMDs to help improve identification of SUD and access to care across the treatment continuum, reduce overdose deaths and avoidable acute care use, build provider capacity, and strengthen care coordination and transitions across levels of care; however, there have also been concerns that expanding Medicaid payment for SUD services provided in IMDs could shift resources toward residential and inpatient care, rather than strengthening community-based SUD services.

As SUD IMD waiver evaluations and renewals are becoming available, states face a shifting Medicaid and policy and waiver landscape. The 2025 Reconciliation Law included historic restrictions in Medicaid financing and coverage that could make it hard to maintain incremental expansions in mental health and SUD benefits. At the same time, other federal efforts, including a recent opinion from the Department of Justice, may affect how care is delivered across settings for some people with SUD, including some experiencing homelessness, following decades of policy aimed at expanding access to community-based care for people with mental health conditions or SUD, when appropriate. This brief examines findings from the first available summative evaluations (due 18 months after the end of the demonstration) for SUD IMD waivers and what they show about progress toward meeting goals and milestones.

Key Takeaways:

• SUD IMD waivers, a common Medicaid pathway for covering short-term residential and inpatient SUD treatment in IMDs, have been adopted by 38 states (including D.C.). Federal SUD IMD authority began in 2015 (updated in 2017)to allow states to use Medicaid funds for short-term residential and inpatient SUD treatment in facilities that were previously excluded from federal reimbursement. As of April 2026, 38 states, including D.C. had approved SUD IMD waivers, three more had applications pending, and at least 20 had received Centers for Medicare and Medicaid Services (CMS) approval for five-year extensions. Most initial waivers were approved between 2016 and 2020, with most demonstrations running five years.
• As of April 2026, six states (CA, IN, NH, WA, UT, and MA) had completed summative evaluations, which are due 18 months after the state’s SUD IMD waiver demonstration period ends. To assess progress, states are required to develop evaluation designs with specific research questions, hypotheses, and methods. Although states follow federal guidance, evaluation plans emphasized different priorities and relied on different measures, data sources, and methods. Most used Medicaid claims data, stakeholder interviews, and survey data.
• Early evaluation findings point to improved SUD treatment access across multiple measures although the pandemic and other intervening issues make isolating waiver findings challenging. Summative evaluations generally suggest increases in SUD residential and inpatient care, along with growth in community-based care or capacity and increased access to medications for opioid use disorder. Most states reporting SUD-related emergency department use found decreases, and some reported improved follow-up after ED visits or discharge from residential or inpatient care, though follow-up rates often remained relatively low. However, evaluation periods often overlapped with major disruptions in SUD treatment need, service delivery, and Medicaid policy, including the COVID-19 pandemic, the fentanyl-driven rise in overdose deaths, and concurrent state Medicaid changes, making it difficult to isolate waiver effects. In addition, evaluations varied in their measures, detail, and focus, limiting the ability to compare across states or draw consistent conclusions about quality and outcomes.
• Evaluations pointed to challenges, including workforce or infrastructure shortages, administrative barriers, and housing instability, that may have affected waiver outcomes. These included workforce shortages, fragmented and uneven treatment systems, administrative barriers, and housing instability, with each of these areas reported across multiple evaluations. Fragmentation and gaps in treatment infrastructure made care transitions harder, while housing instability often made it difficult for patients to sustain recovery after discharge.

What is an IMD and the IMD payment exclusion?

IMDs are specialized behavioral health facilities that provide residential or inpatient treatment (Figure 1).  In Medicaid, an Institution for Mental Diseases, or IMD, is an administrative category for a hospital, nursing facility, or other institution with more than 16 beds that is “primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services” (42 U.S.C. § 1396d(i)). IMD status is based on facility type, the population type served, and its size. The IMD status is determined by the state. Although IMDs tend to overlap with higher levels of care, the clinical intensity of SUD treatment is generally described using frameworks such as the American Society of Addiction Medicine (ASAM) criteria, which do not determine whether a facility is an IMD. Other SUD care settings include outpatient treatment services, specialty outpatient services,  and emergency and crisis services, which are not subject to the IMD payment exclusion (Figure 1). State Medicaid programs cover a range of services and states have expanded these services in recent years.

While all states are required to cover inpatient hospital services, federal Medicaid law generally excludes IMD services for adults 21 to 64, a policy known as the “IMD payment exclusion.” Since Medicaid’s inception, federal law has generally prohibited states from using Medicaid funds for services provided to nonelderly adults in IMDs (§1905(a)(30)(B) of the Social Security Act [SSA]). The IMD payment exclusion was intended to leave states with the primary responsibility for financing inpatient or residential behavioral health services. While all states that choose to participate in the Medicaid program must cover inpatient hospital services, those services specifically exclude care provided in IMDs for adults ages 21 to 64. The payment exclusion applies to services provided within an IMD as well as to services provided outside an IMD while a nonelderly adult is still a patient of an IMD. In recent years, the federal government has provided new mechanisms for states to receive federal matching funds for IMD services for adults 21 to 64 in certain situations. There are now four options for states to cover these services. See Box 1 for exceptions to the IMD payment exclusion.

How many states have SUD IMD waivers, and how are they evaluated?

As of April 2026, 38 states had approved SUD IMD waivers.  Three more states had initial SUD IMD waiver applications pending with CMS (Figure 2). At least 20 states had also received CMS approval for five-year extensions of SUD IMD waivers, and additional states have submitted five-year extension requests (data not shown).  

SUD IMD waivers are intended to expand access to the full SUD treatment continuum, including residential and inpatient services provided in IMDs, and to improve outcomes. CMS established six goals and six milestones for these waivers, covering areas such as treatment access, placement standards, provider capacity, and care coordination (See Box 2). States are required to track progress through independent evaluations, including an interim evaluation report, due one year before the demonstration ends and a summative evaluation report due 18 months after it concludes.

To assess progress, states must develop evaluation designs with specific research questions, hypotheses, and methods. Although all states follow federal guidance in evaluation designs, state evaluation plans can emphasize somewhat different priorities. For example, New Hampshire included a specific focus on adolescent access to residential care networks, and California’s plan factored in its unique county-level behavioral health delivery model. States also organized their evaluation topics differently. Some grouped measures under broad areas such as “access” and “quality,” while others grouped measures more closely to the CMS-enumerated goals and milestones (Box 2) or led with more state-specific questions and priorities. Appendix Table 1 summarizes state-level evaluation topics, hypotheses, and implementation features.

As of April 2026, six states have summative evaluations of SUD IMD waivers: California, Indiana, New Hampshire, Utah, Washington, and Massachusetts. Evaluations rely primarily on Medicaid administrative claims data, stakeholder interviews, and survey data to assess impact. Evaluation methods vary across states, with some relying on descriptive pre-post analyses and others using more rigorous methods designed to control other factors that may contribute to observed changes over time.  

What are the key findings from the SUD IMD waiver summative evaluations?

The six summative evaluations are the most comprehensive assessments available for the SUD 1115 waiver demonstrations, but overlapping factors such as COVID-19, the opioid epidemic, and various state policy changes mean the findings are best read as directional signals within an emerging evidence base rather than isolated estimates of waiver impact. This analysis focuses on a limited set of CMS goals and milestones (CMS goals 1, 3, 4, and 5 and milestones 1, 4, and 6) because they were most consistently reported, most directly tied to SUD/OUD treatment access, utilization, care transitions, and overdose outcomes. The analysis excludes goals and milestones that primarily reflect implementation standards or were not reported consistently enough to support synthesis. Appendix Table 1 summarizes states’ evaluation topics as well as notable waiver features and implementation details.

Cross-state comparisons are limited by differences in evaluation design, measures, baseline SUD treatment capacity, waiver implementation, and broader state context. Though states use a variety of data and analytic methods, this summary does not weigh or assess research methods and draws from both raw and adjusted findings across evaluations. All states used claims data, and most also included survey and/or qualitative findings, but most lacked a comparison group. Timeliness is another challenge, as summative evaluations are due 18 months after the demonstration ends, and some expected demonstrations are not yet readily available through CMS materials. Most evaluation periods coincided with major disruptions in SUD treatment need, service delivery, and Medicaid policy, including the COVID-19 pandemic, the fentanyl-driven escalation in overdose deaths, and concurrent state Medicaid changes, making it difficult to isolate waiver effects. As a result, findings are not interpreted as causal or directly comparable across states; they are best understood as directional signals that contribute to an emerging evidence base on how SUD IMD 1115 waivers may affect access and outcomes.

Evaluations generally showed increased use of inpatient and residential SUD treatment, with some evidence of expanded treatment capacity. SUD IMD waivers expanded access to the full treatment continuum, including coverage for inpatient and residential SUD services provided in an IMD. Measures in this section were reported in some form by all states and were commonly used as indicators of access to IMD care. While average length of stay was not typically identified as a central outcome in state evaluation plans, it is included below as an additional utilization measure.

• Inpatient and Residential SUD Treatment: Inpatient or residential treatment utilization increased in five of the six states reporting this measure (CA, IN, MA, NH, and UT). These findings point to greater use of IMD services under the waivers, which was previously limited by the IMD exclusion. Massachusetts reported large increases in newly covered residential rehabilitation services, with average quarterly utilization substantially higher in the second measurement period than the first. California also reported large increases, with the number of unique patients in waiver counties using residential services rising 400% above non-waiver counties. Though SUD treatment rates in Washington IMDs were unchanged, key informants reported that the waiver helped them connect patients to treatment during their “window of willingness,” when motivation may be higher after first presenting for care. They also noted that the waiver may have been particularly helpful for nondisabled, single men, who were often lower on the priority list for treatment.
• Inpatient and Residential SUD Capacity: Inpatient or residential treatment capacity increased in all four states reporting data (IN, MA, NH, and WA). While the evaluations do not show whether states reached sufficient capacity, the findings suggest progress toward expanding capacity for this type of care. In Indiana, the number of residential SUD providers grew from none at the start of the demonstration to 55 by the end. New Hampshire also reported net growth overall, although some facilities closed in the fourth year of the demonstration. Washington reported growth in the number of SUD treatment facilities and Massachusetts reported growth in residential beds.
• Average Length of Stay (ALOS):  Early SUD waivers approved under 2015 guidance often included maximum length of stay limits of 30-days for residential and 15-days for inpatient IMD stays. CMS guidance updated in 2017 instead established a statewide average length of stay of 30 days as a performance monitoring target for residential SUD services in IMDs, intended in part to ensure that IMD services did not displace community-based care.  Under this approach, longer stays for some individuals could be offset by shorter stays for others.  In the three states reporting this measure (CA, IN, and WA), the ALOS was under or near the 30 days performance target. Indiana’s was well below that target at 4.7 days, though qualitative findings from enrollees raised concerns that stays may be too short to support transition and recovery. California’s average was slightly above the 30-day target, at 31.2 days after excluding extreme outliers. These findings suggest that for states reporting  ALOS, average lengths of stay were generally close to waiver targets, but they do not show whether the length of stay was clinically appropriate for all patients.

Evaluations generally showed increases in SUD diagnosis and treatment access, as well as some evidence of expanded community-based treatment capacity. In addition to expanding access to IMD-based care, the waivers were also intended to strengthen access across the broader SUD treatment continuum, including outpatient treatment and evidence-based care for OUD. Community-based treatment, capacity, and medication for opioid use disorder (MOUD) measures reported in this section were often included in state evaluations and aligned with CMS goals and milestones. This analysis uses MOUD to refer to medication-based OUD treatment measures, including measures that state evaluations described as medication-assisted treatment (MAT). Though diagnosis was not explicitly identified in most evaluation plans, it is included below because it was reported by most states and may suggest progress toward improved identification of SUD.

• Diagnosis: Four of the five states reporting measures of SUD diagnosis (IN, MA, NH, and UT) showed increases. Utah reported the largest growth, with a 67% increase in SUD-only diagnoses, though this increase coincided with the state’s ACA Medicaid expansion. Indiana and New Hampshire also reported increases, though more modest at 23% and 11%, respectively. Massachusetts reported a modest increase in the number of members with SUD diagnoses, though the number with an OUD diagnosis declined, which may be due to data challenges. Diagnosis measures varied across states, with some states, including New Hampshire and Washington, requiring both a diagnosis and service use. Increases in SUD diagnoses may reflect increases in treatment use, since a diagnosis is typically recorded when a treatment claim is submitted. Some of the increases may also reflect the period during the pandemic when Medicaid disenrollments were paused and people retained coverage and access to treatment services.
• Any Treatment: Five of six states (CA, IN, MA, UT, and WA) showed increases in treatment use or initiation. These findings generally point to improved treatment access, but the measures differed across evaluations. Indiana reported a 52% increase in enrollees receiving any treatment, while Utah reported a 160% increase in the number receiving treatment. Utah’s unmet needs for SUD treatment decreased, relative to a synthetic control group. In addition to increases in any SUD treatment, Washington also reported increases in treatment initiation, rising by 8.7 percentage points relative to baseline. Massachusetts reported higher outpatient SUD utilization among members with SUD and OUD that remained above baseline, though use declined somewhat overtime and the OUD growth was weaker than the pre-waiver trend. New Hampshire’s evaluation measured whether treatment was initiated and sustained after a new SUD diagnosis, and findings were more mixed. Treatment initiation, defined as initiating treatment within 14 days of diagnosis, declined in later demonstration years, while treatment engagement (two or more SUD visits within 34 days of initiation visit) increased substantially, ending 30% above baseline in year five.
• Access to Medications for Opioid Use Disorder (MOUD): MOUD is a core part of OUD treatment and is recommended for most people with OUD. Of the three FDA-approved MOUD medications, buprenorphine and naltrexone can be prescribed, while methadone is available only through federally certified Opioid Treatment Programs (OTPs). Three of four states reporting this measure (IN, MA, and WA) showed increases in MOUD treatment. In Massachusetts, the share of members with OUD using medication treatment increased from an average of 32% each quarter during the baseline period to 43% by the final quarter of the evaluation period, though this growth was already underway before the waiver. The number of MOUD users in Indiana increased from about 6,000 before the demonstration started to over 15,000 during it, a 156% increase, though this acceleration was not different from the growth trend already underway before the waiver took effect. California reported a net decline, as decreases in methadone use during the pandemic were not fully offset by increases in buprenorphine use, likely because methadone treatment depended on frequent in-person visits. Though New Hampshire did not include a quantitative MOUD measure, most respondents to its SUD residential provider survey reported that medications were accessible to Medicaid members when needed. Some state metrics include medications used to treat alcohol alongside opioid use disorder medications.
• Community-Based Treatment Capacity: All three states reporting community-based or outpatient treatment capacity measures (IN, MA, and WA) described growth in outpatient treatment infrastructure, although they used different measures. Indiana reported growth in SUD outpatient and MOUD-related providers identified through claims data. Using national survey data, Indiana found that the share of all SUD facilities accepting Medicaid increased from 60% to 78%. Massachusetts also reported growth in MOUD provider capacity compared to baseline, though the growth rate was similar to the baseline period. Washington reported large increases in outpatient SUD providers, from 515 to over 9,500, which coincided with shifts from county-based to managed care delivery. California did not report quantitative measures, but county administrators attributed quality of care improvements to a stronger continuum of care and expanded provider networks, which they said made it easier to match patients to appropriate levels of care. Workforce shortages and uneven geographic access remained common constraints.

Evaluations also point to declines in SUD-related ED use, and some improvement in SUD follow-up after acute care. The measures presented in this section were commonly included in state evaluations, though states framed these measures differently, sometimes included as access measures and others as measures of quality. These measures also align with waiver goals to reduce preventable ED use and preventable readmissions through improved access to other services, along with the CMS milestone focused on care coordination and transitions between levels of care.

• ED Utilization: All five states reporting this measure (IN, MA, NH, UT, and WA) showed declines in SUD-related ED utilization over the demonstration period. These findings suggest that ED utilization decreased in waiver states, which may be related to greater availability of other SUD services and could also reflect overall drops in ED utilization during COVID years. Washington also reported declines in ED visit rates per 1,000 members. Indiana was the only state to assess "potentially preventable" ED visits and found that, although overall SUD-related ED use declined, the share categorized as potentially preventable remained stable.
• Care Transitions After ED Use: Follow-up after ED visits for SUD improved in two of three reporting states (IN and WA). Indiana and Washington showed increases in follow-up care after ED visits for SUD, though rates remained relatively low, at 40% in Washington within 30 days of an ED visit and 10% in Indiana within 7 days. Improved care transitions after an ED visit may support continued treatment engagement. In Indiana, the percentage of enrollees with a follow-up within 7 days increased from 7% to 10%. Washington reported a five-percentage point increase in follow-up care within both 7 and 30 days after an ED visit for SUD. California did not report comparable follow-up measures, though county administrators described stronger ED-to-treatment linkages where EDs used navigators. In Massachusetts, there was little overall change in follow-up after ED visits.
• Care Transitions After Residential or Inpatient Treatment: All three states reporting post-discharge measures (CA, IN, and NH) showed improved transitions or follow-up after residential or inpatient care. Increases in transitions to lower levels of care after discharge may support ongoing treatment. California reported an increase in transitions from residential/inpatient to outpatient settings, from about 7% to 10%. Indiana reported greater use of community-based services and MOUD after discharge, with MOUD increasing from 29% to 44% post-discharge in 2020 — and other community-based services increasing from 82% to 93% post-discharge. New Hampshire reported higher follow-up treatment rates at multiple post-discharge intervals

Evaluations do not support clear cross-state conclusions about overdose outcomes. States used different overdose measures, populations, and time periods, and some did not report overdose outcomes at all, which may reflect differences in evaluation plans. For example, California reported fentanyl-related overdose deaths, Indiana and Massachusetts reported Medicaid-specific overdoses, and Washington reported overall overdose deaths that were not limited to Medicaid, while New Hampshire and Utah did not report overdose findings in their summative evaluations. Among states reporting overdose deaths, deaths generally increased. Massachusetts reported nonfatal opioid overdoses and found that nonfatal opioid overdoses declined somewhat, while fatal overdose death rates remained flat among Medicaid enrollees were mostly flat overall but began to decline by the end of the demonstration period. It is difficult to determine how much of any observed overdose change was due to the SUD IMD waiver versus broader conditions during the evaluation period, including the COVID-19 pandemic and the rapid fentanyl-driven rise in overdose deaths.

What challenges were noted in waiver evaluations?

Evaluations pointed to challenges and barriers that may have affected waiver outcomes. These were drawn primarily from key informant interviews, stakeholder surveys, and focus groups, as well as evaluator observations and provider survey data. Not all challenges were reported from every evaluation, and the depth of qualitative reporting varied across states.

Workforce shortages limited access across the treatment continuum. Across several evaluations, states cited shortages of SUD providers as a key constraint on treatment capacity, particularly for certain specialty services and geographies. California reported gaps in youth treatment services. Key informants in Washington pointed to shortages of licensed behavioral health professionals and cited low reimbursement and complex licensing and credentialing processes as contributing barriers. Utah stakeholders described similar challenges and noted that these barriers may make Medicaid participation more difficult for smaller providers with limited administrative support. Indiana also cited structural limits, noting that state caps on the number of opioid treatment programs constrained access to methadone.

Fragmented systems and uneven treatment infrastructure made care transitions harder. Across multiple evaluations, stakeholders described fragmentation when benefits are split across health plans or systems and when certain types of treatment are in short supply, making it harder to connect people to outpatient treatment after crisis or inpatient care. In California, stakeholders described mental health and SUD treatment as separate systems with different financing and rules that can slow referrals across systems, likely complicating coordination of care across mental health and substance use treatment. Utah stakeholders described similar barriers when physical and behavioral health benefits are split across separate plans. One plan described this fragmentation as creating a  “black hole of care coordination,” where enrollees can lose connection to care as responsibility shifts across plans. Washington cited limited discharge information and regional gaps in outpatient capacity as drivers of uncertain handoffs, and Indiana similarly reported difficulty finding appropriate follow-up care close to home after discharge.

Administrative barriers discouraged provider participation and could delay care. Across evaluations, three issues often surfaced: unclear billing and documentation rules, burdensome provider enrollment and credentialing, and delays tied to prior authorization. In California, administrators estimated that about half of case management services initially went unbilled because requirements were unclear, leading the county to absorb costs rather than navigate the unclear billing processes. Across multiple states, burdensome provider enrollment and credentialing processes were cited as deterrents to provider participation. Indiana and Washington further noted that prior authorization (PA) could delay care, especially when requirements were complex or when interpretations varied across managed care plans. For example, even after Indiana introduced a universal PA form, providers reported continued variation across plans in medical necessity interpretations, documentation requirements, and review processes, increasing burden for providers contracted with multiple plans.

Housing instability made it harder to sustain recovery after discharge. Multiple evaluations described homelessness or unstable housing as common among people in SUD treatment. Providers and other stakeholders noted that patients discharged to unstable environments often regressed quickly. Utah clinicians described feeling "helpless” to prevent negative outcomes without stable housing and reported “downward spirals” that could lead to re-hospitalization or overdose. Evaluations in California, Indiana, and Utah also noted that many people leaving residential care lacked appropriate step-down options, such as recovery residences or transitional housing.

State SUD IMD Waiver Evaluation Topics, Hypotheses, and Implementation Features

Summary of selected state evaluation plan research questions and hypotheses, condensed and grouped by topic, with notable waiver features or implementation details.

This table summarizes selected evaluation topics, hypotheses, and implementation features from state SUD IMD waiver evaluation plans and summative evaluation reports. Information is condensed and organized by topic and may not capture all topics, hypotheses, or implementation details. Cost-related topics and hypotheses are excluded because they are outside the focus of this table. Approval date refers to CMS’s initial approval date for the state’s SUD IMD section 1115 demonstration.

KFF analysis of SUD 1115 Waiver evaluation plans and summative evaluation reports

Long-term care (LTC) encompasses the broad range of paid and unpaid medical and personal care services that assist with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medication, and housekeeping). The Department of Health and Human Services (HHS) reports that after age 65, over half of people will at some point need help with at least two activities of daily living, over half will use paid LTC, and over one-third will use some nursing home care. People under 65 with disabilities also rely on LTC for assistance with activities of daily living and instrumental activities of daily living. Medicaid is the primary payer for long-term care (LTC), and KFF analysis of Medicaid claims data found that over half of people who used any Medicaid LTC were under 65. 

Direct care workers play a pivotal role in providing LTC services. They perform demanding, high-stress work for low wages and often no benefits. This has contributed to the long-standing shortages and high turnover rates among direct care workers in both home care and institutional care settings. Recent federal policy changes could further exacerbate the challenge of retaining and growing the workforce to care for the aging population. Specific policy changes that could exacerbate these challenges include the following.

• Broad changes to Medicaid, including $911 billion in reductions to federal spending and Medicaid work requirements, could have implications for the direct care workforce given Medicaid’s outsized role in LTC spending and relatively high Medicaid coverage rates among direct care workers.
• Direct care workers may also feel the impacts of recent changes in immigration policy. Three in ten direct care workers are immigrants, including naturalized citizens and noncitizens, who include lawfully present and undocumented immigrants. The Trump Administration’s intensified immigration enforcement and restrictive policies are deepening anxiety and fear among immigrants of all statuses and could contribute to reduced immigration in the future, which could exacerbate workforce shortages.
• Two proposed rules from the Department of Labor may also have an impact on direct care workers. One rule would roll back minimum wage and overtime protections for home care workers. The other rule would make it easier for employers to classify direct care workers as independent contractors, which would strip them of some labor protections.
• CMS has also delayed enforcement of a provision in the Medicaid Access Final Rule that would have required states to establish an advisory group to provide recommendations on direct care worker provider rates.

This analysis uses the 2024 American Community Survey (ACS) to provide an overview of demographic and socioeconomic characteristics of the direct care workforce, including home health aides, personal care aides, and nursing assistants who work in nursing facilities, residential care facilities, home health, and settings that provide nonresidential services for older adults and younger adults with disabilities (see Methods). 2024 ACS data was released in late 2025 and is the most recent data available. Other KFF analyses on the direct care workforce in nursing homes include RNs and LPNs (collectively referred to as “nurses”), but this analysis excludes nurses and only includes aides that assist older adults and people with disabilities with essential daily tasks. Nurses provide key services for older adults and younger people with disabilities who use long-term care services but are excluded from this analysis because they are socioeconomically and demographically different than aides. Key takeaways include:

• In 2024, there were 2.3 million direct care workers who provided long-term care to people ages 65 and older and people under 65 with disabilities (Figure 1).
• Direct care workers are significantly more likely to be age 50 years or older, female, Black or Hispanic, or immigrants when compared to all other adult workers in the U.S. (Figure 2).
• Direct care workers are also significantly more likely to have a high school degree or less, work part-time, be low-wage, or be covered by Medicaid or be uninsured when compared to all other adult workers in the U.S. (Figure 2).
• The share of direct care workers who are immigrants varies by state, ranging from 0% in Wyoming to 60% in New York (Figure 4).
• At least one in five immigrant direct care workers is from a country within the 75 countries that are part of the Trump administration’s immigrant visa pause, which could further strain the workforce in future years (Figure 5).

In 2024, there were 2.3 million direct care workers who provided long-term care to people ages 65 and older and people under 65 with disabilities (Figure 1). Direct care workers include personal care aides, nursing assistants, and home health aides.Other sources use a similar definition of direct care workers but use data from the Bureau of Labor Statistics (BLS) to estimate the total number of workers, leading to different counts. The BLS data are more recent than the American Community Survey. See Box 1 for a definition of types of direct care workers included in this analysis.

Direct care workers provide long-term care services across a variety of settings, with 66% providing care in home care settings, 22% in nursing facilities, and 12% in residential care facilities (Figure 1). “Home care settings” include “home health” and “services for the elderly and people with disabilities” from Figure 1 and Box 1. Excluding Figure 1 and Box 1, this analysis presents these categories as one combined “home care” category. See Box 1 for definitions of the direct care worker and setting types. 

Direct care workers are significantly more likely to be age 50 years or older, female, Black or Hispanic, or immigrants when compared to all other adult workers in the U.S. (Figure 2). Direct care workers are more likely to be age 50 years or older when compared to all other adult workers (41% vs 33%), as well as more likely to be female (85% vs 47%). They are also more likely to be Black than all other adult workers in the U.S. (30% vs 11%). They are also more likely to be Hispanic when compared to all other adult workers in the U.S. (23% vs 19%).Immigrants, including naturalized citizens and noncitizens, make up 30% of the overall direct care workforce, higher than the share of all adult workers in the U.S. who are immigrants (18%).

Direct care workers are also significantly more likely to have a high school degree or less, work part-time, be low-wage, and be covered by Medicaid or be uninsured when compared to all other adult workers in the U.S. (Figure 2). Direct care workers are more likely to have a high school degree or less than compared to all other adult workers (55% vs. 31%). They are also more likely to work part-time and make less than $35,000 annually (referred to as “low wage”) when compared to all other adult workers (39% vs 18%; 66% vs 31%). Direct care workers are also much more likely to be covered by Medicaid (32%) than all other adult workers (9%) and more likely to be uninsured when compared to all other adult workers (13% vs. 9%).

Direct care workers in home care settings are different than direct care workers in nursing homes or residential care facilities (Appendix Table 1). A higher share of direct care workers in home care settings are immigrants (33%) when compared to direct care workers in nursing facilities (25%) and residential care facilities (23%) (Figure 3). Additionally, a higher share of direct care workers in home care settings work part-time (42%) when compared to workers in nursing homes (24%) and residential care facilities (25%). Similarly, a higher share of home care workers are low-wage (72%) when compared to those working in nursing homes (56%) or residential care facilities (58%) (Appendix Table 1).

Immigrants make up 30% of the overall direct care workforce providing long-term care services (Figure 3). Naturalized citizens make up a significantly larger share of direct care workers in home care settings (19%) when compared to nursing facilities (16%) and residential care settings (14%). Home care workers are also significantly more likely to be noncitizen immigrants (14%) when compared to workers in nursing homes (9%) and residential care facilities (9%). Noncitizen immigrants include both lawfully present and undocumented immigrants.

The share of direct care workers who are immigrants varies by state, ranging from 0% in Wyoming to 60% in New York, and, in many cases, reflects the share of overall immigrant workers (Figure 4). In 20 states, including many Southern states, the share of direct care workers who are immigrants is under 10%. In 9 states, the share of direct care workers who are immigrants is between 10% and 19%. In 9 states, 20% to 29% of direct care workers are immigrants, and in the remaining 13 states (including DC), 30% or more of direct care workers are immigrants. The share of direct care workers who are immigrants is strongly positively correlated with the overall share of workers in a state that are immigrants.

Immigrants from 13 countries make up nearly two-thirds (65%) of all immigrant direct care workers providing long-term care in the U.S. (Figure 5). The remaining one-third of immigrant direct care workers come primarily from a mix of countries in South and Central America, Africa, and Asia. Six countries each account for 5% or more of immigrant direct care workers: Mexico (14%), Dominican Republic (7%), Philippines (7%), Jamaica (6%), China (6%), and Haiti (6%).

At least one in five immigrant direct care workers is from a country that is part of the Trump administration’s immigrant visa pause (Figure 5). Among the top 13 countries that make up nearly two-thirds of immigrant direct care workers, five of them are part of the Trump administration’s immigrant visa pause (Jamaica, Haiti, Nigeria, Cuba, and Ghana) that impacts 75 countries. While the immigrant visa pause is facing a court challenge, it currently remains in effect. On June 25, 2026, the Supreme Court issued a ruling allowing the Trump administration to proceed with terminating Haiti’s TPS designation, which could impact over 300,000 Haitian TPS holders. These policies could further strain the workforce in future years.

Methods

Data: These findings are based on KFF analysis of the 2024 American Community Survey (ACS) 1-year Public Use Microdata Sample (PUMS) files. The ACS includes a 1% sample of the U.S. population, and the subset of direct care workers used here includes 19,612 observations.

Identifying Direct Care Workers in ACS: Direct care workers are those who fall into the following occupation codes: Home health aides (3601); Personal care aides (3602); and Nursing assistants (3603). This analysis only includes those who work in the following industries: Home Health Care (8170), Nursing Care Facilities (8270), Residential Care Facilities (8290), and Individual and Family Services (8370). “Individual and family services” are also referred to as “services for the elderly and people with disabilities.” Home health care and individual and family services are collapsed into “Home care” for this analysis. These industries capture most workers providing long-term health services. The ACS only includes the primary industry and occupation of a respondent’s current or most recent (in case the respondent is not currently working) job.

We define the direct care workforce as all individuals 18 and older who earned at least $1,000 during the year and indicated that their job was in both the long-term care industry and occupation codes listed above. The comparison group “All Adult Workers in the U.S.” includes all individuals 18 and older who earned at least $1000 during the year.

Health Insurance Coverage in ACS: The ACS asks respondents about their health insurance coverage at the time of the survey. Respondents may report having more than one type of coverage; however, individuals are sorted into only one category of insurance coverage. See notes here for more information on the insurance coverage hierarchy.

Identifying Immigrants in ACS: Immigrants are identified as those who report their citizenship status (variable name: CIT) in ACS as being a “U.S. citizen by naturalization” or as “not a citizen of the U.S.”, with the former being grouped under “naturalized citizens” and the latter being grouped under “noncitizen immigrants” for the purpose of this analysis. Noncitizen immigrants include lawfully present and undocumented immigrants.

Appendix

Characteristics of Direct Care Workers and All Other Adult Workers

*Indicates statistically significant difference between Direct Care Workers and All Other Adult Workers at the p<0.05 level. NH=Non-Hispanic.

KFF analysis of American Community Survey, 2024

The contraceptive implant is the most effective reversible birth control method available. Implants, along with intrauterine devices (IUDs), are known as long-acting reversible contraception (LARCs) because they can be used to prevent pregnancy for several years and can be removed at any time. Implants have been available since the 1990s and have undergone substantial design modifications since their debut. The newest generation implant was introduced to the U.S. market in 2006 and remains the only contraceptive implant available in the U.S. Barriers to implant use include limited awareness and availability, high up-front costs for clinicians to stock the device, and required insertion and removal by a trained clinician. This fact sheet provides an overview of contraceptive implants including use, availability, and financing.

Background

In 1990, the Food and Drug Administration (FDA) approved Norplant, manufactured by Leiras Oy, the first subdermal contraceptive implant that was inserted under the skin of the upper arm by a trained clinician. Made of silicone, it had six capsules containing levonorgestrel, a synthetic hormone, and was effective for up to five years. Following concerns about its effectiveness and lawsuits on behalf of users who experienced complications, Norplant’s distributor, Wyeth-Ayerst, discontinued its U.S. distribution in 2002.

In 2006, the FDA approved Implanon, a single, thin, plastic, etonogestrel-releasing rod inserted under the skin of the arm. It is manufactured by Organon USA, a division of Merck. The improved design and composition made Implanon easier and faster to insert and remove than first generation implants. In 2010, the manufacturer replaced Implanon with Nexplanon, which is designed to be radiopaque (visible through x-ray) and has an improved insertion device. It is FDA-approved for use up to five years and prevents pregnancy by suppressing ovulation.

With a 0.05% failure rate, the contraceptive implant is the most effective FDA-approved reversible contraceptive. Additionally, the implant removes the potential for user error and non-use associated with self-administered contraception because it is inserted by a clinician and does not require any regular maintenance by the user.

Implants must be inserted and removed by a trained clinician who uses a special insertion device to place the implant just under the skin of the patient’s upper arm. Once inserted, the clinician ensures proper placement of the device by palpating the insertion site. The minor surgical procedure takes a few minutes and requires a local anesthetic and a small incision. After five years of use, the implant must be removed by a trained clinician, and if the patient desires, a new implant can be placed at that time. Implants may be removed by a clinician at any time before five years, and pregnancy can occur as soon as the first week following removal. 

Contraceptive implants are safe for most people and can be inserted any time if the user is not pregnant. Implants are primarily used for pregnancy prevention, but they can also be used to reduce menstrual cramps and make menstrual periods lighter. While there has been some concern about hormonal contraception for individuals who are breastfeeding, findings from the U.S. Selected Practice Recommendations for Contraceptive Use show that progestin-only methods, such as the implant, do not appear to negatively affect breastfeeding outcomes. Some common side effects include irregular menstrual bleeding, headache, weight gain, and breast pain, which may lead to discontinuation among some users. Although rare, some users who smoke or have certain health conditions may have a higher risk of developing severe complications.

Implant Use, Availability, and Awareness

Use

Because of their efficacy, continuation, and satisfaction rates, leading medical groups including the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics have recommended the use of implants for most individuals of reproductive age, including adolescents and nulliparous and postpartum women. However, research demonstrates persistent misperceptions and a lack of awareness about implants. Although implant use in the U.S. has increased since it was first introduced in 1995, it is still lower than other contraceptive methods such as the IUD, pill, and sterilization.

Between 2022 and 2023, the most recent years for which there are national data, 5% of women ages 15-49 who were currently using contraception used the implant (Figure 1). Implant users tended to be younger, lower-income, and covered by Medicaid. Notably, one in ten (11%) adolescent girls who use contraception report using the contraceptive implant compared to only 1% of women ages 35 to 49. Possible explanations for the association of higher implant use among younger women and lower-income women include the desire to avoid pregnancy for a longer period of time, lower maintenance and chance of user error, promotion of LARCs by medical organizations for adolescents, and availability at publicly funded clinics.

Availability and Awareness

Access to implants can depend, in part, on the clinician’s ability and willingness to offer them. A 2023 KFF survey of OBGYNs found that eight in ten (83%) OBGYNs provided contraceptive implants in their practice. Publicly funded family planning clinics are an important source of care for many low-income and uninsured people of reproductive age. Access to contraceptive implants has been challenging for some clinics due to high upfront costs, as well as limited training and staff capacity to insert the device. As a result, some sites may be unable to provide the full range of contraceptive services to their patients, including contraceptive implants. Overall, 75% clinics offered implants from 2022-2023 compared to 61% in 2015.

Physicians may require multiple visits for a contraceptive implant insertion, which can be inconvenient for patients with limited time and resources. ACOG recommends OBGYNs implement same-day insertion procedures to improve patient access and experiences with contraceptive care, but some clinicians report barriers such as high upfront costs and challenges with reimbursement for contraceptive implants. Nonetheless, the share of publicly funded family planning clinics that offer same-day contraceptive implant insertions has increased overall. Between 2022 and 2023, about two-thirds (69%) of clinics performed same-day insertions, compared to one in three (37%) in 2015. 

In 2026, the FDA made some changes to the provision of implants. One change was the extension of the use of the implant from three to five years. Additionally, the FDA made the implant available only through the FDA’s Risk Evaluation and Mitigation Strategy program (REMS), a drug safety program with special requirements for clinicians, pharmacies, and other distributors who wish to provide the implant, due to the rare but serious health risks associated with improper insertion of the device. The Nexplanon REMS program requires clinicians to register with REMS, pass a specialized knowledge assessment, and complete an in-person 90-minute training from the manufacturer to become certified in Nexplanon insertion and removal. In addition to medical doctors, the training is open to advanced practice clinicians (such as nurses and physician assistants) who are authorized to perform implant insertions and removals in their practice jurisdiction. Additional clinical training for the implant is available from a variety of reproductive health organizations.

Insurance Coverage and Financing of Implants

The wholesale price for an implant is about $1275, in addition to potential costs associated with insertion and removal. The Affordable Care Act’s (ACA) contraceptive coverage requirement eliminated many women’s out-of-pocket costs for contraceptives, although some women still do not have access to full coverage.

There is currently no generic or therapeutically equivalent version of Nexplanon available in the U.S. Nexplanon’s manufacturer, Organon USA (a division of Merck), currently holds patents on the device and associated materials, though these patents are set to expire between 2027 and 2030.

Private Insurance

The ACA includes a requirement that most private insurance plans cover at least one type of all 18 FDA-approved contraceptive methods as prescribed without cost sharing. This means that most private plans must cover the implant at no cost to policy holders. Before the ACA was passed, individuals with private insurance were likely to face out-of-pocket expenses for the implant and associated visits. After the contraceptive coverage mandate went into effect in 2012, research found that about three in four (73%) women with private insurance paid $0 in out-of-pocket expenses for contraceptive implants in 2020, compared to about three in then (28%) in 2012. However, recent research suggests an increase in the number of women with out-of-pocket expenses for contraceptive implant insertion, despite the coverage requirement. While nearly two-thirds (64%) of women with private insurance continued to have no out-of-pocket expenses for contraceptive implant insertion, over one in three (36%) paid a median cost of $16.88 for implant-related services in 2023—including office visits, ultrasounds, medications, and STI and pregnancy testing. Nonetheless, studies have found an increase in LARC initiation overall among women with private insurance coverage since the ACA’s coverage requirement took effect.

Insurers can use medical management to help control costs and encourage beneficiaries to choose more affordable contraceptive methods, but federal guidance prohibits insurers from categorically restricting access to a particular contraceptive method. Insurers can choose to cover generic contraceptives while charging cost-sharing for the brand-name version. Since contraceptive implants do not have a generic equivalent, the brand-name version (Nexplanon) must be covered without cost-sharing.

Medicaid

Federal law requires Medicaid programs to cover family planning services and supplies without cost sharing, but there are variations in coverage between states and between different Medicaid populations. For enrollees of the traditional Medicaid programs that were in place prior to the passage of the ACA, coverage of implants is determined by each state program. Recognizing the high (cost) effectiveness of LARCs, many states are pursuing policies to reduce barriers to provision, like reimbursing for insertion and removal, returning unused devices for credit, and providing hospitals with separate payments for post-partum LARC insertion.

Those who qualify for Medicaid under the ACA’s expansion of the program must receive coverage for the implant because the ACA requires these expansion programs to cover all FDA-approved methods for women without cost sharing, which is the same as the requirement for private insurance plans. Furthermore, 30 states and D.C. extend Medicaid coverage for family planning services, including contraception, to some uninsured women who do not qualify for full scope Medicaid.

Uninsured

The federal Title X Family Planning Program funds a network of clinics to provide family planning care to millions of low-income and uninsured people at reduced or no cost. Federal guidelines such as the Office of Population Affairs’ and the CDC’s Providing Quality Family Planning Services (QFP) and the Health Resources and Services Administration’s (HRSA) recommendations for women's preventive services state that offering women the full range of FDA-approved contraceptive methods is a crucial aspect of quality family planning services.

Research shows that sites that received Title X funds were consistently more likely to offer contraceptive implants compared to sites that do not receive Title X funding. Community health centers (CHCs) and specialized family planning clinics such as Planned Parenthood centers play a critical role in providing reproductive health care to low-income people, medically underserved communities, and people who are uninsured. CHCs are required to provide “voluntary family planning” services but have significant leeway in determining the specific services they provide. For example, nearly all (98%) Planned Parenthood clinics offered same-day implant insertions from 2022 to 2023, compared to just over half (57%) of federally qualified health clinics.

As a result of the 2025 One Big Beautiful Bill Act and other federal policy changes, the uninsured rate is expected to rise substantially over the next decade. Uninsured women could decide to stop using contraception because they cannot afford it or switch to a less effective method, which could result in an increase of unwanted pregnancies and a loss of reproductive autonomy. KFF research has found that one in five uninsured women of reproductive age has had to stop using a birth control method in the past 12 months because they couldn’t afford it, a rate that is four times greater than those with Medicaid (5%) or private insurance (2%).

As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. Broadly speaking, these technologies include health-related applications (“apps”), online patient portals, and connected devices such as smartphones and wearable devices that can be used to measure or track health data.   

A central component of CMS’s efforts in this area is the Health Tech Ecosystem, launched in 2025, through which CMS partners with private-sector organizations, including health care providers, payers, health app developers, and electronic health record vendors, to increase the availability of digital health tools and improve access to and exchange of electronic health information. While the initiative spans all CMS programs, people with Medicare gained access to the first wave of personalized health apps through the new Medicare app Library launched in April 2026, which allows beneficiaries to access third-party apps that have undergone independent review and meet certain requirements for privacy and security.

Separately, CMS introduced the ACCESS Model, a new Center for Medicare and Medicaid Innovation payment model scheduled to begin in July 2026 that aims to expand access to technology-enabled care for people in traditional Medicare with certain chronic conditions. CMS also enhanced the Medicare Plan Finder, the official online tool on Medicare.gov that helps beneficiaries compare and select Medicare coverage options.

This brief summarizes these digital health initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to highlight facts about recent experiences with and use of digital health tools among Medicare beneficiaries and older adults more generally.

The CMS Health Tech Ecosystem Aims to Expand Access to Patient-Facing Apps and Improve Health Data Exchange  

As part of the CMS Health Tech Ecosystem, dozens of companies have pledged to develop patient-facing apps that support exchange of health data and enable connectivity to the new Medicare App library, where people with Medicare can access third-party apps that meet CMS’s privacy and security criteria. To support the use of these tools, participating app developers, health information networks, electronic health record vendors, and payers have agreed to adopt common standards that make it easier for patients and providers to access and exchange electronic health information through the apps. The Medicare App library that launched in April 2026 will feature apps that meet one of the following initial use cases:

• Supporting management and prevention of diabetes and obesity, such as features that enable medication management or include resources related to prediabetes.
• Integrating conversational artificial intelligence (AI) assistants to help people navigate their care options and manage aspects of their health care, such as checking symptoms.
• Allowing patients to securely share their health and identity information electronically at check-in instead of completing paper forms (so-called “kill the clipboard” apps). Patients can also receive a summary of their visit through the same platform.

As of June 2026, the Medicare app library lists five apps that are available to beneficiaries and an additional eight apps that are expected to be added soon. A search tool on the app library website enables a comparison of apps based on 13 key features, such as managing health records, connecting to wearable devices, or sharing information with caregivers or providers, as well as searching for apps tailored to a range of health conditions and by price, with some apps being free and others requiring a subscription or having paid features.

CMS’s efforts to expand the availability of health care apps that have been vetted by the agency and meet specified standards for privacy and security build on the popularity and appeal of these tools, including among older adults.In 2025, eight in 10 (78%) Medicare beneficiaries ages 65 and older used a health care app or website to manage their health care in the past year, and more than half (58%) said these tools make managing their health care easier, according to a September 2025 KFF Health Tracking Poll (Figure 1). Three-quarters (75%) say they have used a health care app or website to access their medical records or lab results, the most common reported use of health apps among Medicare beneficiaries.

In addition, nearly two-thirds (63%) of older adults on Medicare say it’s important for Medicare to increase the availability of apps that help manage chronic conditions with the help of a health care provider, but few older adults on Medicare—about one in four (23%)— say they have used a health app or website in the past year to manage a chronic condition with their health care provider.

The ACCESS Model Expands Access to Technology-Enabled Care for People in Traditional Medicare with Certain Chronic Conditions

The CMS Innovation Center launched the ACCESS Model in December 2025 to test a national, voluntary payment approach that uses technology-supported care options to help traditional Medicare beneficiaries prevent and manage a specified set of chronic conditions. These chronic conditions are grouped into an initial set of four clinical tracks, two of which target cardiovascular, kidney, or metabolic conditions (e.g., hypertension, diabetes), one that targets musculoskeletal conditions (e.g., chronic musculoskeletal pain), and another that targets behavioral health conditions (e.g., depression). About 7 in 10 Medicare beneficiaries have conditions that qualify for at least one track, though this estimate may change as CMS considers additional conditions and clinical tracks in the future.

The model is voluntary for both participating organizations and people in traditional Medicare, who need to enroll directly with participating organizations or through a referral from their provider. It will run for 10 years from July 2026 through June 2036, with organizations joining in cohorts on a rolling basis throughout the model period. Medicare beneficiaries may disenroll or switch participating organizations after 90 days of their enrollment, and participating organizations may withdraw with advance notice to CMS and beneficiaries. 

To date, 190 organizations have been accepted as participants, including digital health companies, mental health organizations, health systems, and physician groups, most of which, according to CMS, have not previously served Medicare beneficiaries. These participants, who must enroll as Medicare Part B providers or suppliers, will receive monthly payments for managing beneficiaries’ qualifying conditions, with full payment tied to achieving certain health outcomes, such as helping a beneficiary with hypertension lower their blood pressure to a specific level. Currently, the vast majority of accepted applicants (151 organizations) have signed up for at least one of the two tracks focused on cardiovascular, kidney, or metabolic conditions, while 108 have signed up for the track on behavioral health conditions and 76 for the musculoskeletal track. Because organizations can participate in multiple tracks, these categories are not mutually exclusive.

Currently, it is unclear how broadly individual participants will operate geographically or the scope of services offered by each participant. CMS plans to launch a public directory of all ACCESS participants in July 2026, allowing people with Medicare and their providers to identify participating organizations, the conditions they treat, with risk-adjusted outcome measures for each organization expected to be added beginning in 2028. Organizations that participate in the model and also pledge to join the Health Tech Ecosystem will also be featured in the Medicare App Library as participants.

Participating organizations may use a variety of digital tools to deliver services under the Model, ranging from FDA-regulated medical devices such as continuous glucose monitors, to mobile applications, wearables, and non-FDA regulated software. CMS gives participants flexibility in selecting technologies and clinical tools that support the model. Some tools may be classified as clinical devices, including continuous glucose monitors, blood pressure cuffs, and wearable devices such as fitness trackers and smartwatches. Beneficiaries may receive these tools on either a loan or ownership basis from the participating organization or use their own devices. While participants generally may not require beneficiaries to purchase or rent devices classified as clinical, beneficiaries may still need access to non-clinical technologies, such as internet access, tablets, or smartphones to use technology-enabled services.

Variation in the technologies used under the ACCESS Model, as well as Medicare beneficiaries’ access to and familiarity with digital tools, may lead to differences in how people in traditional Medicare access and experience technology-supported care under this model. For example, some beneficiaries may enroll with participating organizations that incorporate the use of technologies already integrated into their care, such as Medicare-covered continuous glucose monitors. Others may enroll with participating organizations that incorporate technologies such as wearable fitness trackers that are generally not covered by Medicare and may be less widely adopted among beneficiaries. For example, in 2024, just under a quarter (23%) of adults ages 65 and older used an electronic wearable device to monitor or track their health or activity in the past year, based on KFF analysis of the Health Information National Trends Survey (Figure 1).  However, among older adults who use wearable devices, the vast majority (85%) said they would be willing to share data from their device with their health care providers.

Medicare Advantage enrollees, who account for more than half of all Medicare beneficiaries, do not qualify for the ACCESS Model, but 16 insurers, including those serving Medicare Advantage enrollees, have pledged to adopt similar models of care to date. Many Medicare Advantage enrollees report having conditions being targeted by the ACCESS Model, including hypertension (64%), diabetes (35%), and depression (28%), based on a KFF analysis of the 2023 Medicare Current Beneficiary Survey (MCBS). Because details about the programs pledged by the 16 insurers are not yet available, it is unclear how they will be structured or the patient populations that will be targeted, though they may resemble existing supplemental benefits offered by Medicare Advantage plans. In 2026, 44% of enrollees are in individual Medicare Advantage plans that offer remote access technologies, which may include clinical devices such as continuous glucose monitors, and 95% are in plans that offer fitness benefits, which may include discounts on wearable devices. For example, some plans offered by Devoted Health, which has pledged to align with ACCESS, offer partial reimbursement for the purchase of a wearable device as part of a fitness benefit. While CMS collects data on use and spending on supplemental benefits in Medicare Advantage plans, such as the number and characteristics of enrollees who use these benefits, this data is currently unavailable to researchers and consumers.

Changes to the Medicare Plan Finder Could Make It Easier to Compare and Select Medicare Coverage Options

In 2025, CMS announced enhancements to the Medicare Plan Finder, the official tool on the Medicare.gov website that helps beneficiaries compare and select Medicare coverage options. These enhancements include the following updates: 

• Offering Medicare Advantage provider directory information to help beneficiaries identify whether their doctors are in a plan’s network. Unlike traditional Medicare, most Medicare Advantage insurers use provider networks, which can change from year to year. Medicare beneficiaries say having access to their preferred providers is an important factor when selecting their Medicare coverage, yet in 2022, Medicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area. Prior to 2025, the Medicare Plan Finder did not include data on provider networks, resulting in beneficiaries’ going to each plan’s website or third-party sources to determine whether their preferred providers were in the network. Incorporating provider directory information in the Medicare Plan Finder may make it easier for beneficiaries to evaluate their coverage options, though the usability and completeness of this feature continue to evolve.
• Showing additional details on more than 30 supplemental benefits under Medicare Advantage. These details include in-network and out-of-network cost sharing amounts, whether prior authorization is required for each benefit, and whether there are limits on how much the plan will provide. Currently, most Medicare Advantage enrollees are in plans that offer supplemental benefits not covered by traditional Medicare, such as vision, hearing, and dental, and beneficiaries highlight the availability of extra benefits as a reason they choose to enroll in Medicare Advantage plans.

CMA also announced the launch of an “AI-powered” prescription drug search tool that will provide personalized cost comparisons across pharmacies. While prescription drug costs covered under Medicare Part D, including premiums and deductibles, can change from year to year and vary by plan, most enrollees in Medicare Advantage prescription drug plans (81%) and stand-alone prescription drug plans (69%) in 2023 did not compare their plans’ drug coverage with drug coverage offered by other plans in their area. According to CMS, the new prescription drug search tool will be available on Medicare.gov to users with an individual account but will not be incorporated in the Medicare Plan Finder. This tool could provide more individualized guidance to help Medicare beneficiaries lower their prescription drug costs beyond the prescription drug lookup tool that is already incorporated in the plan finder.

However, these enhancements will require beneficiaries to access the Medicare website and navigate the plan finder, even as just over half (53%) of Medicare beneficiaries said they hadn’t visited the Medicare website, according to KFF analysis of the 2023 MCBS, and it is unknown how many beneficiaries have used the Medicare Plan Finder specifically to compare coverage options or enroll in a plan. But with less than a third (28%) of Medicare beneficiaries comparing their coverage options during a previous open enrollment period for Medicare, enhancements to Medicare Plan Finder and Medicare.gov may help address some of the challenges beneficiaries face when evaluating their coverage options and comparing costs.