The Medical Frailty Exemption from Medicaid Work Requirements: Key Takeaways from the CMS Interim Final Rule
This brief describes new guidance and potential challenges states will face in operationalizing the medical frailty exemption.
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Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements
FeatureKFF's interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.
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Key Facts about the Uninsured Population
Issue BriefThe number and share of people without insurance grew in 2024, increasing for the first time since 2019, according to KFF's analysis of data from the American Community Survey (ACS). This issue brief describes trends in health coverage in 2024, examines the characteristics of the uninsured population , and summarizes the access and financial implications of not having coverage.
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Recent State Actions Related to Immigrants’ Access to Services and Immigration Enforcement
Issue BriefThis brief summarizes recent and proposed actions by states related to access to state-funded health coverage and other services for immigrants and immigration enforcement activity during the 2025 and 2026 state legislative sessions.
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Forthcoming Policy Changes to Medicaid State Directed Payments
Issue BriefThe 2025 reconciliation law reduced federal Medicaid spending by an estimated $911 billion from 2025 through 2034, some of which stems from new restrictions on Medicaid state directed payments (SDPs) for hospital and other health care services. This issue brief describes SDPs and forthcoming policy changes stemming from the 2025 reconciliation law and the proposed regulation to implement those requirements and make other changes.
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Federal Medicaid Spending Through State Directed Payments Nears $100 Billion Annually Across 41 States, With New Limits Set to Reduce Funding to States
News ReleaseForty states and DC currently receive $93 billion in annual federal Medicaid spending through state directed payments (SDPs) and may be at risk due to forthcoming limits on these payments, according to new KFF estimates. Annual federal spending on SDPs is highest in California (an estimated $10.6 billion)—followed by Texas ($6.3 billion), North Carolina ($5.2 billion), and Illinois ($5.1 billion).
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Spending on Medicaid State Directed Payments Before New Limits Take Effect
Issue BriefThis issue brief analyzes Medicaid spending by state on SDPs that require prior CMS approval to better understand the use of SDPs before new limits in the reconciliation law take effect.
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What to Know About Recent Federal Actions Involving State Medicaid Program Integrity
Issue BriefThis brief describes recent HHS actions (state-specific and nationwide) related to Medicaid program integrity and outlines some open questions about the future of Medicaid program integrity, including which states might become a focus of administration effort.
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A Closer Look at North Carolina’s Implementation of the 2025 Reconciliation Law Medicaid Provisions and Other Changes Amid Medicaid Budget Shortfalls
Policy WatchThis policy watch provides initial insight into how North Carolina is preparing to implement certain Medicaid provisions of the 2025 reconciliation law and how other policy changes may affect coverage and access to care.
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Understanding Medicaid Cost Sharing and Policy Changes from the 2025 Reconciliation Law
Issue BriefThis brief explains current Medicaid cost sharing rules and changes made to cost sharing rules by the 2025 reconciliation law, reports on cost sharing amounts states currently impose on ACA expansion adults, and highlights literature on the impact of cost sharing.