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An Early Look at States’ Differing Approaches to Implementing Medicaid Work Requirements Amid Cost and Time Constraints and Uncertainty

A new KFF survey of state Medicaid officials and focus groups in eight states captures the different choices states are making about how to implement Medicaid work requirements, with seven states planning for a more restrictive approach to verifying work or exemption status or to implement work requirements early. These implementation plans are taking shape as states encounter time, cost, and other constraints as well as uncertainty about how to define and verify certain exemptions due to delayed federal guidance.

Medicaid Work Requirements

Tracking Medicaid Work Requirements: Data and Policies

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements.

understanding medicaid

Medicaid Financing

Medicaid represents $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term care. This brief examines key questions about Medicaid financing and how it works.

Medicaid Program Integrity

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.

Medicaid and Provider Taxes

All states except Alaska cover some state Medicaid costs with taxes on health care providers. This brief uses data from KFF’s 2024-2025 survey of Medicaid directors to describe current practices and the federal rules governing them.

Medicaid and Hospitals

Absorbing reductions in Medicaid spending could be challenging for hospitals, particularly for those that are financially vulnerable. This brief provides data on the reach of Medicaid across hospitals, patients, and charity care.

Medicaid Home Care

This issue brief provides an overview of what Medicaid home care (also known as “home- and community-based services”) is, who is covered, and what services were available in 2025.

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  • State Options for Medicaid Coverage of Inpatient Behavioral Health Services

    Report

    This report provides data to understand current patterns of Medicaid enrollees’ use of inpatient and outpatient substance use disorder and mental health treatment services; explains the options for states to access federal Medicaid funds for enrollees receiving IMD services; analyzes current Section 1115 waiver activity; and draws on interviews with policymakers using IMD waivers in Vermont, Virginia, and San Diego County to examine successes and challenges

  • Community Health Centers Prepare for Funding Uncertainty

    Issue Brief

    With the Community Health Center Fund, a key source of federal funding, set to expire in September, community health centers across the country are considering steps to reduce staffing, close some locations and eliminate or reduce services as they cope with uncertainty about their future financing.

  • Medicaid Provisions in the American Rescue Plan Act

    Issue Brief

    The American Rescue Plan Act, the COVID-19 relief package that became law on March 11, 2021, contains a number of provisions designed to increase coverage, expand benefits, and adjust federal financing for state Medicaid programs. These provisions are briefly described below and summarized in Table 1. Separate briefs summarize provisions in the new law relating to the Marketplaces and public health.

  • Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities

    Issue Brief

    The American Rescue Plan includes a provision to increase the federal matching rate (FMAP) for spending on Medicaid HCBS by 10 percentage points from April 1, 2021 through March 31, 2022 provided states maintain state spending levels as of April 1, 2021. This brief discusses the proposal and provides state by state estimates of the potential effects of the policy change. It was updated on May 28 to include key points from the new CMS…

  • KFF Health Tracking Poll: Economic Hardship, Health Coverage, And The ACA

    Feature

    This poll examines the public's assessments of the Biden administration's handling of the coronavirus pandemic, the impact COVID-19 has had on people's finances, and support for provisions of the latest COVID-19 relief bill. It examines the public's views of the ACA and possible next steps.

  • Disparities in Health and Health Care: 5 Key Questions and Answers

    Issue Brief

    Disparities in health and health care for people of color and underserved groups are longstanding challenges. This brief provides an introduction to what health and health care disparities are, why it is important to address disparities, the status of disparities today, recent federal actions to address disparities, and key issues related to addressing disparities looking ahead.