Federal Budget

In his latest column, KFF President and CEO Drew Altman explains why Medicaid, despite former President Donald Trump’s silence on the topic, warrants greater attention given the potential for drastic changes or cuts to it should Republicans win control in the election.

This brief analyzes Medicaid enrollment and spending trends for FY 2024 and FY 2025, based on data provided by state Medicaid directors as part of the 24th annual survey of Medicaid directors.

States expect national Medicaid enrollment to decline by about 4% and state Medicaid spending to rise by 7% in fiscal year (FY) 2025. These rates follow a larger but anticipated enrollment decline and state spending increase in FY 2024, as pandemic-era policies and federal funding expired, according to KFF’s 24th…

Medicaid financing is complex. This policy watch explains how Medicaid financing works, describes various conservative proposals to change Medicaid financing, and explores the implications of those changes for states and enrollees.

The U.S territories – American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) – have faced longstanding fiscal and health challenges exacerbated by recent emergencies. This issue brief provides background on how Medicaid financing differs between U.S. territories and states and what these differences mean for funding as well as health care coverage and access.

A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.The impacts…

As Congressional Republicans and President Trump search for trillions of dollars in cuts to mandatory federal spending that could help offset the cost of extending expiring tax cuts, this brief analyzes current support from the federal government for health programs and services, including both spending and tax subsidies as context for those federal budget discussions.

Program integrity efforts work to prevent and detect fraud, waste, and abuse, to increase program transparency and accountability, and to recover improperly used funds. 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.

The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade to help pay for tax cuts. Major cuts to Medicaid may impact coverage for the almost 1 in 5 Medicare beneficiaries (12.2 million) who are also enrolled in Medicaid.

KFF and the Peterson Center on Healthcare examine market trends contributing to rising health costs and identify several potential federal and state policy issues to watch throughout 2025, including high-cost drugs, federal funding cuts, and workforce shortages.