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The 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.
Forty 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).
This 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.
This brief compares the prices paid by private insurers for hospital care to increases in Medicare payment using data from the Bureau of Labor Statistics (BLS) Producer Price Index (PPI), finding that hospital prices have risen much faster for private insurance than Medicare since 2019.
This brief examines the implications of the growing use of AI for racial and ethnic disparities in health and health care and discusses factors that can help reduce AI-related bias in health care.
Amid reports of Immigration and Customs Enforcement (ICE) at hospitals and President Trump's reversal of policy protecting "sensitive locations" like hospitals, KFF's Health Tracking Poll finds that a majority of the public say they are concerned about the Trump administration's actions in health care settings.
This analysis examines the competitiveness of markets for hospital care and finds that nearly half of metropolitan areas across the country had only one or two hospitals or health systems providing general inpatient hospital care in 2024.
Panelists discussed the motivations behind horizontal and vertical consolidation in health care, its potential to lower or raise costs, the implications for patients and payers, and how policy makers could respond.
This data note analyzes the extent to which hospital spending has contributed to the growth in national health expenditures in recent years and over the long term using data from the Centers for Medicare & Medicaid Services (CMS) National Health Expenditures Accounts (NHEA).
This policy watch discusses the implications for the U.S. health care workforce of the recent DOS immigrant visa pause for individuals from 75 countries deemed more likely to be a public charge.
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