A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes
This report highlights key policy priorities and issues state Medicaid programs focused on in FY 2025 and are prioritizing in FY 2026.
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State Medicaid Officials Project Flat Enrollment Post Unwinding but Increased Spending and Budget Pressures, as States Prepare for Impact of Federal Medicaid Policy Changes
News ReleaseAs states completed the “unwinding” of pandemic-era continuous coverage, Medicaid enrollment fell 7.6% in FY 2025 and is expected to be largely flat in FY 2026. At the same time, total Medicaid spending grew by 8.6% in FY 2025 and is expected to grow by 7.9% in FY 2026.
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Medicaid Home Care (HCBS) in 2025
Issue BriefThis issue brief provides an overview of what Medicaid home care (also known as “home- and community-based services” or HCBS) is, who is covered, and what services were available in 2025.
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A Look at Medicaid Enrollment and Finances of the Five Largest Medicaid Managed Care Plans
Issue BriefThis brief examines enrollment and financial data through the end of September 2024 from quarterly company earnings reports and calls, financial filings, and other company materials as well as from national administrative data.
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Prior Authorization Process Policies in Medicaid Managed Care: Findings from a Survey of State Medicaid Programs
Issue BriefThis brief examines state policies related to prior authorization processes in Medicaid managed care and includes findings about how states approach prior authorization decision timeframes, electronic denial notices, and access to external medical reviews, all as of July 1, 2024.
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North Carolina’s Effort to Relieve Medical Debt
Policy WatchThis policy watch examines the burden of medical debt in North Carolina and the state’s new plan to leverage the Medicaid program to provide debt relief and support access to care for low- and middle-income North Carolinians.
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Experience of the Five Largest Publicly Traded Companies Operating Medicaid Managed Care Plans During Unwinding
Issue BriefThis brief takes a closer look at the five largest publicly traded companies (also referred to as “parent” firms) operating Medicaid MCOs, which account for half of Medicaid MCO enrollment nationally. This analysis presents the latest enrollment and financial data (through the end of 2023) as well as key takeaways from the firms’ unwinding experience.
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Strategies to Manage Unwinding Uncertainty for Medicaid Managed Care Plans: Medical Loss Ratios, Risk Corridors, and Rate Amendments
Issue BriefThis brief provides a high-level snapshot of states with minimum medical loss ratio (MLR) and remittance requirements and risk corridors in place as of July 1, 2022 that may provide financial protection and limits on financial risk for states and plans as the unwinding unfolds.
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Increasingly Privatized Public Health Insurance Programs in the US
PerspectiveIn this JAMA Forum column, KFF’s Larry Levitt examines the growing role of private insurance companies in public programs, including Medicare Advantage and Medicaid managed care, and the tradeoffs that result.
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Health Insurer Financial Performance in 2023
Issue BriefUsing health insurer financial data for 2023, we find that in 2023, per enrollee gross margins were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual insurance market. Across most markets, gross margins have been relatively stable in recent years.