State Budgets

On May 18, the House Budget Committee advanced a budget reconciliation bill that includes significant changes to the Medicaid program. As anticipated, Medicaid work requirement provisions are included and preliminary estimates released by the Congressional Budget Office (CBO) show that this provision would reduce federal spending by $280 billion over ten years, nearly half of all estimated Medicaid savings in the bill. The provisions raise many operational and implementation questions, particularly considering the experience of Arkansas and Georgia with implementing work requirements through waivers.

This analysis examines the potential impacts of a provision in the House reconciliation bill that proposes reducing the federal matching rate for the Affordable Care Act (ACA) Medicaid expansion population from 90% to 80% for states that either provide health coverage or financial assistance to purchase health coverage to individuals who are not lawfully residing in the United States.

Based on draft reconciliation language from the Energy & Commerce Committee, the Congressional Budget Office (CBO) released preliminary estimates showing proposed Medicaid changes would reduce federal Medicaid spending by $625 billion. Building on earlier KFF analysis, this analysis puts this magnitude of federal funding cuts into context by showing how the cuts relate to states’ budgets and exploring the potential effects on Medicaid enrollment by state.

A new KFF analysis examines a range of measures that may make it harder for states to respond to possible federal Medicaid cuts and finds that six states (Kentucky, Mississippi, Missouri, New Mexico, South Carolina, and West Virginia) rank in the top five for multiple risk categories. Across four broad categories of measures that could affect demand for Medicaid and states’ abilities to raise revenue or reduce spending—population demographic characteristics, health status of Medicaid enrollees, available revenue and state budget choices, and health care costs and access to care—KFF finds that 15 states rank in the top five for at least one category of risk factors.

This analysis examines the potential impacts on states and Medicaid enrollees of implementing a per capita cap on the federal share of Medicaid spending for the ACA Medicaid expansion population only, which is another proposal that has been discussed by members of Congress.

As Congress weighs potential cuts in federal Medicaid spending through budget reconciliation, one option under consideration is to limit the use of state taxes on providers. This brief uses data from KFF’s 2024-2025 survey of Medicaid directors to describe states’ current provider taxes and the federal rules governing them.

This brief explores the magnitude of the potential federal Medicaid funding cuts under the House budget resolution. This brief puts the $880 billion in cuts in context by comparing the size of the cuts to states’ tax revenues, spending on education, and the number of Medicaid enrollees covered for that cost.

This analysis examines the potential impacts on states, Medicaid enrollees, and providers of implementing a per capita cap on federal Medicaid spending, which is one proposal that has been discussed in Congress. Such a plan could decrease federal Medicaid spending by $532 billion to almost $1 trillion over a 10-year period, depending on how states respond. An estimated 15 million people could lose Medicaid coverage by 2034.

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 services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.