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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 describes recent HHS actions (state-specific and nationwide) related to Medicaid program integrity and outlines some open questions about the future of Medicaid program integrity, including which states might become a focus of administration effort.
This brief provides an update on Planned Parenthood closures and participation in the Title X program in the midst of substantial policy changes leading to decreased funding for Planned Parenthood including the One Big Beautiful Bill Act and the withholding of federal Title X funding to Planned Parenthood clinics.
This policy watch provides initial insight into how North Carolina is preparing to implement certain Medicaid provisions of the 2025 reconciliation law and how other policy changes may affect coverage and access to care.
Noncitizen immigrants, particularly those who are undocumented, face significant barriers to accessing health coverage and care and are significantly more likely than citizens to be uninsured. This brief provides an overview of state health coverage programs for immigrants, including among states that have taken up options in Medicaid and the Children’s Health Insurance Program (CHIP) to expand coverage for lawfully present immigrants and/or established fully state-funded programs to fill gaps in coverage for immigrants.
This issue brief provides background on the GENEROUS model, examines the factors that will contribute to the model’s overall impact on Medicaid drug costs, and illustrates how savings will depend on model details that are confidential or uncertain at this time.
This issue brief examines California's Medicaid work requirement implementation plans to provide initial insight into how California is preparing to implement work requirements amid projected state budget shortfalls and changes in the 2025 reconciliation law.
Our updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees.
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