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This analysis estimates the number of states impacted by and the amount of current federal spending on Medicaid state directed payments for hospital services that exceeds the new limits established by the 2025 reconciliation law when fully implemented.
In a new column, Dr. Drew Altman, KFF's Founding President and CEO, discusses how New Mexico made childcare universal and became the only state to fully replace lost enhanced ACA tax credits while its leaders avoided polarizing labels like “progressive or “socialist.”
This page tracks emerging developments in the federal government’s approach to Medicaid program integrity, along with the implications of those actions for different states.
This brief summarizes recent and proposed actions by states related to access to state-funded health coverage and other services for immigrants and immigration enforcement activity during the 2025 and 2026 state legislative sessions.
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.
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