State Budgets - Research and Data from KFF

Responding to Federal Medicaid Reductions: Which States Are Most at Risk?

May 2, 2025

Issue Brief

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.

A Medicaid Per Capita Cap on the ACA Expansion Population: State by State Estimates

Apr 25, 2025

Issue Brief

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.

5 Key Facts About Medicaid Expansion

Apr 25, 2025

Issue Brief

This issue brief examines Medicaid expansion enrollment and Medicaid spending in expansion and non-expansion states and describes the characteristics of adults covered by the Medicaid expansion.

Putting $880 Billion in Potential Federal Medicaid Cuts in Context of State Budgets and Coverage

Mar 24, 2025

Issue Brief

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.

Capping Per Enrollee Spending Could Reduce Federal Medicaid Expenditures by $532 billion to Nearly $1 Trillion Over 10 Years Depending on How States Respond and Result in as Many as 15 Million People Losing Medicaid Coverage by 2034

Feb 26, 2025

News Release

As Congress considers ways to cut Medicaid spending to help finance the extension of federal tax cuts, a new KFF analysis finds that imposing a cap on federal spending per Medicaid enrollee—known as a “per capita cap”—could trigger a decrease in federal Medicaid spending over a 10-year period of $532 billion to almost $1 trillion,…

A Medicaid Per Capita Cap: State by State Estimates

Feb 26, 2025

Issue Brief

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.

As Governors Meet in D.C., Possible Federal Medicaid Cuts Loom as Big State Funding Issue

Feb 20, 2025

Quick Take

In the face of reduced federal funding for Medicaid, states could be left with difficult choices – raise revenue or cut spending. Cuts to Medicaid could mean eliminating coverage for children, parents, working adults or those who might need long term care; limiting benefits; or cutting rates for plans or providers.

Eliminating the ACA Medicaid Expansion Match Could Reduce Total Medicaid Spending by Up To $1.9 Trillion Over 10 Years and End Coverage for 20 Million People

Feb 13, 2025

News Release

A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.

Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates

Feb 13, 2025

Issue Brief

This analysis examines the potential impacts on states and Medicaid enrollees of eliminating the 90% federal match rate for the Affordable Care Act (ACA) expansion. Eliminating the federal match rate for adults in the Medicaid expansion could reduce Medicaid spending by nearly one-fifth ($1.9 trillion) over a 10-year period and up to nearly a quarter of all Medicaid enrollees (20 million people) could lose coverage.

Making Sense of Medicaid Work Requirements

Dec 17, 2024

From Drew Altman

In this column, KFF President and CEO Drew Altman examines the data and history around adding work requirements to Medicaid and why the administrative burdens it imposes may offset any savings even for states that ideologically favor such an approach.

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