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As 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.
This report highlights key policy priorities and issues state Medicaid programs focused on in FY 2025 and are prioritizing in FY 2026.
Under the reconciliation package, federal Medicaid spending in rural areas is estimated to decline by $137 billion, more than the $50 billion appropriated for the rural health fund.
This analysis allocates the CBO’s estimated reduction in federal spending in the enacted reconciliation package across states based on KFF’s state-level data and where possible, prior modeling work; and shows the federal spending reductions relative to KFF’s projections of federal spending by state under current law.
In his latest Beyond the Data column, KFF President and CEO Dr. Drew Altman examines the controversial rural hospital grant program, noting “Will the new $50 billion rural hospital grant program in the big Republican tax and spending law just amount to a bunch of ribbon cutting and big check ceremonies, or will it help rural hospitals offset coming Medicaid cuts, help them in general, or all of the above?”
In his latest Beyond the Data column, President and CEO Dr. Drew Altman discusses whether Democrats can make the Medicaid and ACA cuts a winning political issue before the midterm elections and before most people feel the cuts.
In his latest column, President and CEO Drew Altman discusses how, with nearly half, or about 10 million MAGA supporters and Republicans receiving coverage through the ACA Marketplaces, the policy changes and cuts being considered by Republicans to the Marketplaces will directly affect their own voters. Altman writes: "Republicans are no longer interested in repealing the ACA but seem comfortable shrinking it significantly if they can, so long as they don’t touch protections for pre-existing…
The Congressional Budget Office’s (CBO) latest estimate shows that the One Big Beautiful Bill would reduce federal Medicaid spending by $793 and that the Medicaid provisions would increase the number of uninsured people by 7.8 million. Previous CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid in 2034. Building on prior KFF analysis, this analysis allocates these estimated federal spending reductions and enrollment losses across the states.
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 “a qualified alien.”
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