State Level

Medicaid financing is complex. This policy watch explains how Medicaid financing works, describes various conservative proposals to change Medicaid financing, and explores the implications of those changes for states and enrollees.

The U.S territories – American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) – have faced longstanding fiscal and health challenges exacerbated by recent emergencies. This issue brief provides background on how Medicaid financing differs between U.S. territories and states and what these differences mean for funding as well as health care coverage and access.

The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade to help pay for tax cuts. Major cuts to Medicaid may impact coverage for the almost 1 in 5 Medicare beneficiaries (12.2 million) who are also enrolled in Medicaid.

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.

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 allocates the CBO’s estimated reduction in federal spending in the Senate reconciliation bill 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.

House Republicans have passed a reconciliation package (the “One Big Beautiful Bill Act”) that would make significant changes to Medicaid and the Affordable Care Act (ACA) Marketplaces and increase the number of people without health insurance by an estimated 10.9 million. This analysis estimates state-level increases in the number of uninsured people due to this legislation, along with other changes to the Marketplace, including the expiration of the enhanced premium tax credits.

This page displays an interactive map of the current status of state decisions on the Affordable Care Act’s Medicaid expansion. Additional Medicaid expansion resources are listed (with links) below the map.