The 2025 reconciliation law makes sweeping changes to Medicaid that will affect every state through key eligibility and financing changes, including new work requirements, immigrant eligibility restrictions, and changes to provider taxes and state directed payments. This issue brief explains which states will be affected by each of these key provisions.

This brief describes current fiscal conditions using the latest state revenue and spending data from the National Association of State Budget Officers (NASBO) and analyzes how these conditions may impact states’ Medicaid budget decisions going forward.