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  • Bar chart shows the number of states, including DC, offering Medicaid home care through various federal programs in 2025.

    Medicaid Home Care (HCBS) in 2025

    Issue Brief

    This issue brief provides an overview of what Medicaid home care (also known as “home- and community-based services” or HCBS) is, who is covered, and what services were available in 2025.

  • number of responding states, including DC, that allow payments for family caregivers by type of home care program and type of caregiver.

    Medicaid’s Home Care Support for Family Caregivers in 2025

    Issue Brief

    Medicaid home care programs offer various supports to family caregivers such as paid caregiving, self-directed services, respite care, and caregiver training. This issue brief describes the availability of self-directed services and supports for family caregivers in Medicaid home care in 2025, before most provisions in the reconciliation law take effect.

  • Section 1115 Waiver Watch: CMS Phasing Out Workforce Initiatives

    CMS Phasing Out Medicaid Workforce Initiatives

    Policy Watch

    On July 11, CMS notified states that, going forward, it does not anticipate approving new 1115 demonstration workforce initiatives or extending existing waivers. Such changes may limit states’ abilities to pursue initiatives investing in the Medicaid workforce.

  • diff data sources, same MEdicaid work requirements

    Different Data Source, But Same Results: Most Adults Subject to Medicaid Work Requirements Are Working or Face Barriers to Work

    Issue Brief

    To understand the impact of Medicaid work requirements included in the budget reconciliation bill being debated in Congress, KFF has undertaken two different analyses using different data sources. Using 2023 data from the Survey of Income and Program Participation, this analysis looks at the share of adults who work at least 80 hours per month, the reasons some do not, and how consistently individuals meet the requirement over a six-month period.

  • Understanding the Intersection of Medicaid and Work: An Update

    Issue Brief

    Amid renewed interest in Medicaid work requirements as part of a broader legislative package designed to significantly reduce federal Medicaid spending, KFF has updated its analysis of the work status and demographic characteristics of Medicaid enrollees with the latest data. Data show that, in 2023, 92% of Medicaid adults were either working full or part-time (64%), or were not working due to barriers to work such as caregiving responsibilities, illness or disability, or school attendance…

  • Implementing Work Requirements on a National Scale: What We Know from State Waiver Experience

    Policy Watch

    On May 18, the House Budget Committee advanced a budget reconciliation bill that includes significant changes to the Medicaid program. As anticipated, Medicaid work requirement provisions are included and preliminary estimates released by the Congressional Budget Office (CBO) show that this provision would reduce federal spending by $280 billion over ten years, nearly half of all estimated Medicaid savings in the bill. The provisions raise many operational and implementation questions, particularly considering the experience of…

  • States that were approved under the Biden administration "HRSN framework," as well as states that received approval for DSHP funding authority.

    Section 1115 Waiver Watch: Early Signs Point to New Directions Under Trump Administration

    Issue Brief

    Recent actions from the Trump administration could signal limits to curtail Medicaid waivers related to social determinants of health and to limit waiver financing tools and flexibility. Two major changes demonstrate this shift: (1) rescinding Biden-era guidance on covering health-related social needs (HRSN) services, and (2) phasing out federal funding for “Designated State Health Programs” (DSHP) in waivers.