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Medicaid work requirements

Tracking the 2025 Reconciliation Law’s Medicaid Work Requirements: Data and Policies

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements.

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Medicaid Financing

Medicaid represents $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term care. This brief examines key questions about Medicaid financing and how it works.

Medicaid Program Integrity

This brief explains what is known about improper payments and fraud and abuse in Medicaid and describes ongoing state and federal actions to address program integrity.

Medicaid and Provider Taxes

All states except Alaska cover some state Medicaid costs with taxes on health care providers. This brief uses data from KFF’s 2024-2025 survey of Medicaid directors to describe current practices and the federal rules governing them.

Medicaid and Hospitals

Absorbing reductions in Medicaid spending could be challenging for hospitals, particularly for those that are financially vulnerable. This brief provides data on the reach of Medicaid across hospitals, patients, and charity care.

Medicaid Home Care

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

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  • More Children are Losing Medicaid Coverage as Child Poverty Grows 

    News Release

    Children’s Medicaid and Children’s Health Insurance Program (CHIP) enrollment declined by 5.5%, or 2.3 million children, from March 2023, before the unwinding began, to September 2023, according to KFF’s latest analysis. Across all 50 states and DC, at least 14,377,000 people were disenrolled from Medicaid between April 1 and January 9, 2024. Medicaid eligibility levels are higher for children, raising concerns that they may be losing coverage and becoming uninsured despite remaining eligible. Medicaid covers…

  • What Trump’s 2024 Victory Means for Medicaid

    Quick Insights

    While Medicaid did not receive a lot of attention during the campaign, if cuts to Social Security and Medicare are largely off the table, Medicaid is the likely source of funding to extend expiring tax cuts.

  • Medicaid Work Requirements: Current Waiver and Legislative Activity

    Issue Brief

    With Donald Trump returning to the presidency and Republican control of the Senate and House, work requirements are likely to be back on the agenda—through federal legislation or Medicaid waivers. This issue brief highlights the history of Medicaid work requirements, describes recent state activity to advance work requirement policies, and recaps the landscape of work requirement approvals and pending requests at the end of President Trump’s first term.

  • Will Insurance Cover Over-the-Counter Contraceptive Pills? A Discussion of Coverage Options and Challenges

    Event Date:
    Event

    The U.S. Food and Drug Administration recently approved Opill—the first over-the-counter daily oral contraceptive pill in the United States. Beginning in early 2024, people will be able to purchase Opill without a prescription, expanding options for contraceptive access across the country. On September 15, 2023, a panel of experts joined Laurie Sobel, associate director for KFF’s Women’s Health Policy program, to explore approaches to covering over-the-counter oral contraception without a prescription. The panel discussed lessons…

  • Will Availability of Over-the-Counter Narcan Increase Access?

    Policy Watch

    Making Narcan available OTC has the potential to expand access, but several obstacles may limit its reach. Decisions by pharmacies on whether to stock OTC Narcan, the product's placement within stores, and lingering stigmas can impact accessibility. Furthermore, public knowledge plays a role; many people may not realize that OTC Narcan is available without a prescription from a doctor and that insurance may help cover the costs.

  • KFF Examines Challenges in Navigating Coverage for Opill, the First Over-the-Counter Daily Oral Contraceptive Pill, Coming to Market Next Year 

    News Release

    As Opill—the first over-the-counter daily oral contraceptive pill in the United States—is expected to be available for purchase in early 2024, new research conducted by KFF examines barriers to its accessibility for consumers and challenges in providing insurance coverage for it. Based on interviews with nearly 80 representatives from private insurance plans, state Medicaid programs, chain pharmacies, and other key groups, the report provides a deeper view into the operational challenges in expanding access to…

  • How Has Projected Medicaid Spending and Enrollment Changed Since Passage of the 2025 Reconciliation Law?

    Policy Watch

    CBO’s latest projections of Medicaid spending and enrollment from February 2026 show how enrollment and spending are expected to change over the next decade, accounting for the historic policy changes and their expected reductions in future federal Medicaid spending, as well as other economic and technical changes. This policy watch compares CBO’s February 2026 projections of Medicaid spending and enrollment to earlier CBO projections.