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Medicaid work requirements

Medicaid and the Road Ahead: Spending Cuts, Work Requirements and What’s Next for States, Providers and Families

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Passed last year, President Trump’s One Big Beautiful Bill Act made significant changes to Medicaid—the primary insurance provider for health and long-term care for people with low incomes. These changes are expected to lead to coverage loss for many current enrollees and will reduce funding for Medicaid, placing new financial pressures on states and health care providers. On July 23, KFF and States Newsroom hosted an event focused on the impacts of work requirements and other federal policy changes on states, health care systems, and people.

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understanding medicaid

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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  • Welfare Reform and Elderly Legal Immigrants

    Report

    This report presents the findings of researchers at the National Academy on Aging on welfare reform and elderly legal imigrants. The Personal Responsibility and Work Opportunity Reconciliation Actof 1996 included an array of structural reforms affecting access to cash assistance programs such as AFDC and SSI as well as Medicaid. This study profiles elderly legal immigrants in the United States and explores the implications of welfare reform for this population. Report Report

  • Assessing the Role of Recent Waivers in Providing New Coverage

    Issue Brief

    This analysis finds that recent waivers have expanded coverage in important ways in a few states, but, overall, the number of people who have gained new coverage under recent waivers has been quite limited, well below projections and small compared to overall growth in Medicaid enrollment. Issue Paper (.pdf)

  • The Role of Health Coverage for People with Disabilities

    Event Date:
    Event

    People with disabilities are at risk in the health-care system because of their wide-ranging health-care needs, their relatively heavy use of prescription drugs, health-care and support services, and typically low incomes. A new survey of people with permanent mental and/or physical disabilities explores their health-care experiences and challenges in accessing and paying for care. Report Chartpack Health Affairs Article-- "Uncovering the Health Challenges Facing People with Disabilities: The Role of Health Insurance"

  • Challenges and Tradeoffs in Low-Income Family Budgets:  Implications for Health Coverage

    Report

    Challenges and Tradeoffs in Low-Income Family Budgets: Implications for Health Coverage - Report This report explores the experiences of families trying to make ends meet on limited budgets. By discussing these families’ work, spending patterns, financial challenges, priorities and tradeoffs and health care and coverage, this report intends to provide a deeper understanding of families’ financial pressures and choices and information to assess the impact of current and proposed policies. Report (.pdf)

  • Medicaid and Long-term Care – Report

    Report

    Medicaid and Long-term Care This report examines Medicaid's role in providing long-term care services, including the services provided, the population needing services, and how the services are delivered. Current policy issues and challenges for Medicaid's role in providing these services are also discussed. Report (.pdf)

  • Medicaid Financing Issues:  Intergovernmental Transfers and Fiscal Integrity

    Fact Sheet

    Medicaid Financing Issues: Intergovernmental Transfers and Fiscal Integrity Since its enactment in 1965, Medicaid has been a joint venture between the states and the federal government. While each state administers its own Medicaid program within broad federal guidelines, the federal government provides over half of the program’s financing. As a result, Medicaid represents a spending item, but it is also the single largest source of federal revenue to the states. In recent years there has…

  • One State’s Medicaid Managed Care Formulary Operations:  A Look at Pennsylvania, 2001-2002

    Report

    One State’s Medicaid Managed Care Formulary Operations: A Look at Pennsylvania, 2001-2002 This report examines formulary implementation under mandatory Medicaid managed care in Pennsylvania between 2001 and 2002. It looks at one state during a yearlong period; formulary operations are likely to vary across states and programs and over time. The report includes findings about Pennsylvania’s formulary operation and observations about improving the system. Report (.pdf)