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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.

Dual Eligibles

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  • Unintended Consequences: The Potential Impact of Medicare Part D on Dual Eligibles with Disabilities in Medicaid Work Incentive Programs

    Report

    Individuals with disabilities who are eligible for both Medicare and Medicaid must also shift to a Medicare prescription drug benefit in 2006. This report analyzes how younger dual eligibles in Kansas enrolled in work incentive programs differ than other Medicare enrollees in the types of drugs they use and how much drug spending they have to better assess the impact of the Medicare drug benefit on this population. Report (.pdf)

  • Preserving Recent Progress for Health Coverage of Children and Parents: New Tensions Emerge

    Report

    The latest survey of eligibility rules and enrollment and renewal procedures in all 50 states and the District of Columbia in their Medicaid and SCHIP programs for children and parents. It reflects changes states implemented between January 2002 and April 2003. The current survey also solicited information about states premiums and cost-sharing practices. Report Enrolling Children and Families in Health Coverage: The Promise of Doing More (50 State Survey as of January 2002) >>All 50-State…

  • Fact Sheets Summarize President’s Budget Proposals for Health Insurance Coverage, Including Medicaid and SCHIP

    Fact Sheet

    Fact Sheets Summarize President's Budget Proposals for Health Insurance Coverage, Including Medicaid and SCHIP The President's fiscal year 2008 budget proposal includes changes to Medicaid, provisions for the reauthorization of SCHIP, and the health coverage initiative, Affordable Choices. These fact sheets provide an overview of President Bush's policy plans on these health coverage issues. The Affordable Choices Initiative: An Overview President's FY2008 Budget and The State Children's Health Insurance Program President's FY 2008 Budget and…

  • Short Term Options for Medicaid in a Recession

    Issue Brief

    This policy brief discusses several short-term options for strengthening Medicaid at time when the economic recession has increased demand for the program and constrained state budgets. It details potential steps such as increasing federal funding, easing enrollment barriers and temporarily expanding coverage. Policy Brief (.pdf)

  • Community Health Centers

    Fact Sheet

    This fact sheet provides a basic overview of community health centers, covering issues such as the patients they serve, the services they provide and the financing they receive. Community health centers provided comprehensive primary care to 16.1 million patients in 2007. Fact Sheet (.pdf)

  • Implications Of A Federal Block Grant Program For Medicaid

    Issue Brief

    This issue brief examines the broad implications of converting Medicaid to block grant financing, one of several ideas that have been put forth to help reduce the federal deficit. The paper, which does not analyze any specific proposal, notes that switching to block grant financing would fundamentally alter the Medicaid program and could have significant implications for states, localities, beneficiaries and health care providers. Issue Brief (.pdf) Related Resources: Prior Analyses of Block Grant Proposals…

  • A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law

    Issue Brief

    With the Supreme Court preparing to hear oral arguments about challenges to the 2010 Affordable Care Act in March 2012, this Kaiser Family Foundation brief serves as a primer on the pending case, which challenges the constitutionality both of the law's individual mandate that requires most Americans to obtain health insurance and of provisions requiring states to expand eligibility for their Medicaid programs. The brief provides an overview of the pending case, the key constitutional…

  • Resources on Dual Eligibles and Issues Related to Their Transition to the New Medicare Drug Benefit

    Event Date:
    Event

    With the new Medicare prescription drug benefit available as of January 1, 2006, over 6 million low-income seniors and people with disabilities who are enrolled in both Medicaid and Medicare—also known as dual eligibles—have been transitioned from Medicaid drug coverage to new Medicare drug plans. While there are many policy issues related to the overall establishment of the new drug benefit, the mandatory transition of dual eligibles has created a special set of challenges for…

  • A Forum on the Implications of Changes in the Health Care Environment for Native American Health Care

    Report

    With the assistance of the First Nations Development Institute, the Henry J. Kaiser Family Foundation commissioned several studies of critical issues in Native-American health care. These studies examined the trends shaping the future of Native-American health care; the existing health systems and planning capacity in the Native-American health care system; the changes occurring in the IHS; the role of Medicaid in Native-American health care; the attitudes and preferences of Native American health care consumers; and…