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Work Requirements

Challenges with Implementing Work Requirements

Many states are anticipating a variety of implementation challenges, including the need for complex system changes, a compressed implementation timeline, and limited staff capacity.

What is the Medicaid Hardship Exception?

The number of Medicaid expansion enrollees who ultimately qualify for the high unemployment hardship exception will depend on how the exception is implemented and how unemployment rates changes.

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

KFF’s interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.

Medicaid Budget Survey

Medicaid Home Care

Using data from the 23rd KFF survey of officials administering Medicaid home care programs, this issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025

This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect. The data come from KFF’s 23rd survey on Medicaid home care programs in all 50 states and DC.

KFF regularly surveys states about their Medicaid home- and community-based services (HCBS) programs and their eligibility policies for people who are eligible for Medicaid on the basis of having a disability or being 65 and older.

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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 2024.

Eligibility and coverage

  • Eligibility, Enrollment, and Renewal Policies

    KFF's survey findings capture state actions that seek to improve the accuracy and efficiency of Medicaid and CHIP enrollment and renewal processes, as of January 2025.

  • Seniors and People with Disabilities

    More than 1 in 3 people with disabilities (15 million) have Medicaid (35%). In comparison, only 19% of people without disabilities have Medicaid.

  • Children with Special Needs

    Amid debates about proposed cuts to federal Medicaid spending, this brief analyzes key characteristics of children with special health care needs and explores how Medicaid provides them with coverage.

  • People With Intellectual and Developmental Disabilities

    Among the estimated 8 million people with intellectual and developmental disabilities (I/DD), over three million have Medicaid coverage.

  • Adults with Chronic Conditions

    Among working age adults enrolled in Medicaid, approximately three quarters have one or more chronic conditions, and nearly one-third have three or more.

The Essentials

  • 5 Facts: Immigrants and Medicaid

    This brief provides five key facts on Medicaid and immigrants as context for understanding the potential impacts of policy changes under the Trump administration.

  • 5 Facts: Medicaid and Hospitals

    This brief explains the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid, the share of births covered by the program, and how Medicaid expansion has impacted hospital finances.

  • Medicaid Financing: The Basics

    Medicaid is a major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.

  • 5 Facts: Medicaid’s Share of National Health Spending

    This brief explores how Medicaid spending contributes to national health spending and how different service areas contribute to Medicaid costs.

  • 5 Facts: Medicaid and Nursing Facilities

    The substantial Medicaid savings in the reconciliation bill could have major implications for nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them.

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  • Health Policy Resources for Covering the 2020 Elections

    News Release

    As the 2020 Election Day approaches, many candidates continue to focus on health care issues, including on the public health and economic response to COVID-19, the future of the Affordable Care Act, health care costs and abortion.

  • Eliminating the ACA: What Could It Mean for Medicaid Expansion?

    Policy Watch

    The debate over filling the Supreme Court seat previously held by Ruth Bader Ginsburg has brought renewed attention to the possibility of the Affordable Care Act (ACA) being overturned under the court challenge in California v. Texas, currently scheduled to be heard shortly after the election this November. The expansion of Medicaid was a central component of the ACA, and 39 states have now adopted the ACA expansion into their Medicaid programs. Because Medicaid is administered by states, under federal guidelines, there may be some confusion about how overturning the federal law would affect state Medicaid programs.

  • Rising Cases in Long-term Care Facilities Are Cause for Concern

    Issue Brief

    LTC cases in hotspot states are increasing at 4x the rate as LTC cases in non-hotspot states. Media has largely focused on the share of cases attributed to a younger population. However, increased cases in long-term care facilities are cause for concern, given that nearly half of all COVID-19 deaths have been in long-term care facilities. This piece provides state-level data, including data that shows that long-term care cases in Texas and Florida have increased by over 50% in 2 weeks.

  • Racial and Ethnic Disparities in COVID-19 Cases and Deaths in Nursing Homes

    Issue Brief

    This data note presents national data that shows that nursing homes with a high share of Black or Hispanic residents were more likely to have at least one coronavirus case, at least one COVID-19 death, and (among facilities with cases) more severe case outbreaks than facilities with a low share of Black or Hispanic residents. This piece also includes state-level data from 21 states where a sufficient sample of facilities with a high share of Black or Hispanic residents was available.

  • How Has the Pandemic Affected Health Coverage in the U.S.?

    Policy Watch

    Findings from administrative data suggest that the decline in enrollment among employer-sponsored insurance was far less than overall declines in employment as of September, and that many who did lose their job-based coverage likely found a safety net in coverage through Medicaid or the ACA marketplaces.

  • Health Insurer Financial Performance Through September 2020

    Issue Brief

    In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.