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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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  • Puerto Rico: Medicaid, Fiscal Issues and the Zika Challenge

    Fact Sheet

    Roughly one in two Puerto Ricans (49%) are enrolled in the island’s Medicaid program. This fact sheet provides an overview of the Medicaid program in Puerto Rico and emerging fiscal issues facing its health care system as Zika cases on the island continue to mount.

  • Data Note: Effect of State Decisions on State Risk Scores

    Issue Brief

    To gauge whether individual market risk pools are healthier in states that have expanded Medicaid and did not allow transitional plans, this data note compares average state risk scores using data from the Centers for Medicare & Medicaid Services Summary Report on Risk Adjustment for the 2015 benefit year. The analysis finds that states that expanded Medicaid and did not allow transitional plans had lower average risk scores, suggesting the risk pools in those state’s markets are healthier than in non-expansion states and in states that allowed transitional plans.

  • 50-State Survey Finds Slower Growth in Total Medicaid Spending Nationally in FY 2016 and Projected for FY 2017 as Earlier Increases from the Affordable Care Act’s Coverage Expansions Taper Off

    News Release

    After record increases in fiscal year 2015, growth in Medicaid enrollment and total Medicaid spending nationally slowed substantially in FY 2016 and are projected to continue to slow in FY 2017 as the initial surge of enrollment under the Affordable Care Act’s coverage expansions tapered off, according to the 16th annual 50-state Medicaid Budget Survey by the…

  • Takeaways From Alaska’s Medicaid Expansion

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman discusses the implications of the governor of Alaska’s decision to move ahead unilaterally with Medicaid expansion.

  • California’s Previously Uninsured After The ACA’s Second Open Enrollment Period

    Report

    The Kaiser Family Foundation California Longitudinal Panel Survey is a series of surveys that, over time, tracks the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). The initial baseline survey was conducted with a representative sample of 2,001 nonelderly uninsured Californian adults in summer 2013, prior to the ACA’s initial open enrollment period. The second survey in the series followed up with the same group of previously uninsured Californians who participated in the baseline (a longitudinal panel survey). The third in the series, and the focus of this report, followed up with them again after the second open enrollment period in spring 2015 to find out whether more have gained coverage, lost coverage, or remained uninsured, what barriers to coverage remain, how those who now have insurance view their coverage, and to assess the impacts that gaining health insurance may have had on financial security and access to care.

  • 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers

    Report

    This nationwide survey analysis of Marketplace consumer assistance programs and brokers examines the nature of Marketplace assistance during the second open enrollment period for 2015 coverage, and offers unique insights into how Affordable Care Act (ACA) implementation is progressing, what is changing, and what challenges remain. Building upon our Survey of Health Insurance Marketplace Assister Programs (2014), the analysis compares Assister Program capacity and experiences from the first open enrollment period to the next, and also includes the enrollment experience of brokers for the first time.

  • New Article and Infographics in JAMA Examine Medicaid and Medicare at 50 Years

    News Release

    The July 28 special issue of the Journal of the American Medical Association (JAMA) includes an article written by Kaiser Family Foundation President and CEO Drew Altman and former U.S. Senate Majority Leader William H. Frist, MD, and two infographics from the Foundation that examine the past, present, and future of Medicaid and Medicare.

  • Medicare and Medicaid at 50 Years: Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers

    From Drew Altman

    In this article for the Journal of the American Medical Association (JAMA), Drew Altman and former U.S. Senate Majority Leader William Frist examine the roles the Medicaid and Medicare play in the health system today from the perspectives of the public and beneficiaries, providers, and policymakers, and discusses the challenges they face in the future. The article is accompanied by an audio interview with Altman and Frist, who is a member of the Foundation’s board of trustees.

  • Trends in Medicaid and CHIP Eligibility Over Time

    Report

    While Medicaid and CHIP eligibility has increased over time, there is significant variation in eligibility levels across states and eligibility groups. This analysis examines trends in Medicaid and CHIP eligibility limits over time for children, pregnant women, parents, and other adults. It also explores how trends in eligibility for these groups vary by several variables, including geographic region, Medicaid expansion status, and state health ranking.