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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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  • Voices from Puerto Rico: Reflections Two Months After Maria (Report)

    Issue Brief

    Two months after Maria made landfall, Kaiser Family Foundation staff traveled to Puerto Rico. This brief presents findings from focus groups and individual interviews with 40 individuals from 10 different regions on the island affected by the storm.

  • Tax Cuts Could Make It Harder to Change Medicare, Medicaid

    From Drew Altman

    In this Axios column, Drew Altman discusses how cutting Medicare and Medicaid has always been a challenge, but if the public comes to view “entitlement reform” as a means to pay for tax cuts, the GOP will have an even stiffer challenge, including with their base.

  • Voces de Puerto Rico: Reflexiones Dos Meses Después de María (Informe)

    Issue Brief

    Dos meses después que el huracán María tocara tierra, la Kaiser Family Foundation viajó a Puerto Rico. Este informe presenta los resultados de grupos focales y entrevistas individuales con 40 personas de 10 diferentes regiones de la isla afectadas por la tormenta.

  • Voces de Puerto Rico: Reflexiones Dos Meses Después de María (Video)

    Video

    En este video, los residentes de Puerto Rico hablan sobre su vida cotidiana y puntos de vista de los esfuerzos de recuperación dos meses después del huracán María. Describen un clima de frustración, la pérdida de empleo y problemas económicas, la falta de servicios básicos como la electricidad y el efecto en la salud mental y física de la población

  • Approved Changes to Medicaid in Kentucky

    Issue Brief

    On January 12, 2018, the Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 demonstration waiver in Kentucky, entitled “Kentucky Helping to Engage and Achieve Long Term Health” or KY HEALTH. On the same day that CMS approved Kentucky’s waiver, Governor Bevin issued an executive order directing the state to terminate the Medicaid expansion if a court decides that one or more of the waiver provisions are illegal and cannot be implemented. This fact sheet summarizes key provisions of Kentucky’s approved waiver.

  • Medicaid: What to Watch in 2018 from the Administration, Congress, and the States

    Issue Brief

    Medicaid provides health insurance coverage for about one in five Americans and is the largest payer for long-term care services in the community and nursing homes. Efforts in 2017 to repeal and replace the Affordable Care Act (ACA) and cap federal financing for Medicaid were unsuccessful but help to set the stage for 2018. As 2018 begins, there is a focus on administrative actions using Medicaid Section 1115 demonstration waivers, state actions on Medicaid expansion, and funding for the Children’s Health Insurance Program (CHIP) and other federal health care priorities. Medicaid in 2018 is also likely to continue to be part of both federal and state budget deliberations. Pressures to control the federal deficit may reignite efforts to reduce or cap federal Medicaid spending. In addition, Governors will soon release proposed budgets for state FY 2019 that will need to account for uncertainty around CHIP and Medicaid, changes in the economy and the effects of the recent tax legislation as well as funding for rising prescription drugs and initiatives to combat the opioid epidemic. This brief examines these issues.

  • Medicaid Enrollment & Spending Growth: FY 2017 & 2018

    Issue Brief

    This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2017 and 2018. Findings are based on interviews and data provided by state Medicaid directors as part of the 17th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.