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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.

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  • 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.

  • New KFF Resource Tracks Developments in States’ Section 1115 Medicaid Waivers

    News Release

    A new resource from the Kaiser Family Foundation enables users to keep abreast of Section 1115 Medicaid waivers that are pending or have been approved by the Centers for Medicare and Medicaid Services. KFF’s Medicaid waiver tracker includes interactive maps that allow users to view states’ approved and pending waivers according to category, including Medicaid expansion; work requirements; benefit restrictions, copays and healthy behaviors; enrollment and eligibility restrictions; managed long-term services and supports; and more.…

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    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

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  • What Are States Proposing for Work Requirements in Medicaid?

    News Release

    With the approval of Kentucky’s Medicaid expansion waiver, the Centers for Medicare and Medicaid Services (CMS) has for the first time granted a state permission to make Medicaid eligibility conditional on meeting a work requirement. Nine other states have waivers pending at CMS that would impose work requirements, including Arizona, Arkansas, Kansas, Indiana, Wisconsin, Maine, New Hampshire, Mississippi and Utah. A new brief from the Kaiser Family Foundation highlights what the work requirements would be in…

  • 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,…

  • Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2017 and FY 2018

    Issue Brief

    This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states: Nevada, North Carolina and West Virginia. These case studies build on findings from the 17th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) and Health Management Associates (HMA).

  • Medicaid in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018 at a Forum with the National Association of Medicaid Directors

    Event Date:
    Event

    At 9:30 a.m. ET on Thursday, Oct. 19, the Kaiser Family Foundation released its 17th annual 50-state Medicaid budget survey for state fiscal years 2017 and 2018. Kaiser and the National Association of Medicaid Directors (NAMD) are holding a joint briefing to discuss trends in enrollment and spending and highlight key policy developments in state programs at a time when policymakers in Washington and some states have sought big changes to Medicaid and its financing.…

  • How Medicaid Section 1115 Waivers Are Evolving: Early Insights About What to Watch

    Issue Brief

    While efforts to pass major federal legislation to repeal and replace the Affordable Care Act (ACA) and restructure and reduce federal Medicaid financing may be on hold temporarily, the focus of the Centers for Medicare and Medicaid Services (CMS) and states is expected to turn to achieving significant Medicaid program changes through Section 1115 demonstration waivers. This issue brief presents three questions to help analyze the evolution of federal waiver policy as new waiver proposals…