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An Early Look at States’ Differing Approaches to Implementing Medicaid Work Requirements Amid Cost and Time Constraints and Uncertainty

A new KFF survey of state Medicaid officials and focus groups in eight states captures the different choices states are making about how to implement Medicaid work requirements, with seven states planning for a more restrictive approach to verifying work or exemption status or to implement work requirements early. These implementation plans are taking shape as states encounter time, cost, and other constraints as well as uncertainty about how to define and verify certain exemptions due to delayed federal guidance.

Medicaid Work Requirements

Tracking Medicaid Work Requirements: Data and Policies

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements.

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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  • The Impact of the COVID-19 Recession on Medicaid Coverage and Spending

    Issue Brief

    Unlike previous recessions in modern history, this past recession was spurred by the spread of a virus (COVID-19), which created a public health crisis with unique health implications. This brief describes the broader impacts of this most recent recession – which lasted from February 2020 to April 2020 -- and also explores how trends in Medicaid spending and enrollment differed from past recessions and what that might mean for state Medicaid programs moving forward.

  • Medicaid Home & Community-Based Services: People Served and Spending During COVID-19

    Issue Brief

    This issue brief presents FY 2020 state-level data on the number of people receiving Medicaid HCBS and HCBS spending. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related brief presents the latest data and highlights themes in key state policy choices about optional HCBS.

  • Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey

    Report

    The 20th annual survey of state Medicaid and CHIP program officials conducted by the Kaiser Family Foundation (KFF) and the Georgetown University Center for Children and Families in January 2022 presents a snapshot of actions states are taking to prepare for the lifting of the continuous enrollment requirement, as well as key state Medicaid eligibility, enrollment and renewal procedures in place during the PHE.

  • How Many Medicaid Enrollees Moved In 2020 And What Are The Implications For Unwinding the Public Health Emergency?

    Issue Brief

    Once states resume redeterminations and disenrollments at the end of the public health emergency (PHE), Medicaid enrollees who moved within a state during the pandemic but are still eligible for coverage are at increased risk of being disenrolled if their contact information is out of date. We analyzed federal survey data for 2020 and found that roughly 1 in 10 Medicaid non-elderly enrollees (9%) moved in-state in 2020. A much smaller share, just 1%, moved…

  • States Are Planning for the End of the Continuous Enrollment Requirement in Medicaid After the COVID-19 Public Health Emergency Expires, But Many Have Not Made Key Decisions

    News Release

    As states plan for the end of the COVID-19 public health emergency, the resumption of eligibility redeterminations and disenrollments when the continuous Medicaid enrollment requirement is lifted could lead to coverage disruptions and losses, according to a new KFF 50-state survey. The requirement, a condition of states receiving enhanced federal Medicaid funding during the pandemic, has helped drive Medicaid and CHIP enrollment to a record 85 million people, an increase of 19.1 percent since the…

  • Federal Policy May Temporarily Close the Coverage Gap, But Long-term Coverage May Fall Back to States

    Policy Watch

    Recent policy attention has focused on closing the coverage gap for roughly 2.2 million individuals living in the 12 states that have not adopted Medicaid expansion included in the Affordable Care Act (ACA). These individuals do not qualify for Medicaid and have incomes below poverty, making them ineligible for premium subsidies in the ACA Marketplace. Pending federal legislation may temporarily provide coverage to individuals in the coverage gap, but providing a permanent pathway to coverage may fall back…

  • Analysis Examines How States Can Use Medicaid Programs to Facilitate Access to Vaccines for Low-Income Children

    News Release

    As states expand COVID-19 vaccination efforts to reach newly eligible children ages 5 to 11, a new KFF analysis highlights several tools state Medicaid programs have at their disposal to increase access to, and take up of, vaccines among lower-income children. Among the key findings: States can request Medicaid administrative federal matching funds for state-funded monetary incentives to encourage uptake of the vaccine. In recent months, several states reported activities and incentives within contracted Medicaid…