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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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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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  • An Early Look at Implementation of Medicaid Work Requirements in Arkansas

    Issue Brief

    This brief analyzes the early experience with implementation of work and reporting requirements in Arkansas, based on publicly available data and information, as well as targeted interviews with state officials, health plans, providers, and beneficiary advocates conducted in August and September 2018.

  • Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act

    Issue Brief

    On October 3, 2018, the Senate overwhelmingly passed comprehensive, bipartisan legislation to address the opioid epidemic, sending the measure to President Trump who has indicated he will sign it. The bill, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, was passed earlier by the House and tackles many aspects of the epidemic, including treatment, prevention, recovery, and enforcement. While very broad in scope, the final legislation…

  • State Medicaid Fact Sheets Highlight the Role of Medicaid in the U.S. Health Care System

    News Release

    An updated collection of state Medicaid fact sheets from the Kaiser Family Foundation summarizes Medicaid coverage and spending nationally and in each state. The fact sheets for each state are accessible via an interactive map of the U.S. and display a wide range of data, including: The share of the state population covered by Medicaid and the Children’s Health Insurance Program (CHIP), including the number covered by the Medicaid expansion in the 33 expansion states. Medicaid…

  • 2018 Elections: Key Medicaid Issues to Watch

    Issue Brief

    Medicaid provides health insurance coverage for more than 76 million Americans, supplies funding for safety-net providers, and is the largest source of federal revenues for states. At this time last year, Congress was debating repeal and replace of the Affordable Care Act (ACA) as well as more fundamental changes to Medicaid financing. While federal legislative changes to Medicaid did not pass in 2017, the outcomes of the 2018 elections will shape program changes at both…

  • Un año después de las tormentas: la recuperación y la atención de salud en Puerto Rico y las Islas Vírgenes de EE.UU. (Informe)

    Issue Brief

    Un año después que los huracanes Irma y María tocaran tierra, Puerto Rico y las Islas Vírgenes de EE.UU. (USVI) todavía sienten los efectos de las tormentas. Basándose en entrevistas con partes interesadas clave y en informes públicos, este reporte proporciona una visión general del estado de recuperación y los esfuerzos de preparación para la actual temporada de huracanes, un año después de las tormentas, enfocándose en los sistemas de atención de salud de los…

  • One Year after Hurricanes Irma and Maria, Recovery Has Progressed Slowly in Puerto Rico and the U.S. Virgin Islands and Health Care Challenges Remain, Particularly in Mental Health

    News Release

    One year after Hurricanes Irma and Maria made landfall, recovery has progressed slowly and unevenly in Puerto Rico and the U.S. Virgin Islands. The territories’ health care systems continue to face capacity, infrastructure and financial challenges even as health needs have increased, especially in mental health, according to two new reports from the Kaiser Family Foundation. The reports, drawing upon interviews with government and health officials from both territories, public documents and data, and an…

  • One Year after the Storms: Recovery and Health Care in Puerto Rico and the U.S. Virgin Islands

    Issue Brief

    One year after Hurricanes Irma and Maria made landfall, Puerto Rico and the U.S. Virgin Islands (USVI) are still feeling the storms’ effects. Drawing on key stakeholder interviews and public reports, this brief provides an overview of recovery status and preparation efforts for the current hurricane season one year after the storms, with a focus on the territories’ health care systems.

  • Community Health Centers’ Experiences in a More Mature ACA Market

    Issue Brief

    Community health centers provide comprehensive primary care services in some of the most underserved communities in the nation. This brief summarizes findings from the Kaiser Family Foundation/Geiger Gibson Program in Community Health Policy 2018 Health Center Survey to provide a snapshot of health centers’ outreach and enrollment activities as well as changes in service capacity, and overall financial condition since implementation of the ACA.

  • Does Employment Lead to Improved Health? New Research Review Finds Mixed Evidence with Caveats that Could Impact Applicability to Medicaid Work Requirements

    News Release

    With nearly a dozen states seeking or implementing waivers to add work requirements for some Medicaid beneficiaries, a central question is whether such policies promote health and therefore promote the goals of the Medicaid program. A new Kaiser Family Foundation report reviews research about the relationship between work and health and finds only limited evidence that employment improves health, with some studies showing a positive impact and others showing no relationship at all or only…