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Medicaid work requirements

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.

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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  • Medicaid Enrollment & Spending Growth: FY 2018 & 2019

    Issue Brief

    This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2018 and 2019. Findings are based on interviews and data provided by state Medicaid directors as part of the 18th 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.

  • States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019

    Report

    This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019 (which began for most states on July 1, 2018). Key areas covered include changes in…

  • 50-State Survey Finds Flat Medicaid Enrollment Tied to a Stronger Economy and New Eligibility Systems

    News Release

    For the first time in a decade, states are reporting no overall growth in Medicaid enrollment last year and expecting minimal growth this year amid a stronger economy, a new Kaiser Family Foundation survey finds. The 18th annual 50-state survey of Medicaid directors reveals that enrollment was flat in state fiscal year (FY) 2018 (down an average 0.6 percent), and states are budgeting for minimal increases during FY 2019 (up an average 0.9 percent). States…

  • Conversation on Health Care and the 2018 Midterm Elections

    Event Date:
    Event

    Health care ranks among the top issues voters want to hear candidates talk about on the campaign trail, with costs being the most concerning health issue for voters. Meanwhile, the constitutionality of the Affordable Care Act (ACA) continues to be challenged in the judicial system with the latest case potentially jeopardizing the law’s protections for people with pre-existing conditions. And in four states, ACA Medicaid expansion initiatives are on the ballot to newly expand or…

  • Health Care and the Candidates in the 2018 Midterm Elections: Key Issues and Races

    Issue Brief

    Introduction With the 2018 midterm election season in full swing, health care has emerged as one of the top issues for voters. The issue is playing a prominent role in many House, Senate, and gubernatorial races, and health-related measures have made it onto the ballot in several states. Democratic candidates, in particular, have made health care a central part of their campaigns and a focus of their political ads, highlighting popular provisions in the Affordable…

  • The Implementation of Work Requirements in Arkansas Has Been Complex and Many Medicaid Enrollees Are Not Aware of New Rules or Face Obstacles in Complying

    News Release

    The implementation of Medicaid work requirements in Arkansas has been complex, with many Medicaid enrollees still not aware of program changes despite substantial outreach.  In addition, an online reporting requirement is proving difficult for many enrollees due to limited knowledge of the requirements as well as lack of computer literacy and internet access, according to a new analysis from KFF (the Kaiser Family Foundation). Since Arkansas became the first state to implement Medicaid work requirements in…

  • 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…