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Number of States Affected by Key Medicaid Provisions in the 2025 Reconciliation Law

Which States Will Be Affected by Key Medicaid Provisions in the 2025 Reconciliation Law?

The 2025 reconciliation law makes sweeping changes to Medicaid that will affect every state through key eligibility and financing changes, including new work requirements, immigrant eligibility restrictions, and changes to provider taxes and state directed payments. This issue brief explains which states will be affected by each of these key provisions.

Medicaid work requirements

Nebraska Renewal Outcomes Among Individuals Subject to Medicaid Work Requirements

Early Medicaid Work Requirement Insights From Nebraska

This brief describes the verification process for Medicaid work requirements in Nebraska and examines early data on outcomes for individuals subject to work requirements. Among Medicaid enrollees renewing coverage under Nebraska's work requirements, 93% met the requirements or qualified for an exemption —while 7% lost coverage.

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. The Congressional Budget Office estimates that the 2025 reconciliation law will increase the number of people who are uninsured in 2034 by 10 million. Coverage losses from Medicaid work requirements account for over half, or 5.3 million, of the increase in the number of uninsured.

understanding medicaid

Medicaid Financing: The Basics

Medicaid represents $1 out of every $5 spent on health care in the U.S. This brief examines key questions about Medicaid financing and how it works.

Medicaid and Provider Taxes

This brief explores how rules governing provider taxes are changing because of the 2025 reconciliation law and the regulations implementing that law, and summarizes which changes may affect each state.

5 Key Facts About Medicaid and Hospitals

This brief explains the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid and how Medicaid expansion has impacted hospital finances.

Medicaid home Care

Medicaid Home Care/HCBS Survey

Since 2001, KFF has administered regular surveys of states about their Medicaid home- and community-based services (HCBS) programs. The survey is sent to officials administering Medicaid HCBS programs in all 50 states and the District of Columbia.

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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…