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5 Facts: Medicaid Fraud, Waste, Abuse and Improper Payments

Program integrity efforts work to prevent and detect fraud, waste, and abuse; increase program transparency and accountability; and recover improper payments. This brief explains what we know about these issues and efforts to address program integrity.

Medicaid: What to Watch in 2026

Medicaid: What to Watch in 2026

In this brief, KFF explores how state fiscal pressures are likely to converge with the implementation of the 2025 reconciliation law to affect Medicaid coverage, financing, and access to care over the next year, especially leading up to the midterm elections.

Medicaid Watch

Featuring policy research, polling and news about how Medicaid is changing, and the impact of those changes due to the tax and spending cuts law

Medicaid and work

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 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.

5 Facts: 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 in 2025

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.

5 Facts: 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.

2025 Medicaid Home Care survey

Payment Rates Ahead of 2025 Reconciliation Law

This issue brief describes Medicaid payment rates for home care and other workforce supports that are in place in 2025, before the majority of the 2025 reconciliation law provisions start taking effect.

Home Care Support for Family Caregivers in 2025
number of responding states, including DC, that allow payments for family caregivers by type of home care program and type of caregiver.

This issue brief describes the availability of self-directed services and supports for family caregivers in Medicaid home care in 2025, before most provisions in the reconciliation law take effect.

States’ Management of Home Care Spending

This issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

Waiting Lists for Medicaid Home Care, 2016 to 2025
A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025

This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect.

Eligibility and coverage

  • Eligibility, Enrollment, and Renewal Policies

    KFF's survey findings capture state actions that seek to improve the accuracy and efficiency of Medicaid and CHIP enrollment and renewal processes, as of January 2025.

  • Seniors and People with Disabilities

    More than 1 in 3 people with disabilities (15 million) have Medicaid (35%). In comparison, only 19% of people without disabilities have Medicaid.

  • Children with Special Needs

    Amid debates about proposed cuts to federal Medicaid spending, this brief analyzes key characteristics of children with special health care needs and explores how Medicaid provides them with coverage.

  • People With Intellectual and Developmental Disabilities

    Among the estimated 8 million people with intellectual and developmental disabilities (I/DD), over three million have Medicaid coverage.

  • Adults with Chronic Conditions

    Among working age adults enrolled in Medicaid, approximately three quarters have one or more chronic conditions, and nearly one-third have three or more.

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  • Medicaid’s Role in Kentucky

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Kentucky. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Kentucky.

  • The Opioid Epidemic and Medicaid’s Role in Treatment: A Look at Changes Over Time

    Feature

    This chart pack provides data on opioid addiction, overdose deaths, hospitalizations, and emergency department visits from 2005-2015. It also includes data on Medicaid’s growing role in covering people receiving treatment for opioid addiction, and discusses the potential impact of Medicaid restructuring as proposed in the Better Care Reconciliation Act, the Senate's bill to repeal and replace the Affordable Care Act.

  • Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals

    Issue Brief

    This issue brief provides an overview of Medicaid’s role in financing behavioral health services. It includes information on eligibility, benefits, service delivery, access to care, and spending. It also discusses the potential impact of Medicaid restructuring as proposed in the Better Care Reconciliation Act.

  • States and Medicaid Provider Taxes or Fees

    Fact Sheet

    This is an update on the use of Medicaid provider taxes and fees. It also includes information on which states would be affected by changing the safe harbor threshold from 6% to 5.5%.

  • Favorability of the Affordable Care Act Tops 50%, While Across Many Measures, Majorities Oppose the Republican Plan to Replace It

    News Release

    Three-Quarters of the Public, Including Most Republicans, View Medicaid Favorably; Most Oppose Federal Funding Cuts to States As the Senate prepares to vote on the Republican bill to repeal and replace the Affordable Care Act and cap federal Medicaid funding, a new Kaiser Family Foundation Tracking Poll finds most Americans oppose the Republican plan and…

  • Kaiser Health Tracking Poll – June 2017: ACA, Replacement Plan, and Medicaid

    Feature

    As the Senate prepares to vote on the Republican plan to repeal and replace the Affordable Care Act and limit federal Medicaid funding, a new Kaiser Family Foundation Tracking Poll finds the Affordable Care Act itself remains far more popular than the bill that would replace it. A majority of Republicans, however, continue to support the Republican plan, though by a significantly narrower margin than last month. Furthermore, the Tracking Poll finds that the most of the public - regardless of partisanship - holds favorable views of Medicaid.

  • No Easy Choices: 5 Options to Respond to Per Capita Caps

    Issue Brief

    Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other cuts, reduce benefits, limit coverage of high cost enrollees, reduce rates or implement delivery system reforms, and promote personal responsibility. Each option has challenges that are identified in the brief.