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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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  • Using Medicaid to Wrap Around Private Insurance: Key Questions to Consider

    Issue Brief

    This issue brief raises three key questions for consideration if using Medicaid to wrap around private coverage is going to be considered as an alternative to the ACA's Medicaid expansion under the BCRA. We draw on existing information about state Medicaid premium assistance programs to date, the administrative complexity involved, and the financing implications of premium assistance programs.

  • Medicaid’s Role in West Virginia

    Fact Sheet

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

  • Medicaid’s Role in Tennessee

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Tennessee and describes how implementing a per capita cap or block grant would affect Tennessee.

  • Medicaid’s Role in Alaska

    Fact Sheet

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

  • Medicaid’s Role in Colorado

    Fact Sheet

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

  • Medicaid’s Role in Nevada

    Fact Sheet

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

  • Medicaid’s Role in Louisiana

    Fact Sheet

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

  • Senate Health Bill Proposes Big Changes to Medicaid Beyond Repealing and Replacing the ACA

    News Release

    The Better Care Reconciliation Act (BCRA) under consideration in Congress includes provisions that would fundamentally change Medicaid by phasing out extra federal funding for states’ Medicaid expansions and for the first time limiting federal spending on Medicaid through a per enrollee cap on financing or a block grant for certain adults. While those measures account for most of the bill’s $756 billion reduction in federal Medicaid spending over the next decade, there are other big…

  • Medicaid Changes in Better Care Reconciliation Act (BCRA) Go Beyond ACA Repeal and Replace

    Issue Brief

    Both the Senate's Better Care Reconciliation Act of 2017 (BCRA) and the House's American Health Care Act (AHCA) go beyond repeal and replacement of the Affordable Care Act (ACA) to make fundamental changes to Medicaid by setting a limit on federal funding through a per capita cap or block grant. The BCRA also includes additional changes that would further reduce federal spending for states with high per enrollee spending, limit state financing mechanisms, allow states…