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Work Requirements

Challenges with Implementing Work Requirements

Many states are anticipating a variety of implementation challenges, including the need for complex system changes, a compressed implementation timeline, and limited staff capacity.

What is the Medicaid Hardship Exception?

The number of Medicaid expansion enrollees who ultimately qualify for the high unemployment hardship exception will depend on how the exception is implemented and how unemployment rates changes.

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.

2025-2026 Medicaid Budget Survey

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.

The Essentials

  • 5 Facts: Immigrants and Medicaid

    This brief provides five key facts on Medicaid and immigrants as context for understanding the potential impacts of policy changes under the Trump administration.

  • 5 Facts: Medicaid and Hospitals

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

  • Medicaid Financing: The Basics

    Medicaid is a major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.

  • 5 Facts: Medicaid’s Share of National Health Spending

    This brief explores how Medicaid spending contributes to national health spending and how different service areas contribute to Medicaid costs.

  • 5 Facts: Medicaid and Nursing Facilities

    The substantial Medicaid savings in the reconciliation bill could have major implications for nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them.

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  • Medicaid’s Role for People with Dementia

    Issue Brief

    This issue brief describes Medicaid’s role for people with dementia, including how they qualify, what services Medicaid provides, and what their utilization and spending is, and builds on our work examining Medicaid’s role for vulnerable populations and Medicaid's role in the provision of long-term services and supports.

  • Lessons Learned from Eight Years of Supporting Institutional to Community Transitions Through Medicaid’s Money Follows the Person Demonstration

    Perspective

    Since 2008, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured has periodically surveyed state Money Follows the Person (MFP) programs, conducted state case studies, and profiled the experiences of individual MFP beneficiaries. Based on the information and data collected in our six surveys, we identify some lessons learned from MFP that could inform future Medicaid long-term services and supports rebalancing policies.

  • Money Follows the Person: A 2015 State Survey of Transitions, Services, and Costs

    Report

    The Money Follows the Person (MFP) demonstration provides enhanced federal matching funds, allowing states to better support Medicaid long-term services and supports beneficiaries in transitioning from institutions back to the community. This report highlights 2015 MFP enrollment and spending trends and services and supports offered across state MFP demonstrations.

  • Medicaid in a Time of Growth and Change: Findings from the Annual Kaiser 50-State Medicaid Budget Survey at a Forum with the National Association of Medicaid Directors

    Event Date:
    Event

    The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) released its 15th annual 50-state Medicaid budget survey for state fiscal years 2015 and 2016. Kaiser and the National Association of Medicaid Directors (NAMD) held a joint briefing to discuss key findings and highlight trends in enrollment and spending as well as policy changes in Medicaid programs around the country.

  • The Affordable Care Act Drove Record Annual Increases in Enrollment and Total Medicaid Spending Nationally in FY 2015, As Newly Eligible Adults gained Coverage in Expansion States

    News Release

    High Federal Match for Adult Expansion Group Contributed to Substantially Slower State Medicaid Spending Growth in Expansion States Compared to Non-Expansion States Survey Also Finds States Relying More on Managed Care, Undertaking Delivery System Reforms The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015,…

  • Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016

    Issue Brief

    This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in three states: Alaska, California, and Tennessee. These case studies build on findings from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA).

  • Medicaid Enrollment & Spending Growth: FY 2015 & 2016

    Issue Brief

    This report provides an overview of Medicaid financing and Medicaid spending and enrollment growth with a focus on state fiscal years 2015 and 2016 (FY 2015 and FY 2016.) Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and also look at expansion versus non-expansion states.

  • Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016

    Report

    This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2015 and those planned for implementation in FY 2016 based on information provided by the nation’s state Medicaid Directors. Key areas covered include changes in eligibility and enrollment, delivery and payment system reforms, provider payment rates, and covered benefits (including prescription drug policies).