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What to Watch

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.

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 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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  • GOP Views of Medicaid Expansion Differ From Conventional Wisdom

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman examines Republican attitudes on Medicaid expansion in light of last night’s election of Republican Matt Bevin as Kentucky’s next governor. All previous columns by Drew Altman are available online.

  • Medicaid Home and Community-Based Services Programs: 2012 Data Update

    Report

    This report summarizes the key participation and spending trends in 2012 for the three main Medicaid Home and Community-Based Services (HCBS) programs – (1) the mandatory home health services state plan benefit, (2) the optional personal care services state plan benefit, and (3) optional § 1915(c) HCBS waiver services. Also highlighted are 2014 state eligibility, enrollment, and provider reimbursement policies.

  • Estimates of Eligibility for ACA Coverage among the Uninsured by Race and Ethnicity

    Issue Brief

    This analysis provides national estimates of eligibility for ACA coverage options by race/ethnicity, including Whites, Blacks, and Hispanics. We estimate coverage and eligibility as of early 2015, which is prior to the end of the 2015 Marketplace open enrollment period. Overall, this analysis finds that more than half (55%) of the total 32.3 million nonelderly uninsured are people of color, including 34% who identify as Hispanic, 14% who identify as Black, and 8% who identify as another group or mixed race.

  • The Impact of the Coverage Gap for Adults in States not Expanding Medicaid by Race and Ethnicity

    Issue Brief

    The Affordable Care Act (ACA) expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL) effectively became a state option following the Supreme Court decision, creating a “coverage gap” for many poor uninsured adults in states that do not expand Medicaid. This brief examines the coverage gap by race and ethnicity.

  • 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.