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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.

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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.

Dual Eligibles

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  • Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries

    Issue Brief

    This paper provides an overview of the joint efforts of states and the Centers for Medicare and Medicaid Services (CMS) to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. Dual eligible beneficiaries comprise many of the poorest and sickest people covered by either program, and they account for a disproportionately large share of Medicare and Medicaid spending.…

  • A Prescription Drug Benefit in Medicare: Implications for Medicaid and Low-Income Medicare Beneficiaries

    Issue Brief

    The Senate and House of Representatives each approved legislation in June of 2003 that would establish outpatient prescription drug coverage for Medicare beneficiaries as part of Medicare program reform. Among the key differences in the House and Senate bills that still must be addressed are the treatment of Medicaid beneficiaries and the structure of low-income subsidy programs. The way in which these issues are resolved will have major implications for Medicaid beneficiaries, other low-income individuals,…

  • The “Clawback:” State Financing of Medicare Drug Coverage

    Issue Brief

    This issue paper describes the origins of the clawback, the formula by which each state’s clawback amount is calculated, and the clawback’s implications for states and for low-income Medicare beneficiaries. Issue Paper (.pdf)

  • KFF Briefing Examines Progress and Remaining Challenges for the Health Care Systems in Puerto Rico and U.S. Virgin Islands Six Months After Hurricanes Irma and Maria

    News Release

    Six months after hurricanes Irma and Maria made landfall across Puerto Rico and the U.S. Virgin Islands, local officials described progress but also a long road to full recovery of the U.S. territories’ health care systems, economies and infrastructure during a public briefing Monday at the Kaiser Family Foundation’s Washington D.C. offices. An archived webcast of the 90-minute briefing on the status of the recovery on the islands, with a focus on their health care systems,…

  • Atención de salud en Puerto Rico y las Islas Vírgenes de los Estados Unidos: una revisión, a seis meses de las tormentas (Informe)

    Issue Brief

    Puerto Rico y las Islas Vírgenes de los Estados Unidos (USVI) sufrieron daños significativos en su infraestructura y sistemas de salud a causa del impacto de los huracanes Irma y María en septiembre de 2017. Basándose en entrevistas con residentes, partes interesadas clave, y en informes públicos, este informe proporciona una visión general del estado de los esfuerzos de recuperación, a seis meses de las tormentas, con un enfoque en los sistemas de atención médica.

  • Child Health Facts:  National and State Profiles of Coverage

    Other Post

    Child Health Facts: National and State Profiles of Coverage Appendix 2 Medicaid Enhanced Matching Rate Matching Rate Alabama 69.3% 78.5% Alaska 59.8% 71.9% Arizona 65.3% 75.7% Arkansas 72.8% 81.0% California 51.2% 65.9% Colorado 52.0% 66.4% Connecticut 50.0% 65.0% Delaware 50.0% 65.0% District of Columbia 70.0% 79.0% Florida 55.7% 69.0% Georgia 60.8% 72.6% Hawaii 50.0% 65.0% Idaho 69.6% 78.7% Illinois 50.0% 65.0% Indiana 61.4% 73.0% Iowa 63.8% 74.6% Kansas 59.7% 71.8% Kentucky 70.4% 79.3% Louisiana 70.0%…

  • Medicaid and State Budgets: From Crunch to Cliff

    Fact Sheet

    This fact sheet discusses the status of Medicaid and state budgets in light of the continuing recession and the federal fiscal relief provided to state Medicaid programs through the American Recovery and Reinvestment Act (ARRA). The ARRA money has proved to be critical in helping states address budget shortfalls, preserve Medicaid eligibility and soften program cuts. But ARRA funds are set to expire on Dec. 31, 2010, creating a major cliff in state financing that…

  • Beyond Cash and Counseling: The Second Generation of Individual Budget-Based Community Long-Term Care Programs for the Elderly

    Report

    States are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries’ needs and preferences and to increase their ability to remain outside or leave nursing homes. Beginning in January 2007, a new provision in the Deficit Reduction Act of 2005 (DRA) allows states to offer an individual budget option for an expanded range of home- and community-based services in their Medicaid state plans…