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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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  • Web Briefing: Modern Era Medicaid and CHIP – Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies

    Event Date:
    Event

    The Kaiser Commission on Medicaid and the Uninsured (KCMU) hosts a web briefing to present findings from our 13th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies. The survey provides a profile of where states stand as of January 2015, one year into the implementation of the major Medicaid provisions of the Affordable Care Act (ACA).

  • Proposed Medicaid Expansion in Utah

    Fact Sheet

    This fact sheet provides a summary of the proposal to expand Medicaid in Utah. This has not been officially submitted to CMS and needs state legislative approval before it could be implemented.

  • Medicaid Expansion in Red States

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman explains that Tennessee Gov. Bill Haslam's decision on Medicaid expansion via the Affordable Care Act is the latest sign of pragmatism slowly winning over ideology in red states.

  • El seguro de salud, explicado: ¡los YouToons lo tienen cubierto!

    Video

    El seguro de salud, explicado: ¡los YouToons lo tienen cubierto! desglosa conceptos de seguros como primas, deducibles y redes de proveedores.  Explica cómo las personas pagan por su cobertura y cómo obtener cuidado médico y medicamentos recetados con distintos tipos de seguros de salud, incluyendo HMOs y PPOs.

  • The State Innovation Models (SIM) Program: An Overview

    Fact Sheet

    This fact sheet provides an overview of the Center for Medicare and Medicaid Innovation (Innovation Center)'s State Innovation Models (SIM) initiative. It focuses on the delivery system and payment approaches that Model Testing states are taking and discusses what SIM means for Medicaid. Six states – Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont -- received Model Testing awards to implement and test their Innovation Plans over 42 months.

  • What Drives Spending and Utilization on Medicaid Drug Benefits in States?

    Issue Brief

    With the approval of new specialty drugs, such as the Hepatitis C treatments Sovaldi and Harvoni, states are mindful that the cost the Medicaid prescription drug benefit could increase. To achieve savings, and improve management and health outcomes, it is important to understand which drugs are most frequently prescribed and which drive spending. Using state drug utilization data provided through the Medicaid Drug Rebate Program, as well as an industry drug database, this issue brief examines trends in prescriptions and spending before rebates, and places findings in the context of policy discussion.

  • New Interactive Data Tool Tracks Medicaid Managed Care Market

    News Release

    The Medicaid Managed Care Market Tracker, a new feature of the Foundation’s State Health Facts data center, provides the latest data on key dimensions of risk-based Medicaid managed care for the 39 states that contract with MCOs – these states are home to more than 90 percent of all Medicaid beneficiaries nationwide. On Thursday, December 11 at 12:30 p.m. ET, the Foundation will host an interactive web briefing with Medicaid managed care expert Julia Paradise, an Associate Director of the Foundation’s Kaiser Commission on Medicaid and the Uninsured.

  • Web Briefing: The Medicaid Managed Care Market Tracker

    Event Date:
    Event

    More than half of the nation’s 67.9 million Medicaid beneficiaries now receive their health care in comprehensive managed care organizations (MCOs) – and the number and share are growing.

  • Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker

    Report

    This report highlights 10 key findings on the Medicaid managed care market, based on analysis of data included in the Kaiser Family Foundation's Medicaid Managed Care Market Tracker. The findings provide a partial profile of the Medicaid MCO market nationally and by state. They also illuminate the involvement of large, multi-state health insurance companies in the Medicaid market and the participation of these firms in other markets as well, including the managed long-term services and supports market, the new ACA marketplaces, and the Medicare Advantage market. Finally, these selected highlights serve to illustrate the array of ways the Tracker can be used to understand more about the Medicaid managed care market and its place in the broader market.

  • Web Briefing: Early Impacts of the Medicaid Expansion for the Homeless Population

    Event Date:
    Event

    The Affordable Care Act’s Medicaid expansion provides a significant opportunity to increase health coverage and improve access to care for individuals experiencing homelessness, who historically have had high uninsured rates and often have multiple, complex physical and mental health needs.