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An Early Look at States’ Differing Approaches to Implementing Medicaid Work Requirements Amid Cost and Time Constraints and Uncertainty

A new KFF survey of state Medicaid officials and focus groups in eight states captures the different choices states are making about how to implement Medicaid work requirements, with seven states planning for a more restrictive approach to verifying work or exemption status or to implement work requirements early. These implementation plans are taking shape as states encounter time, cost, and other constraints as well as uncertainty about how to define and verify certain exemptions due to delayed federal guidance.

Medicaid Work Requirements

Tracking Medicaid Work Requirements: Data and Policies

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements.

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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  • Racial and Ethnic Disparities in Access to and Utilization of Care among Insured Adults

    Issue Brief

    This analysis based on data from the 2014 Kaiser Survey of Low-Income Americans examines differences in access to and utilization of care for Black and Hispanic adults compared to White adults among those who are uninsured, enrolled in Medicaid, and privately insured. The findings suggest that gains in health coverage under the ACA will lead to improvements in access to care and utilization for White, Black, and Hispanic adults. They also highlight the importance of…

  • New Survey Examines Assistance Provided to Consumers During Second Affordable Care Act Open Enrollment

    News Release

    A new Kaiser Family Foundation survey of insurance brokers and assistance programs examines the help they provided to consumers during the 2015 open enrollment period for Affordable Care Act coverage. The 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers provides estimates of the number of people helped and the number and type of assister programs, while offering an in-depth look at assisters’ assessments of the enrollment process in the second year of the…

  • 2015 Survey of Health Insurance Marketplace Assister Programs and Brokers

    Report

    This nationwide survey analysis of Marketplace consumer assistance programs and brokers examines the nature of Marketplace assistance during the second open enrollment period for 2015 coverage, and offers unique insights into how Affordable Care Act (ACA) implementation is progressing, what is changing, and what challenges remain. Building upon our Survey of Health Insurance Marketplace Assister Programs (2014), the analysis compares Assister Program capacity and experiences from the first open enrollment period to the next, and…

  • Survey Finds Many Primary Care Physicians Have Negative Views of the Use of Quality Metrics and Penalties for Unnecessary Hospital Readmissions 

    News Release

    Primary Care Providers View Health IT as Improving Quality, But Tilt Negatively on ACOs Half of the nation's primary care physicians view the increased use of quality-of-care metrics and financial penalties for unnecessary hospitalizations as potentially troubling for patient care, according to a new survey from The Commonwealth Fund and the Kaiser Family Foundation. Fifty percent of primary care physicians say the increased use of quality metrics to assess provider performance is having a negative…

  • Primary Care Providers’ Views Of Recent Trends In Health Care Delivery And Payment

    Poll Finding

    A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased…

  • State Medicaid Eligibility Policies for Individuals Moving Into and Out of Incarceration

    Issue Brief

    This brief highlights how state eligibility policies for incarcerated individuals differ, based on a review of state statutes, regulations, Medicaid eligibility manuals and other Medicaid agency guidance publicly available online and Medicaid managed care contracts. Overall, state Medicaid eligibility policies for justice-involved individuals moving into and out of incarceration vary, and these policies affect if and when individuals may enroll in Medicaid and the scope of any resulting savings.

  • Media Briefing to Release New Survey Tracking California’s Previously Uninsured Residents Under the Affordable Care Act

    Event Date:
    Event

    Media-only web briefing that released a new survey tracking the experiences of California's previously uninsured residents under the Affordable Care Act (ACA). New survey provides a detailed assessment of how well the ACA is working for previously uninsured residents in a state that embraced the ACA's coverage expansion opportunities by establishing the Covered California insurance marketplace and expanding its Medi-Cal program.

  • California’s Previously Uninsured After The ACA’s Second Open Enrollment Period

    Report

    The Kaiser Family Foundation California Longitudinal Panel Survey is a series of surveys that, over time, tracks the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). The initial baseline survey was conducted with a representative sample of 2,001 nonelderly uninsured Californian adults in summer 2013, prior to the ACA’s initial open enrollment period. The second survey in…

  • Medicare and Medicaid at 50 Years: Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers

    From Drew Altman

    In this article for the Journal of the American Medical Association (JAMA), Drew Altman and former U.S. Senate Majority Leader William Frist examine the roles the Medicaid and Medicare play in the health system today from the perspectives of the public and beneficiaries, providers, and policymakers, and discusses the challenges they face in the future. The article is accompanied by an audio interview with Altman and Frist, who is a member of the Foundation’s board…