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5 Facts: Medicaid Fraud, Waste, Abuse and Improper Payments

Program integrity efforts work to prevent and detect fraud, waste, and abuse; increase program transparency and accountability; and recover improper payments. This brief explains what we know about these issues and efforts to address program integrity.

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.

Medicaid Watch

Featuring policy research, polling and news about how Medicaid is changing, and the impact of those changes due to the tax and spending cuts law

Medicaid and work

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 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.

5 Facts: 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 in 2025

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.

5 Facts: 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.

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.

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  • Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency

    Issue Brief

    Provisions in the Families First Coronavirus Response Act (FFCRA) require states to maintain continuous Medicaid enrollment for enrollees until the end of the month when the COVID-19 public health emergency (PHE) ends. When the continuous enrollment requirements end and states resume redeterminations and disenrollments, individuals with LEP may be at increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers completing these processes, even if they remain eligible for coverage.

  • How Many Medicaid Enrollees Moved In 2020 And What Are The Implications For Unwinding the Public Health Emergency?

    Issue Brief

    Once states resume redeterminations and disenrollments at the end of the public health emergency (PHE), Medicaid enrollees who moved within a state during the pandemic but are still eligible for coverage are at increased risk of being disenrolled if their contact information is out of date. We analyzed federal survey data for 2020 and found that roughly 1 in 10 Medicaid non-elderly enrollees (9%) moved in-state in 2020. A much smaller share, just 1%, moved to a different state in the U.S. Individuals that move within state may continue to be eligible for Medicaid, while a move out of state would make them no longer eligible for Medicaid coverage in their previous residence. States can take a number of actions to update enrollees’ addresses and other contact information to minimize coverage gaps and losses for eligible individuals after the end of the PHE, particularly for individuals who may have moved within a state.

  • States Look to Bolster Maternal Health

    Feature

    Starting April 1, states have a new option to extend Medicaid postpartum coverage from 60 days to 12 months without having to seek a waiver.

  • Help with Medicare Premium and Cost-Sharing Assistance Varies by State

    Issue Brief

    This data note provides an overview of programs that help beneficiaries with modest incomes with their Medicare costs, including the Medicare Savings Programs and the Part D Low-Income Subsidy, and highlights findings from corresponding state-level profiles of eligibility and enrollment.

  • A Look at the Economic Effects of the Pandemic for Children

    Issue Brief

    Federal policymakers have taken several actions to mitigate the economic impact of the pandemic on families and children by providing state fiscal relief, increased nutrition assistance, Medicaid funding, and the Child Tax Credit (CTC) and Earned Income Tax Credit (EITC); however, some of this assistance has or will expire. This brief examines hardship across three metrics—difficulty paying for normal household expenses, food sufficiency, and uncertainty in paying for rent or mortgage payments for households with children and by income.

  • Medicaid: What to Watch in 2023

    Issue Brief

    As 2023 kicks off, a number of issues are at play that could affect coverage and financing under Medicaid. This issue brief examines key issues to watch in Medicaid in the year ahead.