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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.

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 describes states’ current provider taxes and explores how rules governing provider taxes are changing.

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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  • Medicaid and State Financing: What to Watch in Upcoming State Budget Debates

    Issue Brief

    State legislatures are currently gathering to develop new budgets for state fiscal year (FY) 2025. Heading into this budget cycle, state fiscal conditions are shifting, with state revenues starting to decline following steep revenue growth during the pandemic. This issue brief examines trends in state fiscal conditions and discusses how state budgets and macroeconomic conditions may affect individuals and state Medicaid programs.

  • 10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs)

    Issue Brief

    In 2023, 5.2 million dual-eligible individuals were enrolled in a Medicare Advantage plan designed specifically for dual-eligible individuals, known as Dual-Eligible Special Needs Plans (D-SNPs). This brief highlights 10 things to know about D-SNPs, including national and state enrollment trends, plan availability, insurer participation, benefits, and prior authorization rates and denials

  • What Would Another Trump Presidency Mean for Health Care?

    Perspective

    In a new column in JAMA Health Forum, Larry Levitt, KFF’s executive vice president for health policy, explores what a second Trump presidency might mean for health policy based on his record and remarks, including potentially weakening the Affordable Care Act, reducing federal Medicaid costs, and restricting access to abortion.

  • Section 1115 Waiver Watch: Medicaid Pre-Release Services for People Who Are Incarcerated

    Issue Brief

    In April 2023, the Centers for Medicare and Medicaid Services (CMS) released guidance encouraging states to apply for a new Section 1115 demonstration opportunity to test transition-related strategies to support community reentry for people who are incarcerated. As of August 19, 2024, CMS has approved Section 1115 reentry waiver requests from 11 states, while 13 additional reentry waivers remain pending.

  • An Early Look at Policy Decisions as States Get Ready to Implement Work Requirements

    Issue Brief

    This issue brief presents findings on policy decisions related to implementation of Medicaid work requirements. The findings draw on information from the annual survey of state Medicaid and CHIP program officials conducted by KFF and the Georgetown University Center for Children and Families for the 43 states (including DC) that will be required to implement work requirements and from focus groups with officials in eight states: Arizona, Indiana, Montana, Nebraska, Ohio, Pennsylvania, Virginia, and Washington.

  • Medicaid Work Requirements: Current Waiver and Legislative Activity

    Issue Brief

    With Donald Trump returning to the presidency and Republican control of the Senate and House, work requirements are likely to be back on the agenda—through federal legislation or Medicaid waivers. This issue brief highlights the history of Medicaid work requirements, describes recent state activity to advance work requirement policies, and recaps the landscape of work requirement approvals and pending requests at the end of President Trump’s first term.

  • With or Without ACA Repeal, ACA and Medicaid Cuts are Looming

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt explores why the incoming Trump administration and Republican majorities in Congress are likely to pursue budget cuts in Medicaid and the Affordable Care Act and why such efforts are likely to boost the number of uninsured Americans.

  • A Look at Navigating the Health Care System: Medicaid Consumer Perspectives

    Issue Brief

    This brief gauges Medicaid enrollees’ perspectives on their health insurance, based on findings from KFF’s Survey of Consumer Experiences with Health Insurance, fielded February 21 through March 14, 2023. This brief provides an overview of the survey findings, describes Medicaid enrollees’ views of their health and health coverage, explores problems those with Medicaid experience, compares how Medicaid performs relative to Medicare and private coverage, and reviews variation in Medicaid experiences.

  • How do Medicaid Home Care Programs Support Family Caregivers?

    Issue Brief

    This issue brief provides new information about family caregivers from KFF’s most recent survey of state Medicaid HCBS programs, including a discussion of paying family caregivers, self-direction, and supports available for family caregivers.