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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.

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  • The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings

    Issue Brief

    This brief reviews research from 65 papers published between 2000 and March 2017 on the effects of premiums and cost sharing on low-income populations in Medicaid and CHIP. This research has primarily focused on how premiums and cost sharing affect coverage and access to and use of care; some studies also have examined effects on safety net providers and state savings.

  • Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?

    Issue Brief

    This issue brief examines the factors that could affect states’ ability to cope with reductions in federal Medicaid funding of the sort proposed in the House-passed American Health Care Act (AHCA), which would eliminate enhanced federal matching funds for the Affordable Care Act’s Medicaid expansion and convert Medicaid to a per capita cap or block grant system of financing.

  • No Easy Choices: 5 Options to Respond to Per Capita Caps

    Issue Brief

    Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other…

  • Favorability of the Affordable Care Act Tops 50%, While Across Many Measures, Majorities Oppose the Republican Plan to Replace It

    News Release

    Three-Quarters of the Public, Including Most Republicans, View Medicaid Favorably; Most Oppose Federal Funding Cuts to States As the Senate prepares to vote on the Republican bill to repeal and replace the Affordable Care Act and cap federal Medicaid funding, a new Kaiser Family Foundation Tracking Poll finds most Americans oppose the Republican plan and many of its key provisions. A majority of Republicans, however, continue to support the Republican plan, though by a significantly…

  • How Does Medicaid Work and What’s at Stake Under a Block Grant or Per Capita Cap?: A Video Slideshow

    News Release

    A new video slideshow from the Kaiser Family Foundation explains how Medicaid works now and what is at stake as policymakers in Washington consider converting program financing to a block grant or per capita cap. The 3-minute video describes how Medicaid is financed under current law, whom it covers and how spending is distributed across various groups of enrollees, including children, adults, seniors, and people with disabilities. It shows, for instance, that although seniors and…

  • Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals

    Issue Brief

    This issue brief provides an overview of Medicaid’s role in financing behavioral health services. It includes information on eligibility, benefits, service delivery, access to care, and spending. It also discusses the potential impact of Medicaid restructuring as proposed in the Better Care Reconciliation Act.

  • Medicaid’s Role in Nevada

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Nevada. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Nevada.

  • Medicaid’s Role in Ohio

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Ohio. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Ohio.