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2025 Reconciliation Law

How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State?

This analysis apportions the increase in the number of uninsured across the 50 states and DC. CBO estimates that the reconciliation law will increase the number of uninsured by 10 million in 2034. That number would rise to over 14 million if enhanced premium tax credits for ACA Marketplace enrollees expire later this year.

ANALYSIS

Allocating Federal Medicaid Spending Reductions Across States

Policy Tracker

Medicaid Provisions in the 2025 Budget Reconciliation Law

ANALYSIS

How Might Federal Medicaid Cuts Affect Rural Areas?

From Drew Altman

Can Democrats Make Medicaid and ACA Cuts Their Winning Political Issue?

Work Requirements

How Will States Implement Medicaid Work Requirements?

Event Date:

Four experts, including two state Medicaid directors, will join Health Wonk Shop moderator Larry Levitt in an hour-long discussion of how states will go about implementing new Medicaid work requirements.

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.

  • Adults with Mental Illness

    Options under consideration in Congress to significantly reduce Medicaid spending could have major implications for adults who live with mental illness.

  • 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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  • Addressing the Justice-Involved Population in Coronavirus Response Efforts

    Issue Brief

    Addressing health care needs of people moving into and out of the criminal justice system and staff who work them is an important component of coronavirus response efforts and protecting and promoting public health within the communities in which correctional facilities are located. This brief provides data on spread of coronavirus within correctional facilities, discusses the health risks for the justice-involved population and the staff who work with them, identifies the role Medicaid can play in response efforts for justice-involved individuals, and highlights other steps correctional systems can take to mitigate risk of coronavirus for the justice-involved population and promote public health.

  • States are Shifting How They Cover Prescription Drugs in Response to COVID-19

    Policy Watch

    Medicaid beneficiaries, particularly those with chronic conditions, will need access to medications even during social distancing and their ability to meet with providers to obtain refills may be hindered. States are updating policies to allow beneficiaries to access medications during this public health emergency.

  • Medicaid’s Money Follows the Person Program: State Progress and Uncertainty Pending Federal Funding Reauthorization

    Issue Brief

    Medicaid’s Money Follows the Person (MFP) demonstration has helped seniors and people with disabilities move from institutions to the community by providing enhanced federal matching funds to states since 2007. The program operates in 44 states and has served over 90,000 people as of June 2018. The program is credited with helping many states establish formal institution to community transition programs that did not previously exist by enabling them to develop the necessary service and provider infrastructure. With a short-term funding extension set to expire on December 31, 2019, MFP’s future remains uncertain without a longer-term reauthorization by Congress.

  • Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

    Issue Brief

    To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
    Section 2404 of the Affordable Care Act (ACA) changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through December 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not further extend Section 2404.

  • Key Questions About the New Medicaid Eligibility Pathway for Uninsured Coronavirus Testing

    Issue Brief

    In response to the need to increase access to testing during the COVID-19 pandemic, recent federal legislation, the Families First Coronavirus Response Act, amended by the Coronavirus Aid, Relief, and Economic Security Act, creates a new optional Medicaid eligibility pathway, with 100% federal matching funds, for states to cover coronavirus testing and testing-related services for uninsured individuals. This new option is available from March 18, 2020 through the end of the public health emergency period. This issue brief answers key questions about how the new eligibility pathway is being implemented, drawing on frequently asked questions issued by the Centers for Medicare and Medicaid Services.

  • Early Look at Medicaid Spending and Enrollment Trends Amid COVID-19

    Issue Brief

    The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid, a countercyclical program. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. To help support states as enrollment in Medicaid grows and ensure existing enrollees maintain continuous coverage, the Families First Coronavirus Response Act (FFCRA) authorized a 6.2 percentage point increase in the federal match rate (“FMAP”) (retroactive to January 1, 2020) available if states meet certain “maintenance of eligibility” (MOE) requirements. This brief provides some early insights into the current picture of Medicaid spending and enrollment, as Congress considers providing additional fiscal relief through the federal Medicaid match rate.