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Work Requirements

Challenges with Implementing Work Requirements

Many states are anticipating a variety of implementation challenges, including the need for complex system changes, a compressed implementation timeline, and limited staff capacity.

What is the Medicaid Hardship Exception?

The number of Medicaid expansion enrollees who ultimately qualify for the high unemployment hardship exception will depend on how the exception is implemented and how unemployment rates changes.

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

KFF’s interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.

Medicaid Budget Survey

Medicaid Home Care

Using data from the 23rd KFF survey of officials administering Medicaid home care programs, 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.

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. The data come from KFF’s 23rd survey on Medicaid home care programs in all 50 states and DC.

KFF regularly surveys states about their Medicaid home- and community-based services (HCBS) programs and their eligibility policies for people who are eligible for Medicaid on the basis of having a disability or being 65 and older.

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This issue brief provides an overview of what Medicaid home care (also known as “home- and community-based services” or HCBS) is, who is covered, and what services were available in 2024.

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.

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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  • Snapshots from the Kitchen Table: Family Budgets and Health Care

    Video

    This Kaiser Family Foundation documentary, “Snapshots from the Kitchen Table: Family Budgets and Health Care,” profiles several American families who are struggling to make ends meet. It depicts the narrow financial ledge on which millions of low- and middle- income working households stand even in normal economic times, and illustrates the central role that health care costs and coverage play in a household’s economic stability. Some of the families profiled have health insurance, others do not.

  • Nursing Home Reform: Then and Now

    Video

    To mark the 20th anniversary of the passage of landmark federal legislation to improve the quality of nursing home care, the Omnibus Budget Reconciliation Act of 1987 (known as OBRA 87), this video examines the history surrounding the law. The video includes a look at the state of nursing home care before the law, an overview of the legislative process that brought about the law, and recent developments in nursing home quality. The video features historical clips and new interviews of key individuals from government, the nursing home industry, and consumer advocates who were instrumental in the historical developments related to nursing home reform.

  • The Medicaid Resource Book

    Report

    This reference book describes four pivotal aspects of how the Medicaid program operates — who it covers, what it covers, how it is financed, and how it is administered. It was written to assist the public and policymakers in understanding the structure and operation of the Medicaid program.

  • Faces of Medicaid

    Interactive

    Faces of Medicaid Medicaid, the public program that provides health and long-term care coverage for low-income individuals and families, covers about 60 million people currently, or 1 in 5 Americans. Medicaid beneficiaries include pregnant women, children and families, individuals with disabilities, and seniors.

  • Key Findings from the Field: Early Experience with ACA Enrollment in Maryland and Nevada

    Issue Brief

    To learn more about the early ACA enrollment experience in two states, the Kaiser Commission on Medicaid and the Uninsured and PerryUndem Research and Communication conducted focus groups in Baltimore, Maryland and Reno, Nevada in November 2013 with low- and moderate-income individuals who recently applied for health insurance and consumer assisters trained to help individuals enroll. This study builds on previous work that examined preparations for open enrollment in several states, including Maryland and Nevada, which are both moving forward with the ACA’s Medicaid expansion to low-income adults and have established their own State-based Marketplace (SBM). The focus group discussions included adults who had successfully applied as well as consumer assisters.This brief provides key findings about the early ACA enrollment experience in Baltimore, Maryland and Reno, Nevada based on focus group discussions with these recent applicants and enrollment assisters.

  • CHIP Enrollment: June 2013 Data Snapshot

    Issue Brief

    This issue brief provides state level CHIP enrollment data, adding the June 2013 period. In June 2013, over 5.7 million children were enrolled in the Children’s Health Insurance Program (CHIP.) Enrollment in June 2013 increased by 190,453 or by 3.4 percent, compared to one year earlier. Since 2009, annual rates of growth have remained fairly steady, ranging between 3.2 percent and 3.8 percent. In contrast, during the height of the Great Recession, enrollment increased annually by 7.8 to 10 percent. Overall, CHIP enrollment continued to increase, but growth slow to the lowest rates since the start of the Recession as the economic conditions continued to improve. CHIP programs, along with state Medicaid programs continue to play a critical role in assuring health coverage for uninsured children.

  • Medicaid Enrollment Under the Affordable Care Act: Understanding the Numbers

    Issue Brief

    This issue brief walks through data recently released from Health and Human Services (HHS) and what it can and cannot tell us about the number of people that have applied for Medicaid since open enrollment for health insurance marketplaces began, how many have enrolled, and what the role of the ACA is in recent Medicaid coverage gains.

  • Challenges for the Next Obamacare Open Enrollment

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman pinpoints the Affordable Care Act’s five biggest challenges heading into the second open enrollment period.

  • Medicare Beneficiaries: A Population At Risk – Findings from the Kaiser/Commonwealth 1997 Survey of Medicare Beneficiaries – Report

    Report

    Medicare Beneficiaries: A Population at RiskFindings from the Kaiser/Commonwealth Fund 1997 Survey of Medicare Beneficiaries Cathy Schoen, Patricia Neuman, Michelle Kitchman, Karen Davis, and Diane RowlandDecember 1998 Table Of ContentsExecutive Summary Findings from the Kaiser/Commonwealth 1997 Survey of Medicare Beneficiaries Medicare Beneficiaries: Health Status and Income Health Insurance Coverage Satisfaction, Access, and Financial Burden: Variations…