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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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  • Why it Matters: Tennessee’s Medicaid Block Grant Waiver Proposal

    Issue Brief

    On November 20, 2019, Tennessee submitted an amendment to its longstanding Section 1115 Waiver that would make major financing and administrative changes to its Medicaid program. The Centers for Medicare and Medicaid Services (CMS) certified the waiver as complete and opened a federal public comment period through December 27, 2019. Most significantly, Tennessee is requesting to receive federal funds in the form of a “modified block grant” and to retain half of any federal “savings” achieved under the block grant demonstration. This brief provides a high-level overview of the proposed waiver changes and context for why these changes matter.

  • Key State Policy Choices About Medical Frailty Determinations for Medicaid Expansion Adults

    Issue Brief

    This issue brief answers 3 key questions and provides new data about state medical frailty determinations, which are assuming greater importance as more states adopt restrictive Section 1115 waivers that exempt medically frail enrollees from policies such as work requirements and premiums. The findings are excerpted from our 50-state survey on Medicaid financial eligibility for seniors and people with disabilities.

  • Facing a Potential Funding Crunch, Community Health Centers in Medically Underserved Areas Around the Country Report They Are Considering Reductions in Staffing and Services That Would Limit Patients’ Access to Care

    News Release

    With a key source of federal funding set to expire in September, community health centers across the country are considering steps to reduce staffing, close some locations and eliminate or reduce services as they cope with uncertainty about their future financing, according to a new KFF/GWU survey and analysis.

  • Recent Medicaid/CHIP Enrollment Declines and Barriers to Maintaining Coverage

    Issue Brief

    Recently there have been declines in Medicaid and CHIP enrollment, reversing a previous trend of increases following implementation of the ACA. Experiences in some states suggest that renewal process requirements and growing use of periodic eligibility checks may be contributing to disenrollment among people who are still eligible for coverage as well as increased churn in coverage. This brief reviews current rules and state processes related to renewal and periodic eligibility reviews and discusses potential process issues that may be contributing to Medicaid and CHIP enrollment declines.

  • Advancing Opportunities, Assessing Challenges: Key Themes from a Roundtable Discussion of Health Care and Health Equity in the South

    Issue Brief

    This brief summarizes the primary themes expressed by participants of a roundtable discussion of current and future opportunities and challenges for advancing health care and health equity in the South organized by Kaiser Family Foundation’s Commission on Medicaid and the Uninsured and the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta, Georgia.

  • On Medicaid Expansion, Red States Will Be Watching Red States

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on June 30, 2014. Since the Supreme Court made expanding Medicaid optional for states under the Affordable Care Act, 26 states have expanded Medicaid.

  • Survey of Health Insurance Marketplace Assister Programs

    Report

    This survey by the Kaiser Family Foundation of Navigators and other Marketplace consumer assistance programs under the Affordable Care Act (Obamacare) offers a nationwide analysis of the number and distribution of assisters and people they helped. The report examines the experience of programs in conducting outreach and enrollment assistance during the first open enrollment period. It also reviews the nature of help consumers needed applying for Medicaid or premium tax credits and understanding health insurance choices, and discusses key factors that impacted the effectiveness of Marketplace Assister Programs.

  • Why Medicaid Work Requirements Aren’t the Same as Welfare Reform

    From Drew Altman

    Drawing on his experience in state welfare reform, Drew Altman, in his Axios column, discusses how new state Medicaid work requirements differ fundamentally from welfare reform, which was built on the idea of a “reciprocal obligation” between both beneficiaries and government to do more.