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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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  • Medicaid Enrollment & Spending Trends

    Fact Sheet

    Medicaid Enrollment and Spending Trends This fact sheet summarizes trends of enrollment and spending in the Medicaid program from 2000 to 2006. Fact Sheet, October 2007 (.pdf) Previous Versions: May 2006 (.pdf) June 2005 (.pdf) February 2001 (.pdf) September 1999 (.pdf) October 1998 (.pdf)

  • Citizenship Documentation Requirements in The Deficit Reduction Act Of 2005:  Lessons From New York

    Report

    Citizenship Documentation Requirements in The Deficit Reduction Act Of 2005: Lessons From New York New York State is one of only four states in the nation that already requires documentation of citizenship for Medicaid applicants (the others are Georgia, Montana and New Hampshire), and the only state with significant implementation experience. New York’s citizenship documentation requirement has been in place since the mid-1970s, and provides a solid base of experience that can inform the implementation…

  • The Impact of Recent Changes in Health Care Coverage for Low-Income People:  A First Look at the Research Following Changes in Oregon’s Medicaid Program

    Issue Brief

    The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon's Medicaid Program Oregon recently restructured its Medicaid program through a Section 1115 waiver and other program changes, largely in response to particularly difficult state budget problems. This report summarizes key findings on the impact of Oregon's changes, based on work conducted by a research collaborative within the state. The experience in Oregon may…

  • Center on Budget and Policy Priorities Overview of Medicaid

    Report

    "DSH" Provisions...the Balanced Budget Act of 1997, P.L. 105-33 This report was prepared by the Center on Budget and Policy Priorities for the Kaiser Commission on the Future of Mediciad. Report: Overview of Medicaid "DSH" Provisions...the Balanced Budget Act of of 1997, P.L. 105-33

  • Health Care and the 2004 Elections: Long Term Care

    Issue Brief

    Long Term Care Download a printable .pdf of Health Care and the 2004 Elections: Long Term Care. IssueBackgroundOptions for Addressing Long Term Care NeedsAssessing Candidate Positions Issue Millions of elderly and disabled Americans need long-term care services and supports. The aging of the population in the United States over the next several decades is expected to increase the demand for long-term care services. The number of elderly persons in the United States is projected to…

  • Medicaid Expansion Briefing: What’s at Stake for States?

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    Event

    The Alliance for Health Reform and the Kaiser Family Foundation present a November 30 briefing to discuss the Medicaid expansion and what's at stake for states. Speakers address questions around the potential financial impact of the expansion on states, the role of the federal government in financing the expansion, and what it might mean for providers on the ground level, as well as the effect on the safety net population should states choose to opt…

  • Getting into Gear for 2014: Briefing, Survey Examine 2013 Data From 50-State Survey of Medicaid and CHIP Eligibility and Enrollment Policies

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    Event

    Following the Supreme Court ruling upholding the Affordable Care Act (ACA) and as 2014 approaches, many states are moving into high gear to prepare for implementation of the major provisions of the law, including a new streamlined Medicaid enrollment system and, at states' option, the expansion of Medicaid. Nearly all states are pressing forward with information technology and process improvements to develop faster, streamlined Medicaid enrollment systems as required under the ACA, whether or not…

  • Case Study: Michigan’s Money Follows the Person Demonstration

    Report

    This case study looks at Michigan's Money Follows the Person (MFP) demonstration program, which has enabled the state to accelerate existing transition activities and increase access to home- and community-based services (HCBS) by providing enhanced federal funds for each MFP participant’s 365-day enrollment period. Through MFP, Michigan is able to provide a comprehensive set of demonstration services in addition to existing HCBS waiver services so that each MFP participant receives the services necessary to transition…

  • Roads to Community Living: A Closer Look at Washington State’s Money Follows the Person Demonstration

    Report

    This case study looks at Washington state's Money Follows the Person demonstration program, Roads to Community Living. The program is responsible for assisting over 2,400 Medicaid beneficiaries with complex long-term services and supports (LTSS) needs in transitioning out of institutions back to community-based care settings. Washington State has been a leader in Medicaid LTSS rebalancing efforts over the last two decades. According to the state, in the early 1990s, 82 percent of long-term care funding…