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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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  • Views of Governors and Insurance Commissioners on ACA Repeal and Changes to Medicaid: Responses to a Congressional Request for State Input on Health Reform

    Issue Brief

    This brief summarizes responses from governors and insurance commissioners in 35 states, including DC, to a request from members in the House of Representatives for state input on health care reforms. These responses provide insight into state leaders’ views on repeal and replacement of the ACA and the changes Congress is considering making to the financing and structure of Medicaid. It finds that respondents have mixed views on the ACA and potential repeal and replacement of the ACA; most respondents expressed cautions or concerns about repeal, which are shared among both Republicans and Democrats and those who oppose and support appeal; more respondents expressed concerns about capped Medicaid financing than indicated support, and those that expressed support included significant caveats; less than half of respondents, mostly Republican, cited interest in increased state Medicaid flexibility; over half of respondents supported returning authority to states to regulate insurance markets; and few respondents expressed interest in allowing the sale of insurance across state lines, HSAs, or high risk pools.

  • Data Note: Variation in Per Enrollee Medicaid Spending Across States

    Issue Brief

    Proposals to transition Medicaid a block grant or per capita cap would reduce federal spending. To understand per capita cap proposals, it is helpful to understand variation in per enrollee spending and per enrollee spending growth across states and enrollment groups. A per capita cap policy could lock in historic variation. This data note uses interactive maps and tables to show variation in per enrollee spending and spending growth by state and eligibility group.

  • Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid

    Feature

    This month’s Kaiser Health Tracking Poll explores the public’s views on the changing landscape of the U.S. health care system including proposals to repeal and replace the Affordable Care Act (ACA) and to change Medicaid financing to a system of block grants or per capita allotments. The survey also examines which sources, including news media and other sources, the public trusts for information on the proposed changes to the country’s health care system.

  • Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey

    Issue Brief

    This brief presents the latest information on Medicaid financial eligibility criteria and state adoption of major coverage pathways related to old age and disability. The findings are based on a survey of the 50 states and the District of Columbia that asked questions related to financial eligibility and policy choices related to mandatory and optional eligibility pathways. The brief also analyzes the likelihood of adopting optional pathways given a state’s ACA expansion status.

  • Abismo en el financiamiento de Medicaid: Implicaciones para los sistemas de atención de salud de Puerto Rico y las Islas Vírgenes de los EE.UU.

    Issue Brief

    Este resumen ofrece una descripción general del estado de los sistemas de atención médica y los programas de Medicaid en Puerto Rico y las Islas Vírgenes de los EE.UU. (USVI) aproximadamente un año y medio después que los huracanes Irma y María azotaran las islas, en septiembre de 2017. Después de las tormentas, los programas de Medicaid de los territorios han servido como recursos importantes para atender las necesidades de atención médica de los residentes, pero han operado bajo desafíos financieros de larga data. Este resumen se enfoca en esos desafíos e incluye el análisis de KFF de las consecuencias para las finanzas de los programas de Medicaid de los territorios, ya que la mayoría de los fondos federales de Medicaid provistos a través de la Ley de Cuidado de Salud a Bajo Precio (ACA), y la asistencia para desastres, expirarán a fines de septiembre de 2019. Los otros territorios de los EE.UU. (Samoa Americana, el Commonwealth de las Islas Marianas del Norte y Guam) también enfrentan retos relacionados con el vencimiento programado de los fondos de ACA. Este resumen se basa en trabajos anteriores y en informes públicos recientes, y en entrevistas con funcionarios de los territorios en los lugares afectados, con proveedores, con responsables de planes de salud de Puerto Rico y beneficiarios.

  • Analysis of Recent Declines in Medicaid and CHIP Enrollment

    Fact Sheet

    This fact sheet provides analysis of this recent enrollment decrease and discusses potential implications for coverage rates. It is based on Kaiser Family Foundation analysis of the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data.

  • Medicaid’s Prescription Drug Benefit: Key Facts

    Fact Sheet

    Medicaid provides health coverage for millions of Americans, including prescription drug coverage for many people with substantial health needs. This fact sheet provides an overview of Medicaid’s prescription drug benefit and recent trends in spending and utilization