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An Early Look at States’ Differing Approaches to Implementing Medicaid Work Requirements Amid Cost and Time Constraints and Uncertainty

A new KFF survey of state Medicaid officials and focus groups in eight states captures the different choices states are making about how to implement Medicaid work requirements, with seven states planning for a more restrictive approach to verifying work or exemption status or to implement work requirements early. These implementation plans are taking shape as states encounter time, cost, and other constraints as well as uncertainty about how to define and verify certain exemptions due to delayed federal guidance.

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 Work Requirements

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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  • The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession

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    This annual 50-state survey finds that number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs despite increased financial help from the federal government through the American Recovery and Reinvestment Act (ARRA). The survey finds that these trends are expected to continue well into the 2010 fiscal year, with the slumping economy contributing to the loss…

  • The State of Children’s Health, Care and Coverage

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    A record 90 percent of children now have health coverage – more than a third of whom are covered by Medicaid and CHIP. Yet about 7.5 million children remain uninsured, including 5 million who are eligible for Medicaid and CHIP but not enrolled. Who are the at-risk kids? How are states faring with enrollment and retention? How will children and families be affected once major parts of the Patient Protection and Affordable Care Act (ACA)…

  • The Part D Experience: What are the Lessons for Broader Medicare Reform?

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    Launched in 2006, Medicare added a prescription drug benefit that relies entirely on private plans, while, for other benefits, beneficiaries have a choice between private health plans and traditional fee-for-service Medicare. As policymakers consider changes to Medicare that would give an even greater role to private health plans in caring for Medicare’s nearly 50 million seniors and people with disabilities, the Kaiser Family Foundation hosted a policy workshop to examine how the Part D experience…

  • Article and Policy Forum Examine Medicare, Health Reform and the Challenges Facing People With Disabilities

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    Wednesday, Sept. 8, the Foundation held a policy workshop examining Medicare, health reform and the challenges facing people with disabilities. Younger Medicare beneficiaries with disabilities are much more likely than seniors in the program to report problems accessing and paying for needed medical services, Kaiser Family Foundation researchers report in this Health Affairs article. Based on a national random-sample survey of people on Medicare, the study finds that half of nonelderly disabled beneficiaries report problems…

  • Health Care After the Supreme Court Decision: What’s Next?

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    The Alliance for Health Reform and the Kaiser Family Foundation discuss the recent Supreme Court ruling on the constitutionality of the health reform law. Panelists explore such questions as: What does the court's ruling mean for those without health insurance? Will states that choose to participate in the Medicaid expansion be ready to cover nearly all non-disabled adults under age 65 with household incomes at or below 133 percent of the federal poverty level as…

  • Briefing on State Medicaid Programs, the Recession and Health Reform

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    The Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) held a 9:30 a.m. ET briefing on Thursday, September 30 to examine the challenges facing states as they continue to struggle with the lingering impacts of the recession and begin preparing to implement health reform. Three reports were released at the event: Hoping for Economic Recovery, Preparing for Reform: A Look at Medicaid Spending, Coverage and Policy Trends: Results from a 50-State Medicaid Budget…

  • The New Health Reform Law and Medicaid

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    This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation, explores the provisions of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA). A panel of experts explain how PPACA and HCERA affect Medicaid, and answer questions about their Medicaid-specific provisions, including Medicaid eligibility, financing, and other implementation issues. For more information, please visit Alliance's event page. Full Video   Speakers…

  • Rising Health Pressures in an Economic Recession

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    As millions of people lose their jobs and job-based health insurance during the recession, the Kaiser Family Foundation has several reports and a video that shed light on the rising toll on American families and the public programs that many depend on to fill the gap during times of crisis. Rising Health Pressures in an Economic Recession: A 360-Degree Look at Four Communities, and a companion video, On the Edge: Health Care in the Recession…

  • Policy and Political Implications of the Supreme Court Case on the Affordable Care Act

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    This webcast features a Kaiser Family Foundation briefing held on March 14, 2012, examining the policy and political implications of the pending U.S. Supreme Court case on the Affordable Care Act (ACA). At the briefing, the Foundation released new polling data on the public’s views about the case as well as their more general views about the health reform law. Participants included: Kaiser President and CEO Drew Altman (moderator)Joe Onek, Principal, The Raben Group Sheila…