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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 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 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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  • Faces of the Medicaid Expansion: Experiences and Profiles of Uninsured Adults Who Could Gain Coverage

    Issue Brief

    These two papers provide insight into how state decisions to expand Medicaid under the Affordable Care Act are likely to impact people. Based on focus groups and interviews conducted in Cincinnati, Houston, Las Vegas and Tampa with uninsured adults who could be eligible for the Medicaid expansion in 2014, these papers highlight the experiences of uninsured adults and the significant health and financial consequences of being uninsured, which sometimes impact their ability to work and…

  • The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis

    Report

    A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population. This analysis uses the Urban Institute’s Health Insurance Policy…

  • Why Does Medicaid Spending Vary Across States: A Chartbook of Factors Driving State Spending

    Report

    This detailed chartbook provides an illustrative overview of some of the key factors that contribute to the substantial variation in Medicaid spending across states today. The chartbook provides a broad range of state-by-state data on subjects including state revenue and spending, the demand for public services, health care markets, and state Medicaid policy choices. Understanding this variation can be important for assessing state fiscal issues, the differences across states and their implications for federal and…

  • Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

    Report

    With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and…

  • Kaiser Family Foundation Resources on Deficit-Reduction Debate

    Report

    These Foundation resources shed light on how the ongoing national debate about deficit reduction may affect Medicare, Medicaid and other health-care programs. These resources include analysis of specific savings proposals, polling on the public’s views of deficit-reduction options, summaries and comparisons of relevant elements of major deficit-reduction plans, and explanatory briefs and backgrounders describing key issues related to the debate. Drew Altman: The News Media and Entitlement Reform   Medicare-Specific Analysis Policy Options to Sustain…

  • National and State-By-State Impact of the 2012 House Republican Budget Plan for Medicaid

    Report

    This analysis of the House Budget Plan that was passed in 2012 finds that repealing the Affordable Care Act (ACA) and converting Medicaid to a block grant would trigger significant decreases in federal Medicaid spending and could result in substantial reductions in enrollment and payments to providers compared to current projections. The analysis, conducted by the Urban Institute for the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, updates a similar study from May…

  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…

  • Total Medicaid Spending and Enrollment Growth Slowed Significantly in FY 2012 Amid Signs of Economic Recovery and States’ Efforts To Curb Costs

    News Release

    Washington, D.C. - Growth in total Medicaid spending and enrollment slowed substantially in state fiscal year 2012 as the economy began to improve and states continued to work to control costs. Relatively slow spending and enrollment growth are expected to continue in FY 2013, according to the 12th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, conducted with Health Management Associates. Total Medicaid spending increased 2 percent…