Medicaid

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Medicaid work requirements

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.

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 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.

  • Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs, 2014-2017

    Issue Brief

    Although the outpatient drug benefit accounts for only 6% of total Medicaid spending, drug spending has increased by double digits in recent years, and is expected to grow faster than most other Medicaid services in the next 10 years. This issue brief examines drug spending and utilization from 2014 through 2017 by drug group, brand and generic status, and biologic status to understand the causes for this increase in spending.

  • Analysis Finds that Medications for Hepatitis C and HIV/AIDS Are the Costliest Group of Outpatient Prescription Drugs for Medicaid, While Diabetes Drugs Have Posted the Sharpest Rise in Costs 

    News Release

    Antiviral medications, including those that treat hepatitis C and HIV/AIDS, cost the Medicaid program more money (before rebates) than any other group of outpatient prescription drugs for each year from 2014 to 2017, according to a new KFF analysis. The analysis of utilization and spending trends finds that antivirals accounted for more than 13 percent of the $63.6 billion in Medicaid outpatient drug spending pre-rebates in 2017 -- a level disproportionate to their utilization and…

  • “Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage

    Issue Brief

    The Affordable Care Act (ACA) provides enhanced federal matching funds to states that expand Medicaid to nonelderly adults up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019). The ACA enhanced match (93% in 2019, and 90% in 2020 and thereafter) is substantially higher than states’ traditional Medicaid matching rate. A few states have sought Section 1115 demonstration waiver authority from the Centers for Medicare and Medicaid Services (CMS) to…

  • Ask KFF: MaryBeth Musumeci Answers 3 Questions on Kentucky, Arkansas Medicaid Work and Reporting Requirement Cases

    Issue Brief

    A federal district court has set aside the HHS Secretary’s approval of Medicaid waivers with work and reporting requirements and other eligibility and enrollment restrictions in Kentucky and Arkansas. For context as this all develops, we asked MaryBeth Musumeci, Associate Director at the Program on Medicaid and the Uninsured, three questions about the implications of the decisions.

  • Addressing the Opioid Crisis: Medication-Assisted Treatment at Health Care for the Homeless Programs

    Issue Brief

    Health Care for the Homeless (HCH) programs, a subset of community health centers, play a significant role in addressing the opioid epidemic by providing medication-assisted treatment (MAT). MAT, which combines one of three medications (methadone, buprenorphine, or naltrexone) with behavioral therapies, is the standard of care for opioid use disorder (OUD). This brief presents findings from an analysis of health center data on the provision of buprenorphine-based MAT, as well as interviews with providers and…

  • Explaining Texas v. U.S.: A Guide to the 5th Circuit Appeal in the Lawsuit Challenging the Affordable Care Act 

    News Release

    The outcome of the Texas v. U.S. legal challenge to the Affordable Care Act (ACA) could have far-reaching consequences for the nation’s health system, from rolling back the expansion of Medicaid to removing protections for people with pre-existing conditions and revoking the ability of adult children to stay on their parents’ insurance plans up to age 26. In December, U.S. District Judge Reed O’Connor invalidated the entire ACA after finding the individual mandate unconstitutional. Today,…

  • Medicaid in the Territories: Program Features, Challenges, and Changes

    Issue Brief

    This brief draws on a survey of and interviews with Medicaid officials in U.S. Territories, as well as other research, to examine key issues and trends in their Medicaid programs. Territories differ from the states on key demographic, economic, and health status indicators. Unlike in the states, where federal Medicaid funding is not capped, and the federal share varies based on states’ per capita income, Medicaid in the territories is subject to a statutory cap…

  • Medicaid Enrollment & Spending Growth: FY 2018 & 2019

    Issue Brief

    This issue brief provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2018 and 2019. Findings are based on interviews and data provided by state Medicaid directors as part of the 18th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Family Foundation (KFF) survey and Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth.

  • With Medicare and Medicaid Getting High Marks from the Public and Beneficiaries, Majorities Favor Status Quo over Major Structural Changes Such As Premium Supports or Block Grants

    News Release

    Among Medicare Changes, Strongest and Broadest Support Is for Negotiating Drug Prices People With Medicare, Medicaid and Employer Plans Give Their Coverage Similar Ratings, But Some Report Affordability and Physician Access Problems Fifty years after President Lyndon Johnson signed the law creating the Medicare and Medicaid programs, a new Kaiser Family Foundation poll finds a majority of the public and the vast majority of program beneficiaries view the two programs positively. Likely as a result,…