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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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  • The Louisiana Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of resident socio-demographic characteristics, population health, health coverage, and the health care delivery system in Louisiana both pre-Hurricane Katrina and in the era of health reform.

  • 8 Questions & Answers about Puerto Rico

    Fact Sheet

    These slides provide a quick snapshot of Puerto Rico’s population, as well as current and upcoming issues that are impacting the island’s health care system.

  • Connecting the Justice-Involved Population to Medicaid Coverage and Care: Findings from Three States

    Issue Brief

    This brief provides an overview of initiatives to connect the justice-involved population to Medicaid coverage and care in the community in three states—Arizona, Connecticut, and Massachusetts—based on interviews with key stakeholders. These states are leading efforts in these areas and provide key lessons about how to coordinate across health care and corrections and the potential of such initiatives to better link individuals to the physical and behavioral services they need. Each of the case study states is connecting individuals to coverage at multiple points within the justice system. The study states also connect individuals to care in the community as they are released from jail or prison. Stakeholders and data indicate that these approaches have increased coverage, facilitated access to care, and contributed to administrative efficiencies and state savings. However, more data and time are needed to examine the effects on health and criminal justice outcomes, including recidivism rates.

  • Puerto Rico: Datos Básicos

    Fact Sheet

    Puerto Rico: Datos Básicos provee una descripción general del las características demográficas, y estadísticas de salud y la economía. También se da alguna informacion del gobierno, reglas federales de Medicaid, y asuntos corrientes que estan afectando el territorio, incluyendo a Zika.

  • What do different data sources tell us about Medicaid and work?

    Fact Sheet

    A central question in the ongoing debate about imposing work requirements in Medicaid is what current work patterns are among Medicaid adults and how many so-called “able bodied” adults are not already working. Answers to these questions rely on various data sources, and characteristics of the underlying data and analytic decisions may lead to different conclusions. This data note examines what different data sources and analytic decisions tell us about Medicaid and work.

  • Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses

    Issue Brief

    A number of states have received approval for, have applied for, or are considering Medicaid waiver proposals that would impose work requirements as a condition of eligibility, and some policymakers are calling for a federal requirement that all states implement work requirements in Medicaid. This analysis provides illustrative scenarios of potential nationwide reductions in Medicaid coverage if all states implemented work requirements similar to those currently proposed. The scenarios assume low and high disenrollment rates tied to compliance with the work requirements and related problems with reporting, based on disenrollment rates reported in existing studies of the effect of Medicaid reporting requirements and state estimates of enrollment under proposed waivers.

  • KFF/EHF Poll: Texans’ Top State Health Priorities Include Lowering Out-of-Pocket Costs and Reducing Maternal Mortality

    News Release

    Most Texans Don’t Know their State has the Nation’s Highest Uninsured Rate Texans’ top health care priorities for the state revolve around making health care and prescription drugs more affordable, reducing maternal mortality and increasing access to health insurance coverage, finds a new statewide Kaiser Family Foundation/Episcopal Health Foundation survey on Texas health policy issues.

  • Texas Residents’ Views on State and National Health Policy Priorities

    Report

    As part of the new Kaiser Family Foundation/Episcopal Health Foundation 2018 Texas Health Policy Survey, this brief explores Texans’ views on health policy priorities at both the state and national level. It examines how Texas residents view state spending on health care and how they rank initiatives such as lowering health care costs, reducing maternal mortality, and funding for mental health care. It also explores Texans’ views on the Affordable Care Act and Medicaid, including personal connections to the Medicaid program and support for Medicaid expansion.