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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

Event Date:

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 Expansion Waivers: What Will We Learn?

    Issue Brief

    Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services (HHS) Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. This brief examines some of the major research questions and hypotheses relevant to the federal and state evaluations of Medicaid expansion Section 1115 waivers and explores key challenges that…

  • Medicaid in a Time of Growth and Change: Findings from the Annual Kaiser 50-State Medicaid Budget Survey at a Forum with the National Association of Medicaid Directors

    Event Date:
    Event

    The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) released its 15th annual 50-state Medicaid budget survey for state fiscal years 2015 and 2016. Kaiser and the National Association of Medicaid Directors (NAMD) held a joint briefing to discuss key findings and highlight trends in enrollment and spending as well as policy changes in Medicaid programs around the country.

  • Is Medicaid Too Big to… Block Grant?

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman examines how the politics around the Medicaid program have changed as it has grown much larger and more popular, making it even tougher to block grant the program to cut federal Medicaid spending and hand it off to the states.

  • Nearly a Quarter of People Who Say They Were Disenrolled from Medicaid During the Unwinding Are Now Uninsured   

    News Release

    Nearly a quarter (23%) of adults who say they were disenrolled from Medicaid since early 2023 report being uninsured now, finds a new KFF national survey examining how the unwinding affected enrollees.  Overall, 19% of adults who had Medicaid prior to the start of unwinding say they were disenrolled at some point in the past year. Of this group, a large majority (70%) were left at least temporarily uninsured, while 30% already had another form…

  • States Adopted Changes to Expand Medicaid Eligibility and Streamline Renewal Processes That Will Continue Beyond the Unwinding, Though Challenges Remain

    News Release

    The unwinding of pandemic enrollment protections in Medicaid helped accelerate states’ expansion of eligibility for key groups and adoption of policy and system changes to streamline renewal processes for enrollees, according to findings from a new KFF survey of state Medicaid officials. These changes mean that the return to “routine” operations when the unwinding period ends will not be a return to pre-pandemic operations in many states. The survey examined actions states have taken to…

  • Supreme Court Decision Limiting the Authority of Federal Agencies Could Have Far-Reaching Impacts for Health Policy

    Issue Brief

    On June 28, 2024, the U.S. Supreme Court overturned a longstanding legal precedent that required federal courts to defer to reasonable agency interpretation when statutes are ambiguous. The decision will shift many policy decisions from federal agencies to federal judges, with implications for health policy that will reverberate for years to come. This issue brief examines the decision and assesses what’s ahead.

  • What Could Medicaid Work Requirements Mean for SSI Applicants?

    Issue Brief

    Medicaid work requirements may make it more difficult for some SSI applicants to maintain coverage due to the added complexity of navigating the verification process for the medical frailty exclusion. KFF's policy analysis explains why SSI applicants are particularly at risk of going uninsured under the new Medicaid rules.

  • Racial and Ethnic Health Disparities: Potential Implications of the Election

    Issue Brief

    Former President Trump and Vice President Harris have taken widely different stances and approaches on recognizing and addressing racial and ethnic disparities. These differences can be seen across areas of health care, including health coverage, reproductive and maternal health, and immigrant health and well-being and are likely to have important implications for future efforts to address health disparities.

  • Eliminating the ACA Medicaid Expansion Match Could Reduce Total Medicaid Spending by Up To $1.9 Trillion Over 10 Years and End Coverage for 20 Million People 

    News Release

    A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.The impacts would be felt in both blue and red states and could effectively reverse and end the Medicaid expansion in most or all states that have…