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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.

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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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  • State Responses to Budget Crisis in 2004: An Overview of Ten States – Overview and Case Studies

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    In this report we examine how ten states from around the nation have responded to their budget crises in fiscal year 2004. While states vary in the depth of the budget pressures they faced, as state revenues remained depressed, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures. In general, we found states with few exceptions relied on targeted revenue measures, such as cigarette and alcohol taxes, but…

  • Is the State Fiscal Crisis Over?  A 2004 State Budget Update – Report

    Issue Brief

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  • State Perspectives on Medicaid Long-term Care: Report from a July 2003 State Forum

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    This report summarizes discussions on Medicaid and long-term care at a forum with state officials held by the Kaiser Commission on Medicaid and the Uninsured in July of 2003. The forum, conducted by the National Academy of State Health Policy, addressed issues including Medicaid's role in long-term care, state fiscal crises and cost-containment strategies, and how state long-term care programs are evolving. Report (.pdf)

  • Why Did Medicaid Spending Decline in 2006?  A Detailed Look at Program Spending and Enrollment, 2000-2006

    Issue Brief

    Why Did Medicaid Spending Decline in 2006? A Detailed Look at Program Spending and Enrollment, 2000-2006 This issue brief finds that Medicaid spending declined for the first time in the program’s 40-plus year history in Federal Fiscal Year (FY) 2006, falling by 0.2 percent. The two major factors that underlie the 2006 decline, in addition to a more limited effect of the slowdown in per enrollee spending growth for a few key services, were the…

  • The Role of Health Coverage for People with Disabilities: Findings from 12 Focus Groups with People with Disabilities

    Report

    This report presents findings from focus groups conducted with people with a range of disabilities in an effort to understand the challenges they face and their experiences in the health-care system. To capture variations in experiences by source of health insurance, the groups include people covered under Medicare, Medicaid, and private insurance, as well as those no health insurance at all. The report highlights the ways in which various sources of insurance are working for…

  • Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance

    Issue Brief

    Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance Due to concern that wealthy elderly Americans were transferring assets to gain Medicaid coverage for nursing home care, the Deficit Reduction Act (DRA) of 2005 tightened Medicaid eligibility rules related to asset transfers. About 43 percent of all nursing home residents eventually become Medicaid eligible. This brief concludes that for people becoming Medicaid eligible at the time of nursing home admission, 50 percent had…

  • The New Medicare Rx Benefit:  Challenges for Maintaining Access to Prescription Drugs

    Other Post

    The New Medicare Rx Benefit: Challenges for Maintaining Access to Prescription Drugs With the launch of the new Medicare Part D prescription drug benefit less than 18 months away, and growing interest in beneficiaries’ access to medications in the future, the Kaiser Family Foundation is pleased to release two new publications that examine issues concerning access to medications raised by the implementation of the new Part D Medicare prescription drug benefit. The New Medicare Drug…