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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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  • Medicaid Beneficiaries and Access to Care

    Fact Sheet

    The health reform law relies on a large expansion of Medicaid to reach many low-income uninsured people, many of them adults. This fact sheet summarizes Medicaid beneficiaries' experience in obtaining access to care, a subject that is of keen interest in view of the planned expansion of the program. Medicaid and the Children's Health Insurance Program have substantially increased coverage among low-income Americans, especially children. Research shows that Medicaid compares favorably with private coverage in…

  • Health and the Economy in the Detroit Area

    Poll Finding

    One year after the federal government intervened to aid the automakers, the Foundation along with The Washington Post and Harvard School of Public Health surveyed the residents of the tri-county Detroit area of Macomb, Oakland, and Wayne Counties to ask about their views and experiences in the midst of the area’s economic meltdown. Using data from the comprehensive survey and other publicly available information, this data note provides an overview of the current economic and…

  • Aging Out of Medicaid: What is the Risk of Becoming Uninsured?

    Issue Brief

    This policy brief uses the most recent available data to examine the patterns of health coverage for young adults after they turn 19 and typically are no longer eligible for Medicaid or the Children's Health Insurance Program (CHIP). Medicaid is a key source of coverage for children in the U.S., providing insurance to about 29 million at some point during the year. After turning 19, however, in many cases they lose their eligibility for Medicaid…

  • CHIP TIPS: Children’s Oral Health Benefits

    Issue Brief

    This brief examines a new requirement under the Children's Health Insurance Program Reauthorization Act of 2009 that state CHIP programs cover comprehensive dental benefits. The reauthorization law also allows states with separate CHIP programs to offer a dental-only plan for children who have other health insurance but lack adequate dental benefits. Other oral health improvements in the law include education for new parents, better access to benefit and provider information and enhanced reporting on the…

  • Medicaid Financial Eligibility: Primary Pathways for the Elderly and People with Disabilities

    Issue Brief

    This issue brief details the various eligibility pathways by which individuals with disabilities and the elderly can qualify for Medicaid coverage. The program, which serves as a safety net for many of the nation’s poorest and sickest individuals, provides health coverage to nearly 60 million Americans, including 8.5 million with disabilities and 8.8 million low-income frail, elderly and disabled Medicare beneficiaries who rely on Medicaid to fill Medicare’s gaps.  Issue Brief (.pdf)

  • Resources Examine Medicaid Enrollment Growth And State Budget Pressures

    Fact Sheet

    This package of resources examines the substantial enrollment growth in Medicaid between June 2008 and June 2009 and provides a mid fiscal-year 2010 update on key state Medicaid issues, including the impacts of the economic downturn. News ReleaseWith the country in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis, Medicaid Enrollment: June 2009 Data Snapshot (updated for…

  • Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009

    News Release

    Largest Ever One-Year Increase Illustrates Medicaid’s Role In Covering People During Economic Downturns But Further Strains Tight State Budgets WASHINGTON, D.C.  – With the country mired in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.  It was the biggest ever one-year increase in terms of…

  • Pulling it Together: An Actuarial Rorschach Test

    Perspective

    Drew Altman, Larry Levitt, Gary Claxton My colleagues have worked on this column with me and I invited them to join me as authors. As with pretty much every other discussion of health care going back to the days of Roosevelt, the great reform debate of 2009 (and now 2010) has been distilled into an ideological battle over the role of government. A government-sponsored "public option" has been off the table for a while now,…

  • Medicaid’s Continuing Crunch In a Recession: A Mid-Year Update for State FY 2010 and Preview for FY 2011

    Report

    This report finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment and spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits. The recession and the scheduled end on Dec. 31, 2010 of enhanced federal matching money for Medicaid that was provided through the American Recovery and Reinvestment Act of 2009 will have a significant impact…

  • From Crunch to Crisis: State Budgets, Medicaid and the Economy

    Event Date:
    Event

    Medicaid programs are feeling the strain as enrollment grows while state revenues come in lower than projected. How are Medicaid directors coping? How is the recession affecting low-income individuals and families? This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Commission on Medicaid and the Uninsured, addressed these and related questions. For more information, please visit the Alliance's event page. Full Video   Speakers for this session: The panel is co-moderated by…