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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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  • Issues Facing Medicaid and CHIP

    Event Date:
    Event

    Cindy Mann, senior fellow of the Commission, testified to the Senate Subcommittee on Public Health of the Health, Education, Labor and Pensions Committee on how to sustain and expand health care coverage for low-income children and families, and disabled and elderly people in these challenging times. TESTIMONY Download

  • A Medicare Buy-In for the Near Elderly: Design Issues and Potential Effects on Coverage

    Report

    This report examines a Medicare-based approach to reducing the ranks of the uninsured that would permit early retirees between the ages of 62 and 65 to purchase coverage under Medicare. The paper begins with an overview of the challenges of insuring the near-elderly and explores the potential effects of a Medicare buy-in on coverage of this population. The authors conclude that, unless premiums for such coverage were low or tied to enrollees' income, this approach…

  • SCHIP Administration and Accountability

    Report

    The third in a series of reports on implementation issues and challenges in the first year of S-CHIP finds that non-Medicaid S-CHIP programs faced more administrative challenges. Success with enrollment appeared primarily related to administrative decisions, including a lower band of S-CHIP income eligibility, and the lack of premiums. REPORT Download

  • Medicaid’s Role for Low-Income Medicare Beneficiaries

    Fact Sheet

    Medicaid's Role for Low-Income Medicare Beneficiaries An overview that identifies low-income Medicare beneficiaries (dual eligibles), how Medicaid can provide care for them, and the challenges to accessing care. Fact Sheet

  • Barriers to Medicaid Enrollment for Seniors: Findings from 10 Focus Groups with Low-Income Seniors

    Report

    Medicaid coverage substantially improves access to health care and lessens the financial burden of medical care for low-income seniors, but the program currently reaches only half of all poor Medicare beneficiaries. This report presents findings of focus groups with low-income seniors in an effort to understand barriers to enrollment for those who are eligible for Medicaid but who are not enrolled in the program, and to learn about the experiences of low-income seniors who are…

  • Medicaid and the Prescription Drug Benefit

    Issue Brief

    This policy brief includes background information on Medicaid and its drug benefit, provides examples of how states are using the cost containment mechanisms at their disposal and addresses issues surrounding beneficiary access to outpatient drugs. Policy Brief

  • Reaching Uninsured Children Through Medicaid: If You Build It Right, They Will Come

    Report

    This report analyzes enrollment data of recent years and draws on state experiences to outline the key strategies that will lead to successful enrollment in public health coverage programs and finds that improving enrollment in Medicaid drives improved overall enrollment into a state s public coverage programs. REPORT Download

  • The New Challenge of the Uninsured: Coverage in the Current Economy

    Event Date:
    Event

    Diane Rowland, executive director of the Commission, testified to the House Energy and Commerce Subcommittee on Health about health coverage for the uninsured in the current economy and discussed the special challenges of providing them coverage during uncertain economic times. Please note: the video is no longer available. If you have an urgent need for the video, you may contact us (choose “problem with video” on the form) and we will try to locate the…