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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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  • Building an Express Lane Eligibility Initiative: A Roadmap of Key Decisions for States

    Issue Brief

    The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provides states new options to reach and enroll the estimated 5 million eligible but uninsured low-income children into Medicaid and CHIP. One key tool provided to states by the law is Express Lane Eligibility (ELE), which allows state Medicaid and CHIP agencies to borrow and rely on eligibility findings from other need-based programs, such as Head Start and the National School Lunch Program, to determine…

  • Health Reform: How Will Medicaid Change? Tutorial

    Interactive

    This tutorial was produced for kaiserEDU.org, a Kaiser Family Foundation website that ceased production in September 2013. The kaiserEDU.org tutorials are no longer being updated but have been made available on kff.org due to demand by professors who are using the tutorials in class assignments. You may search for other tutorials to view on kff.org. To download this or other tutorials, visit the tutorials archive page.  Slides are available for download using the "Download Slides" link within the…

  • States Sustain and Expand Coverage For Low-Income Children and Families Despite Recession, But Gains Are Threatened By Impending End of Federal Assistance

    News Release

    New 50-State Survey Illustrates Key Role of CHIP Reauthorization and the Federal Stimulus Law in Safeguarding Coverage    WASHINGTON  – Despite the deep recession, most states have managed to safeguard and, in some cases, expand health coverage for children and parents in their Medicaid and Children's Health Insurance Programs in 2009, according to a new survey from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured.  But the gains, which could serve as a…

  • Alternatives for Financing Medicaid Expansions in Health Reform

    Report

    Expanding Medicaid to cover low-income populations has been a fundamental component of leading health reform proposals. The House Leadership Bill would expand Medicaid to 150 percent of the federal poverty level and the Senate Leadership Bill would expand Medicaid to 133 percent of the federal poverty level. In both scenarios the federal government would finance a substantial share of costs for the expansion groups.  This analysis, however, shows that it is possible to distribute increased…

  • Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid do in Closing the Gaps?

    Other Post

    While Medicaid and the Children's Health Insurance Program (CHIP) have become increasingly important sources of health coverage for low-income children in all racial and ethnic groups, the program plays an especially large role for children of color, who are more likely than white children to be low-income. In 2007, Medicaid and CHIP covered nearly one in five white children, but roughly two in five African American and Hispanic children. As policymakers engaged in health reform…

  • Coverage of Low-Income Children: Key Issues to Consider in Health Reform

    Issue Brief

    A key element of health reform will be meeting the needs of low-income children. Overall, a major goal of proposals is to expand coverage by building on Medicaid, providing subsidies to low- and moderate-income individuals to buy coverage through new health insurance exchanges, and requiring individuals to obtain coverage. Current proposals also could significantly change coverage for some children already eligible for Medicaid and CHIP. This issue brief examines several key issues to consider about…

  • Getting the Most Bang for Our Health Reform Buck: Enrolling and Retaining Everyone Who’s Eligible

    Event Date:
    Event

    As Congress looks for ways to increase access to health care, existing programs such as Medicaid and the Children's Health Insurance Program are often overlooked. Yet enrolling those who are eligible for such programs is one of the easiest ways to expand coverage. This briefing, co-sponsored by Alliance for Health Reform and the Pharmaceutical Research and Manufacturers of America (PhRMA), looked at ways to streamline recruitment and enrollment, while exploring how expanding Medicaid and CHIP…

  • A Foundation for Health Reform: Findings of An Annual 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures and Cost-Sharing Practices in Medicaid and CHIP for Children and Parents During 2009

    Report

    In 2009, despite the bleakest economic picture in years, states managed to safeguard and in some cases expand health coverage for children and parents in their Medicaid and Children's Health Insurance Programs, according to the Kaiser Family Foundation's annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost-sharing Practices. That was in large part due to the substantial help that states received through the congressional reauthorization of CHIP and the…

  • Briefing – A Foundation for Health Reform: Findings of An Annual 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures and Cost-Sharing Practices in Medicaid and CHIP for Children and Parents During 2009

    Report

    In 2009, despite the bleakest economic picture in years, states managed to safeguard and in some cases expand health coverage for children and parents in their Medicaid and Children's Health Insurance Programs, according to the Kaiser Family Foundation's annual 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost-sharing Practices. That was in large part due to the substantial help that states received through the congressional reauthorization of CHIP and the…

  • Protecting Children During the Recession: Spotlight on State Health Coverage Efforts

    Issue Brief

    The beginning of the recession, from December 2007 through December 2008, led to an increase in the overall number of uninsured. Despite a 1.5 million increase in the number of uninsured adults, however, the number of uninsured children declined by 800,000 during this time period. States have played a key role in this progress for children by maintaining and expanding children's coverage. This issue brief highlights seven states (Alabama, Maryland, New Jersey, New York, Oklahoma,…