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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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  • Expanding Medicaid under Health Reform: A Look at Adults at or below 133% of Poverty

    Issue Brief

    This issue brief from the Kaiser Commission on Medicaid and the Uninsured examines the key characteristics of the 17.1 million low-income uninsured adults who currently have incomes that would qualify them for Medicaid under the expansion of the program in health reform. The planned expansion of Medicaid to all individuals with incomes at or below 133 percent of the federal poverty level will establish a national foundation of coverage based on income. Adults whose incomes…

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    Issue Brief

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    Issue Brief

    This brief compares the Medicaid and Children's Health Insurance Program provisions in the new health reform law with pre-reform law governing those programs. The analysis focuses on Medicaid coverage and financing changes; how Medicaid and CHIP will interface with a new health insurance exchange and other Medicaid benefits and access changes. Overall, the new law includes an individual requirement to obtain health insurance, a significant Medicaid expansion and subsidies to help low-income individuals buy coverage…

  • 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…