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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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  • Health Insurance Premiums and Cost-Sharing: Findings from the Research on Low-Income Populations

    Issue Brief

    Health Insurance Premiums and Cost-Sharing: Findings from the Research on Low-Income Populations This policy brief reviews studies on the impact of premiums and cost-sharing, particularly on low-income populations, and finds that premiums generally depressed participation in public programs and cost-sharing affected health utilization, access and outcomes. Policy Brief

  • SCHIP Enrollment in 50 States

    Other Post

    This update shows that enrollment in SCHIP grew by 25,000 to 3,950,000 in 2004, reversing a four quarter decline in enrollment since June 2003, but still slightly below the program's enrollment peak. Report (.pdf)

  • Health Care Coverage and Financing Issues in California:  An October 2005 Update

    Issue Brief

    Health Care Coverage and Financing Issues in California: An October 2005 Update This brief summarizes recent health insurance coverage trends in California and the Medi-Cal program, provides an overview of the state’s newly adopted FY 2005-06 budget agreement, and discusses key issues driving the current health policy agenda. The brief concludes with a discussion on Medicaid reform actions at the federal level and the potential implications for California. Issue Brief (.pdf)

  • Case Study: Georgia’s Money Follows the Person Demonstration

    Issue Brief

    This brief reports on a case study of Georgia's Money Follows the Person (MFP) demonstration program, describing key features of the program and highlighting recent program experiences. The Georgia Department of Community Health (DCH) implemented the program in September 2008. In 2005, before the demonstration began, Georgia’s long-term care expenditures were $1.5 billion, with 70 percent devoted to institutional long-term care and 30 percent on home and community-based services (HCBS). One goal of the demonstration…

  • Small Area Variations and the ACA’s Coverage Expansions

    From Drew Altman

    A new Kaiser analysis sheds light on how the country might react to the Affordable Care Act (ACA) when it is implemented.  It looks at how the benefits of the ACA's coverage expansions will vary around the country by census areas (technically, Public Use Microdata Areas, or PUMAs).  PUMAs are artificial areas of about 100,000 people each created by the Census Bureau to provide more detailed demographic, social and economic information at the local level.  They…

  • How is the Affordable Care Act Leading to Changes in Medicaid Today? State Responses to Five New Options

    Issue Brief

    This policy brief examines how states in every region have responded to five key opportunities available under the health reform law to help them prepare for the significant expansion of Medicaid in 2014. The options covered in the brief include incentives for states to get an early start on the Medicaid coverage expansion; increased federal funding to upgrade Medicaid eligibility systems; money to improve care for beneficiaries with chronic conditions by providing "health home" services;…

  • Total Medicaid Spending and Enrollment Growth Slowed Significantly in FY 2012 Amid Signs of Economic Recovery and States’ Efforts To Curb Costs

    News Release

    Washington, D.C. - Growth in total Medicaid spending and enrollment slowed substantially in state fiscal year 2012 as the economy began to improve and states continued to work to control costs. Relatively slow spending and enrollment growth are expected to continue in FY 2013, according to the 12th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, conducted with Health Management Associates. Total Medicaid spending increased 2 percent…

  • The Role of Medicaid for Adults With Chronic Illnesses

    Fact Sheet

    This report and related fact sheets provide data on spending, utilization, and access to care among low-income nonelderly adult Medicaid beneficiaries with chronic illnesses. Four fact sheets provide detail for beneficiaries with diabetes, respiratory disease, cardiovascular disease, and behavioral health conditions The reports show that, despite relatively high prevalence of chronic conditions and, correspondingly, relatively high spending and utilization rates, Medicaid beneficiaries with chronic illness report better access to care than their uninsured counterparts, many…

  • The Impact of Part D on Dual Eligibles Who Spend-Down to Medicaid

    Issue Brief

    Individuals with incomes exceeding thresholds for regular Medicaid eligibility may qualify under state medically needy programs by spending down excess income on healthcare services. For the vulnerable population of Medicare beneficiaries who spend down to Medicaid, the Part D transition has added additional complexities that may result in disruptions in pharmacy coverage and add financial burdens. This paper explores the inter-relationship of Medicare prescription drug coverage and Medicaid spend-down for the medically needy. It describes…