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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 Watch

Featuring policy research, polling and news about how Medicaid is changing, and the impact of those changes due to the tax and spending cuts law

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 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.

5 Facts: 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 in 2025

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.

5 Facts: 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.

2025 Medicaid Home Care survey

Payment Rates Ahead of 2025 Reconciliation Law

This issue brief describes Medicaid payment rates for home care and other workforce supports that are in place in 2025, before the majority of the 2025 reconciliation law provisions start taking effect.

Home Care Support for Family Caregivers in 2025
number of responding states, including DC, that allow payments for family caregivers by type of home care program and type of caregiver.

This issue brief describes the availability of self-directed services and supports for family caregivers in Medicaid home care in 2025, before most provisions in the reconciliation law take effect.

States’ Management of Home Care Spending

This issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

Waiting Lists for Medicaid Home Care, 2016 to 2025
A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025

This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect.

Eligibility and coverage

  • Eligibility, Enrollment, and Renewal Policies

    KFF's survey findings capture state actions that seek to improve the accuracy and efficiency of Medicaid and CHIP enrollment and renewal processes, as of January 2025.

  • Seniors and People with Disabilities

    More than 1 in 3 people with disabilities (15 million) have Medicaid (35%). In comparison, only 19% of people without disabilities have Medicaid.

  • Children with Special Needs

    Amid debates about proposed cuts to federal Medicaid spending, this brief analyzes key characteristics of children with special health care needs and explores how Medicaid provides them with coverage.

  • People With Intellectual and Developmental Disabilities

    Among the estimated 8 million people with intellectual and developmental disabilities (I/DD), over three million have Medicaid coverage.

  • Adults with Chronic Conditions

    Among working age adults enrolled in Medicaid, approximately three quarters have one or more chronic conditions, and nearly one-third have three or more.

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  • Children and Health Care Reform: Assuring Coverage That Meets Their Health Care Needs

    Issue Brief

    This issue brief examines the health care needs and health costs of children and analyzes the specific health care needs of two children in particular, including one with serious health challenges. The findings have implications for the health reform debate as policymakers consider minimum standards for coverage, required cost sharing amounts and limits on covered benefits in health plans. Issue Brief (.pdf)

  • Consumers’ Experience in Massachusetts: Lessons For National Health Reform

    Report

    This report examines the impact of state health reform efforts on the lives of ordinary people in Massachusetts, including a look at coverage provided by both public programs and private sources. It focuses specifically on people's ability to afford and obtain needed care. Report (.pdf)

  • Struggling With Financing: The Recession and National Health Reform Dominate State Medicaid Concerns

    Report

    The recession has squeezed state Medicaid programs between the twin pressures of rising enrollment and shrinking budgets as the economic downturn triggers both increased demand for safety-net services and a decrease in the tax revenues that state governments rely on to fund them. The report, draws on interviews with state Medicaid directors, discusses the prospect of significant Medicaid cuts in some states, shows how federal stimulus money has been helpful but still leaves states trying…

  • How Will Uninsured Parents Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured parents and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • How Will The Uninsured Be Affected By Health Reform?

    Issue Brief

    This brief examines who the uninsured are and explores how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • How Will Uninsured Childless Adults Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured childless adults and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • How Will Uninsured Children Be Affected By Health Reform?

    Issue Brief

    This brief examines uninsured children and how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • Express Lane Eligibility Efforts: Lessons Learned from Early State Cross-Program Enrollment Initiatives

    Issue Brief

    The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provides states new options to reach and enroll eligible but uninsured low-income children into Medicaid and CHIP. The law's Express Lane Eligibility (ELE) provisions enable state Medicaid and CHIP agencies to identify, enroll and recertify children by relying on eligibility findings from other programs, such as Head Start or Food Stamps, rather than having to re-analyze eligibility under their own rules. Further, CHIPRA authorizes greater…

  • Federal Support for Health Information Technology in Medicaid: Key Provisions in the American Recovery and Reinvestment Act

    Issue Brief

    The American Recovery and Reinvestment Act of 2009 (ARRA) includes an unprecedented nearly $47 billion federal investment in health information technology initiatives. This e-health snapshot provides an overview of the health information technology provisions in the law that have direct implications for Medicaid. Health Information Technology (HIT) offers the promise of potential improvements in quality of care as well as increased efficiencies in care and cost savings. Medicaid, which covers nearly 60 million people, can…

  • Rising Health Pressures in an Economic Recession

    Event Date:
    Event

    As millions of people lose their jobs and job-based health insurance during the recession, the Kaiser Family Foundation has several reports and a video that shed light on the rising toll on American families and the public programs that many depend on to fill the gap during times of crisis. Rising Health Pressures in an Economic Recession: A 360-Degree Look at Four Communities, and a companion video, On the Edge: Health Care in the Recession…