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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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  • Medicare Prescription Drug Improvement and Modernization Act Implementation Timeline: June 2004 – December 2006 Key Dates

    Report

    Key Implementation Dates for the Medicare Prescription Drug Benefit This timeline presents important dates and deadlines of key implementation activities related to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It runs from the beginning of 2005 through the end of 2006, the first year of the new Medicare drug benefit. Some of these dates are defined in the MMA statute, while others are from the final rule issued by the Centers…

  • Medicaid Payment for Outpatient Prescription Drugs

    Fact Sheet

    This fact sheet summarizes Medicaid’s role as the major source of outpatient pharmacy services for low-income Americans. Medicaid spent $25.4 billion on prescription drugs in fiscal year 2009, and outpatient prescription drug coverage is an optional benefit that all state Medicaid programs currently provide. Fact Sheet (.pdf)

  • The Latest Data on Mandatory and Optional Populations and Benefits in Medicaid

    Report

    With discussions on restructuring Medicaid occurring in state capitols and Washington, two new reports provide the latest data on how much of Medicaid's spending is for covering mandatory versus optional populations and services. The analysis shows that although optional populations account for 29 percent of Medicaid enrollment, 60 percent of all Medicaid spending (whether for mandatory or optional populations) is optional and 86 percent of optional spending is for the elderly or individuals with disabilities.…

  • Implementing the ACA’s Medicaid-Related Health Reform Provisions After the Supreme Court’s Decision

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). A majority of the Court also found the ACA’s Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary’s enforcement authority. The practical effect of the Court's decision makes the Medicaid expansion optional for states. This brief addresses questions…

  • Coverage of Preventive Services for Adults in Medicaid

    Issue Brief

    This brief highlights data from a survey of coverage of 42 recommended preventive services for adults in Medicaid fee-for-service programs as of October 2010. Medicaid programs must cover preventive services for children as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, but generally are not required to cover such services for adults. The Affordable Care Act (ACA) provides states the opportunity to earn a one percentage point increase in their federal matching…

  • New Kaiser Resources Examine Medicaid as a Platform for Health Reform

    Issue Brief

    These related research papers examine the policy opportunities for expanding Medicaid to cover more low-income and high-need people in ways that would enable the program to serve as a platform for larger national health reform efforts. As congressional leaders work on proposals for universal coverage, some policymakers have suggested that strengthening Medicaid’s coverage of the poorest Americans and those with special health needs could provide a base for broader health reform efforts to expand coverage,…

  • The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States

    Issue Brief

    This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by researchers at the Foundation's Kaiser Commission on Medicaid and the Uninsured and Avalere Health. Policy Brief (.pdf)

  • Low-Income Medicare Beneficiaries: How the House and Senate Prescription Drug Bills Address Their Drug Needs

    Report

    The House and Senate versions of a Medicare prescription drug bill treat the drug costs of those dually-eligible for Medicare and Medicaid and other low-income Medicare beneficiaries quite differently. The Kaiser Commission on Medicaid and the Uninsured cosponsored a policy briefing on the key issues in the two bills that would impact low-income beneficiaries and released a brief and background report on the topic. A Prescription Drug Benefit in Medicare: Implications for Medicaid and Low-Income…

  • Aging Out of Early and Periodic Screening, Diagnostic and Treatment (EPSDT): Issues for Young Adults with Disabilities

    Issue Brief

    Early and Periodic Screening, Diagnostic and Treatment (EPSDT) coverage offered through the Medicaid program has played an important and unique role for low-income children with disabilities, and maintaining this support is a key concern. This issue brief discusses the challenges and implications for young people with disabilities when they become adults and lose their EPSDT benefits and how recent changes to the Deficit Reduction Act give states an opportunity to increase the availability of services…