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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 Care and Medicaid — Weathering the Recession

    Report

    Rising unemployment is leaving millions more Americans without health insurance, creating challenges for those seeking to stabilize coverage and shore up the nation’s health safety net. In this Perspective article, published March 26 in the New England Journal of Medicine, Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured, examines the ongoing recession’s impact on health coverage and state Medicaid programs, which…

  • Community Health Centers

    Fact Sheet

    This fact sheet provides a basic overview of community health centers, covering issues such as the patients they serve, the services they provide and the financing they receive. Community health centers provided comprehensive primary care to 16.1 million patients in 2007. Fact Sheet (.pdf)

  • Health Affairs Article: Beyond Incrementalism? SCHIP and the Politics of Health Reform

    Report

    This article examines the political and legislative history of the Children's Health Insurance Program and analyzes the lessons for policymakers who are contemplating broader health care reform. It was published online in the journal Health Affairs and was authored by Jonathan Oberlander, an associate professor, social medicine and health policy and management, at the University of North Carolina at Chapel Hill, and Barbara Lyons, a vice president of the Kaiser Family Foundation and deputy director…

  • The Role of Section 1115 Waivers in Medicaid and CHIP: Looking Back and Looking Forward

    Issue Brief

    For many years, Section 1115 waivers have been used in the Medicaid program, and to a lesser degree in the Children’s Health Insurance Program, to provide states an avenue to test and implement coverage approaches that do not meet federal program rules. While these waivers have facilitated important program evolutions over time, some have also raised issues. This brief reviews the experience of Section 1115 Medicaid and CHIP waivers and discusses issues for the Obama…

  • Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

    Fact Sheet

    This fact sheet provides an overview of provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which was signed into law in February 2009. The Act extends and expands the State Children's Health Insurance Program (now referred to as CHIP, not SCHIP) that was enacted with bipartisan support a decade ago as part of the Balanced Budget Act of 1997 (BBA). Fact Sheet (.pdf) Fact Sheet: State Adoption of Coverage and Enrollment…

  • Snapshots from the Kitchen Table: Family Budgets and Health Care

    Report

    This report from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) illustrates the financial struggles of many families in the United States and shows the central role of health care costs and coverage in a household's economic stability. The report, , is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security and households teetering on the financial brink, stretching to pay for…

  • Report and Video Highlight Health Coverage Struggles, Other Economic Concerns of Working Families

    Event Date:
    Event

    This report and video from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) illustrate the financial struggles of many families in the United States and show the central role of health care costs and coverage in a household's economic stability. The report, Snapshots from the Kitchen Table: Family Budgets and Health Care, is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security…

  • The Adequacy of Health Insurance

    Event Date:
    Event

    Testimony by Diane Rowland, executive vice president and executive director of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, at a congressional hearing, titled “Addressing Underinsurance in National Health Reform,” held Feb. 24, 2009, by a special task force of the Senate Committee on Health, Education, Labor, and Pensions. Rowland discussed the status of health insurance coverage in America and the gaps and limits to coverage that leave millions of Americans poorly protected…

  • Snapshots from the Kitchen Table: Family Budgets and Health Care

    Video

    This Kaiser Family Foundation documentary, “Snapshots from the Kitchen Table: Family Budgets and Health Care,” profiles several American families who are struggling to make ends meet. It depicts the narrow financial ledge on which millions of low- and middle- income working households stand even in normal economic times, and illustrates the central role that health care costs and coverage play in a household’s economic stability. Some of the families profiled have health insurance, others do…