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Medicaid work requirements

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.

Dual Eligibles

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  • 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)

  • 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…

  • 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)

  • 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…

  • Rising Health Pressures in an Economic Recession: A 360-Degree Look at Four Communities

    Report

    This report draws on interviews and focus groups in four communities to examine at the grassroots levels the experiences of families, employers, safety-net providers and community organizations in four U.S. communities hard hit by the recession. The communities are Beloit, Wisc.; Tampa-St. Petersburg, Fla.; Long Island, N.Y.; and Sonoma, Calif. The report explores the financial and personal struggles of families who have suffered economic reversals and lost health coverage, forcing many to juggle bills and…

  • Health Reform Opportunities: Improving Policy for Dual Eligibles

    Issue Brief

    As the nation considers national health reform, this brief provides an overview of opportunities to realign federal and state policy for the dual eligibles to promote a more rational, cost-efficient system for 9 million of the poorest, sickest and highest-cost people covered by both Medicaid and Medicare. Navigating two programs with different rules and financing incentives is complex for beneficiaries and providers, impedes efforts to improve care coordination and results in cost-shifting between programs that…

  • New Option for States to Provide Federally Funded Medicaid and CHIP Coverage to Additional Immigrant Children and Pregnant Women

    Fact Sheet

    This fact sheet provides state-level data from a Kaiser survey that found that a large number of states are using state funds to provide health coverage to legal immigrant children and pregnant women through Medicaid, CHIP or another state program. Under the Children's Health Insurance Program Reauthorization Act of 2009, states now have the option to provide federally matched Medicaid or CHIP to some or all of the legal immigrants they have been covering solely…