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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.

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  • 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…

  • New Survey Indicates Medicaid Enrollment Declines For First Time In Nearly A Decade

    Event Date:
    Event

    The annual 50-state survey of state officials on Medicaid and state budget actions reports enrollment in Medicaid declined for the first time in nearly a decade. The 0.5 percent enrollment decline in fiscal year 2007 was driven primarily by two factors. States reported that the new citizenship documentation requirements were causing significant delays in processing applications, affecting mostly individuals already eligible for the program. State officials also cited the good economy and lower unemployment for…

  • CHIP TIPS: New Federal Funding Available to Cover Immigrant Children and Pregnant Women

    Issue Brief

    This brief examines a new option under the Children's Health Insurance Program Reauthorization Act of 2009 that allows states to receive federal funds for providing Medicaid and CHIP coverage to lawfully residing immigrant children and pregnant women regardless of when they entered the country. Previously, states had been prohibited from using federal Medicaid or CHIP funds to cover legal immigrants who had been in the country fewer than five years. The brief, the fifth installment…

  • State Medicaid Coverage of Family Planning Services: Summary of State Survey Findings

    Other Post

    State Medicaid Coverage of Family Planning Services: Summary of State Survey Findings Over the past two decades, Medicaid has played a central and growing role in financing and providing access to family planning services for low-income women. About two-thirds of women covered by Medicaid are of child-bearing age, and for this group of women, access to family planning services fills a key health need. This report highlights findings from the 2007/2008 State Survey of Reproductive…

  • Resources Examine Medicaid Enrollment Growth And State Budget Pressures

    Fact Sheet

    This package of resources examines the substantial enrollment growth in Medicaid between June 2008 and June 2009 and provides a mid fiscal-year 2010 update on key state Medicaid issues, including the impacts of the economic downturn. News ReleaseWith the country in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis, Medicaid Enrollment: June 2009 Data Snapshot (updated for…

  • Resources on Medicaid Policy Changes in the Federal Budget Reconciliation Bill

    Issue Brief

    The Foundation's Kaiser Commission on Medicaid and the Uninsured has collected resources related to the Medicaid policy changes in the budget reconciliation law, Deficit Reduction Act of 2005. Deficit Reduction Act of 2005: Implications for Medicaid West Virginia Medicaid State Plan Amendment: Key Program Changes and Questions KYHealth Choices Medicaid Reform: Key Program Changes and Questions Reports Explore Long-Term Care Issues Included in the Deficit Reduction Act The Nuts and Bolts of Making Medicaid Policy…

  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…

  • State-Specific Section 1115 Waiver Fact Sheets

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured is closely following waiver activity to provide information on how these waivers are impacting the uninsured and affecting Medicaid and SCHIP and the coverage provided to low-income beneficiaries. Tennessee Section 1115 Waiver Amendment Proposal Fact Sheet California Section 1115 Waiver Fact Sheet Colorado Section 1115 Waiver Fact Sheet Delaware Section 1115 Waiver Fact Sheet Illinois Section 1115 Waiver Fact Sheet Maine Section 1115 Waiver Fact Sheet New…

  • National Survey of Public Knowledge of Welfare Reform and the Federal Budget

    Poll Finding

    Survey Shows "Two Faces" Of Public Opinion On Welfare Reform Americans Support Time Limits and Tough Work Requirements, But Reluctant to Abandon Those In Need Public Defines Welfare Broadly Understands Key Details of Welfare Programs Embargoed for release: 9:00 a.m. EST, Thursday, January 12, 1995 For further information contact: Matt James or Tina Hoff Menlo Park, CA -- A new Kaiser/Harvard survey of Americans nationwide has found that the public supports strong welfare reform measures,…

  • Making Medicaid Managed Care Work:  An Action Plan for Persons Living with HIV

    Other Post

    Making Medicaid Managed Care Work: An Action Plan for Persons Living with HIV This report, by the National Association of People with AIDS (NAPWA) with support from The Kaiser Family Foundation, describes nine key points for people living with HIV to keep in mind when trying to influence the development of a managed care system that will serve them effectively. Senator John Chafee (R-RI), an acknowledged ally of NAPWA, gratefully accepted the report upon its…