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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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    Perspective

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  • Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility

    Issue Brief

    Low-income adults (those with incomes below 200 percent of poverty, or $33,200 for a family of three in 2007) account for just over half of the non-elderly uninsured in the United States. This brief reviews the health coverage of non-elderly low-income adults and discusses the implications for national health reform efforts of broadening coverage for this population by filling gaps in Medicaid eligibility. Low-income adults are more than twice as likely to be uninsured as…

  • The Coverage and Cost Impacts of Expanding Medicaid

    Report

    This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates. The analysis models two primary options to expand Medicaid (250% FPL for children, 100% FPL for adults; 300% FPL for children, 150% for adults) as well as the same options with no change for children. Report (.pdf)

  • Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid

    Issue Brief

    This policy brief examines the structure and experience of Community Care of North Carolina, an enhanced medical home model of care that North Carolina began implementing in 1998 as part of its Medicaid program. Evaluations of the initiative, which includes a heavy emphasis on care coordination, disease and care management and quality improvement, suggest that it has resulted in both improved care and cost savings. The program provides important lessons for broader health reform efforts…

  • Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

    Issue Brief

    Medicaid is the health insurance safety net for nearly 60 million of the nation's poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate. This paper, based on years of research and analysis from the Kaiser Commission on…

  • 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,…

  • Congressional Testimony on Expanding Health Care Coverage

    Event Date:
    Event

    On May 5, 2009, the U.S. Senate Committee on Finance held a roundtable discussion on health-care coverage issues as part of its health reform efforts. Diane Rowland, the Foundation's Executive Vice President and Executive Director of the Kaiser Commission on Medicaid and the Uninsured, and Gary Claxton, Foundation Vice President and Director of the Health Care Marketplace Project, participated in the discussion and prepared written testimony at the committee's request. Testimony of Diane Rowland (.pdf)…

  • CHIP TIPS: Citizenship Documentation Changes

    Issue Brief

    This brief, the third in a series, examines changes to citizenship documentation requirements under the Children's Health Insurance Program Reauthorization Act of 2009. The law extends the requirement to document citizenship that applied in Medicaid to CHIP as well. At the same time, it modifies current requirements to reduce the paperwork burden on families and states and helps ensure that eligible children and others are enrolled and receive needed health care without delay. Brief (.pdf)

  • Webinar: Health Policy Provisions of ARRA

    Other Post

    The Kaiser Family Foundation and the National Conference of State Legislatures co-sponsored a webinar, or interactive Web-based seminar, that examined key health policy aspects of the American Recovery and Reinvestment Act (ARRA) of 2009. The webinar for state legislative health chairs provided an overview of the stimulus law with a focus on provisions dealing with Medicaid, COBRA and health information technology. Webinar

  • Trends in Medicaid Physician Fees, 2003-2008

    Fact Sheet

    This study, published in a Health Affairs Web exclusive, provides the first national and state-by-state update of Medicaid physician fees since 2003. Medicaid has historically reimbursed physicians under fee-for-service at levels below what Medicare and private health insurers would pay for the same services. The study finds that Medicaid fees grew by more than 15 percent from 2003 to 2008, but fell in real terms because the gains did not keep pace with inflation. Medicaid…