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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.

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  • Consumer Direction of Personal Assistance Services in Medicaid: A Review of Four State Programs

    Report

    Consumer Direction of Personal Assistance Services in Medicaid: A Review of Four State Programs Medicaid consumer direction of personal assistance services (CD-PAS) is a growing trend. Although overall enrollment in these programs is small, 42 states offered consumer direction in Medicaid in 2006. These programs allow Medicaid beneficiaries control over hiring, scheduling, training and paying of personal care attendants. This report is based on interviews with program administrators from the four states profiled: California, Colorado,…

  • Consumer Direction of Personal Assistance Services Programs in Medicaid: Insights from Enrollees in Four States

    Report

    Consumer Direction of Personal Assistance Services Programs in Medicaid: Insights from Enrollees in Four States Medicaid consumer direction of personal assistance services (CD-PAS) is a growing trend. Although overall enrollment in these programs is small, 42 states offered consumer direction in Medicaid in 2006. These programs allow Medicaid beneficiaries control over hiring, scheduling, training and paying of personal care attendants. This report is based focus groups with enrollees in CD-PAS programs in the four states…

  • Report Examines the Potential Impact of New Federal Initiative To Review Payment and Eligibility Errors in Medicaid

    Report

    Report Examines the Potential Impact of New Federal Initiative To Review Payment and Eligibility Errors in Medicaid The federal government has launched a new initiative, Payment Error Rate Measurement (PERM), to estimate the number of errors states make in determining eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP). This paper reports on interviews of state officials conducted during the summer of 2007. The primary findings include: State officials generally find measuring errors…

  • President’s FY 2009 Budget and Medicaid

    Fact Sheet

    President's FY 2009 Budget and Medicaid The President released his Fiscal Year 2009 budget plan in January 2008. The President would reduce federal Medicaid spending by over $17 billion over the next five years by reducing the federal match rate for certain services, making changes to managed care, long-term care, reimbursement for prescription drugs and making other administrative changes. This fact sheet summarizes the proposals and potential implications. Fact Sheet (.pdf)

  • President’s FY 2009 Budget and SCHIP

    Fact Sheet

    President's FY 2009 Budget and SCHIP The President released his Fiscal Year 2009 budget proposal in January 2008. The President’s plan would increase the State Children's Health Insurance Program (SCHIP) funding by $19.7 billion over the next five years, more than the $5 billion included in his FY 2008 budget proposal, but less than the $35 billion included in the SCHIP reauthorization bills that were vetoed last year. The Foundation's KCMU has prepared a fact…

  • Medicaid: Overview and Impact of New Regulations

    Issue Brief

    In the past year the Bush Administration has moved forward with significant changes to the Medicaid program via rule-making. Taken together, six new regulations could result in an estimated $12 billion reduction in federal Medicaid spending over the next five years according to the regulatory impact statements prepared by Centers for Medicare and Medicaid Services. This brief focuses on the six new regulations that have been the source of considerable controversy and explains current policy,…

  • Current Issues in Medicaid:  A Mid-FY2008 Update Based on a Discussion with Leading Medicaid Directors

    Report

    Current Issues in Medicaid: A Mid-FY2008 Update Based on a Discussion with Leading Medicaid Directors This report provides a brief mid-fiscal year 2008 update on current issues in Medicaid, from the perspective of state Medicaid directors who administer the program. Medicaid directors identified a number of key issues, concerns and priorities in mid fiscal year 2008. At the top of the list were the effects of an increase in fiscal stress across states, a number…

  • Health Coverage for Children and Families in Medicaid and SCHIP:  State Efforts Face New Hurdles

    Report

    Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles The seventh annual 50-state survey of eligibility rules, enrollment and renewal procedures, and cost-sharing practices in Medicaid and SCHIP for children and families reports that nearly two-thirds of states expanded access to Medicaid and SCHIP between July 2006 and January 2008. Executive Summary (.pdf) Report (.pdf)

  • Medicaid’s Role for People With Disabilities

    Event

    Diane Rowland testified before the House Energy and Commerce Subcommittee on Health about Medicaid’s development as a vital source of coverage for people with disabilities and its current role providing coverage and access to health services and supports for this population. Testimony (.pdf)

  • New Requirements for Citizenship Documentation in Medicaid

    Fact Sheet

    This fact sheet provides information on the new federal requirement that all U.S. citizens and nationals applying for or renewing their Medicaid coverage provide documentation of their citizenship status and examines the implications for Medicaid beneficiaries and the states. Fact Sheet (.pdf) Previous versions January 2007 (.pdf) July 2006 (.pdf)