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Number of States Affected by Key Medicaid Provisions in the 2025 Reconciliation Law

Which States Will Be Affected by Key Medicaid Provisions in the 2025 Reconciliation Law?

The 2025 reconciliation law makes sweeping changes to Medicaid that will affect every state through key eligibility and financing changes, including new work requirements, immigrant eligibility restrictions, and changes to provider taxes and state directed payments. This issue brief explains which states will be affected by each of these key provisions.

Medicaid work requirements

Nebraska Renewal Outcomes Among Individuals Subject to Medicaid Work Requirements

Early Medicaid Work Requirement Insights From Nebraska

This brief describes the verification process for Medicaid work requirements in Nebraska and examines early data on outcomes for individuals subject to work requirements. Among Medicaid enrollees renewing coverage under Nebraska's work requirements, 93% met the requirements or qualified for an exemption —while 7% lost coverage.

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

KFF’s interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies. The Congressional Budget Office estimates that the 2025 reconciliation law will increase the number of people who are uninsured in 2034 by 10 million. Coverage losses from Medicaid work requirements account for over half, or 5.3 million, of the increase in the number of uninsured.

understanding medicaid

Medicaid Financing: The Basics

Medicaid represents $1 out of every $5 spent on health care in the U.S. This brief examines key questions about Medicaid financing and how it works.

Medicaid and Provider Taxes

This brief explores how rules governing provider taxes are changing because of the 2025 reconciliation law and the regulations implementing that law, and summarizes which changes may affect each state.

5 Key Facts About Medicaid and Hospitals

This brief explains the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid and how Medicaid expansion has impacted hospital finances.

Medicaid home Care

Medicaid Home Care/HCBS Survey

Since 2001, KFF has administered regular surveys of states about their Medicaid home- and community-based services (HCBS) programs. The survey is sent to officials administering Medicaid HCBS programs in all 50 states and the District of Columbia.

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  • Choosing Premium Assistance: What Does State Experience Tell Us?

    Issue Brief

    Premium assistance programs use federal and state Medicaid and State Children’s Health Insurance Program (SCHIP) funds to purchase private coverage. Overall, few states have premium assistance programs, but interest in premium assistance remains high. This brief examines six state premium assistance programs (in Florida, Idaho, Illinois, Oregon, Utah, and Virginia) that allow families to choose to receive a subsidy to apply to the purchase of private coverage rather than to receive direct Medicaid or SCHIP…

  • Determining Income Eligibility in Children’s Health Coverage Programs: How States Use Disregards in Children’s Medicaid and SCHIP

    Issue Brief

    The Center for Medicare and Medicaid Services issued an August 17, 2007, directive that would restrict states’ flexibility to continue to apply income disregards when determining eligibility for Medicaid and SCHIP coverage for expansions to children above 250 percent of the federal poverty level. This issue brief describes the purpose of income “disregards” (which refer to both income that is excluded and expenses that are deducted from a family’s earnings); how disregards help enable children…

  • New Analysis Shows Effect of Rising Unemployment on Health Coverage, Medicaid and SCHIP Spending and Enrollment

    Event

    As the country faces another economic downturn, many states are scrambling to deal with the impact of poor economic conditions on programs, like Medicaid and the State Children’s Health Insurance Program (SCHIP), that are reliant on state funding. To be better able to cope, states are looking for fiscal relief from the federal government as well as obtaining a moratorium on federal regulations that would reduce Medicaid funding for states from the Congress. New analyses…

  • Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses

    Report

    Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses A new analysis conducted for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured examines the implications of a downturn for health coverage and state programs and projects the impact of one percentage point rise in the national unemployment rate on Medicaid and SCHIP and the number of uninsured individuals. The analysis also documents how federal fiscal relief during the last economic downturn of…

  • Medicaid in a Declining Economy:  Limited Approaches for States to Control Spending

    Issue Brief

    Medicaid in a Declining Economy: Limited Approaches for States to Control Spending This brief analyzes results from its annual 50-state budget surveys of Medicaid directors from 2003 to 2007. The historical results describe how states adopted a wide array of Medicaid cost containment strategies during the last economic downturn and were assisted by the federal government to avoid deeper Medicaid cuts. Issue Brief (.pdf) See related material on this issue

  • 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…

  • New Reports Examine Consumer Direction for Personal Assistance Services in Four States’ Medicaid Programs

    Report

    With a shift towards providing long-term services and supports in the community, policy interest in Medicaid consumer direction of personal assistance services (CD-PAS) has grown. 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. The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured has produced two new reports examining Medicaid’s…

  • 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,…

  • 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)