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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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  • Reports Explore Long-Term Care Issues Included in the Deficit Reduction Act

    Issue Brief

    The Deficit Reduction Act (DRA) of 2005, which became law this February, includes several significant changes to Medicaid long-term care policies. The Kaiser Family Foundation's Commission on Medicaid and the Uninsured is releasing five new reports on long-term care issues that were addressed by the DRA changes. Long-term care accounts for 36 percent of Medicaid spending (over $100 billion annually) and is utilized by many of Medicaid's most costly beneficiaries, the low-income elderly and individuals…

  • Beyond Cash and Counseling: An Inventory of Individual Budget-based Community Long-Term Care Programs

    Issue Brief

    Beyond Cash and Counseling: An Inventory of Individual Budget-based Community Long-Term Care Programs This brief describes the evolution of beneficiary-managed home and community-based services since the original demonstration and provides an overview of state activity as of January 2006. The Deficit Reduction Act of 2005 gives states the option to use this model for an expanded range of home and community based services in their state Medicaid plans without having to obtain a waiver. Issue…

  • Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance

    Issue Brief

    Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance Due to concern that wealthy elderly Americans were transferring assets to gain Medicaid coverage for nursing home care, the Deficit Reduction Act (DRA) of 2005 tightened Medicaid eligibility rules related to asset transfers. About 43 percent of all nursing home residents eventually become Medicaid eligible. This brief concludes that for people becoming Medicaid eligible at the time of nursing home admission, 50 percent had…

  • Medicaid’s High Cost Enrollees: How Much Do They Drive Program Spending?

    Issue Brief

    This brief presents new information on the distribution of Medicaid spending for all enrollees, including those residing in institutions. The analysis finds that fewer than five percent of enrollees (each exceeding $25,000 in annual costs) account for almost half of all Medicaid spending. Issue Brief (.pdf)

  • Medicaid Long-Term Services Reforms in the Deficit Reduction Act

    Issue Brief

    The Deficit Reduction Act of 2005 (DRA) was signed by the President in February 2006 and included major changes to the Medicaid program. This brief provides an overview of the changes to the rules and direction of Medicaid long-term care services as enacted in the DRA. Issue Brief (.pdf)

  • Home Transition Programs: Perspectives of Medicaid Care Planners

    Report

    Home Transition Programs: Perspectives of Medicaid Care Planners This report draws on interviews with Medicaid care planners for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences. Report (.pdf)

  • Health Coverage for Low-Income Populations: A Comparison of Medicaid and SCHIP

    Issue Brief

    Medicaid and the State Children's Health Insurance Program (SCHIP) are often compared because they both serve low-income populations. However, the populations served, the coverage offered and the structure of these programs have differed in important ways. With the passage of the Deficit Reduction Act of 2005, states can now apply some SCHIP-like principles to the Medicaid program. Moreover, SCHIP is due for reauthorization by Congress after fiscal year 2007. This issue brief examines the similarities…

  • Medicaid Spending and Enrollment: State and National Data Update

    Report

    This series of tables provides recent data on state-by-state and national Medicaid spending and enrollment. Using the latest federal information sources available, the first set of tables contains information on Medicaid spending by service using data from the Centers on Medicaid and Medicare Services (CMS) Form 64 for Federal Fiscal Year (FFY) 2004. A second set of tables is based on analysis of a more detailed data source, the Medicaid Statistical Information System (MSIS), which…

  • 2002 State and National Medicaid Enrollment and Spending Data (MSIS)

    Report

    This set of tables, prepared by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, presents state-by-state information on Medicaid enrollment, expenditures, and spending per enrollee for Federal Fiscal Year (FFY) 2002. These tables are based on analysis of data from the Medicaid Statistical Information System (MSIS) and provide a somewhat different measure of spending than CMS-64 data. Please see the "Overview of Differences" document below for more on the features of…