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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.

Dual Eligibles

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  • Financing Health Coverage:  The Fiscal Relief Experience

    Issue Brief

    Financing Health Coverage: The Fiscal Relief Experience This paper provides an overview of the context which prompted federal fiscal relief to the states in 2003 and discusses the implications of this experiment in federal intervention for financing the Medicaid program. Policy Brief (.pdf)

  • Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation

    Issue Brief

    Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation This issue brief describes how dual eligibles are treated under the Medicare drug benefit and the issues raised by their transition from Medicaid to Medicare drug coverage. The brief also explores key differences in the Medicare drug benefit compared to Medicaid drug coverage (formularies, copayments, and appeals policies) which could make the shift especially challenging for dual eligibles. Issue Brief (.pdf)

  • Dual Eligible Home and Community-Based Waiver Program Participants and the New Medicare Drug Benefit

    Issue Brief

    Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan. This paper offers state and federal policymakers…

  • Health Care Coverage and Financing Issues in California:  An October 2005 Update

    Issue Brief

    Health Care Coverage and Financing Issues in California: An October 2005 Update This brief summarizes recent health insurance coverage trends in California and the Medi-Cal program, provides an overview of the state’s newly adopted FY 2005-06 budget agreement, and discusses key issues driving the current health policy agenda. The brief concludes with a discussion on Medicaid reform actions at the federal level and the potential implications for California. Issue Brief (.pdf)

  • New State Surveys Show State Budgetary Pressures on Medicaid Easing, But Long-Term Challenges for Program Remain

    Report

    Three KCMU state surveys indicate improving economy and sustained state cost-containment actions have improved the outlook for Medicaid and SCHIP, but long-term challenges remain due to factors affecting overall health care system. News Release Summary of Findings (.pdf) Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006 State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey, 2005 Update In a Time of Growing Need: State Choices Influence Health Coverage…

  • Health Coverage for Individuals Affected by Hurricane Katrina:

    Issue Brief

    A Comparison of Different Approaches to Extend Medicaid Coverage Approaches have been put forward to extend Medicaid coverage to Hurricane Katrina survivors, but they differ significantly regarding the extent to which they extend Medicaid eligibility and in the role of federal funding for coverage of Hurricane survivors. This publication provides an overview of these approaches and their key differences. First is a table comparing the major components of the September 15, 2005 Senate bill, the…