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Spending on Medicaid State Directed Payments Before New Limits Take Effect

Forty states and DC currently receive $93 billion in annual federal Medicaid spending through state directed payments (SDPs) and may be at risk due to forthcoming limits on these payments, according to new KFF estimates. Annual federal spending on SDPs is highest in California (an estimated $10.6 billion)—followed by Texas ($6.3 billion), North Carolina ($5.2 billion), and Illinois ($5.1 billion).

Forthcoming Policy Changes to Medicaid State Directed Payments

Changes to Medicaid State Directed Payments

The 2025 reconciliation law cut federal Medicaid spending by an estimated $911 billion from 2025 through 2034, some of which stems from new restrictions on Medicaid state directed payments (SDPs) for hospital and other health care services. This issue brief describes SDPs and forthcoming policy changes stemming from the 2025 law and the proposed regulation to implement those requirements and make other changes.

Medicaid Work RequiremEnts

Tracking the 2025 Reconciliation Law’s Medicaid Work Requirements: Data and Policies

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements.

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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  • Medicaid at 40

    Video

    The Kaiser Family Foundation has produced three documentaries to mark the 40th anniversary of Medicare and Medicaid. The documentaries examine the social needs that led policymakers to create these programs, the expectations of what they would achieve and the reality of these programs today. Key policymakers, staff officials and members of Congress involved in the creation and implementation of Medicare and Medicaid are interviewed. Extensive use of historic video helps tell the story of these…

  • Medicare and Medicaid at 40

    Video

    The Medicare and Medicaid health coverage programs were signed into law July 30, 1965. The Kaiser Family Foundation has some new resources that examine how Medicare and Medicaid came into existence and how they have evolved over the past 40 years. You will find new documentaries and extended interviews with key policymakers and government officials examining the origins of Medicare and Medicaid, new interactive historical timelines, a chart pack of key information and statistics, a…

  • Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2003

    Issue Brief

    Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2003 This report provides the latest national and state data on Medicaid enrollment and spending for individuals enrolled in both Medicaid and Medicare, also knows as dual eligibles. Nationally, there are 7.5 million dual eligibles and while they comprise 14 percent of the Medicaid population, they account for 40 percent of Medicaid spending. Issue Paper (.pdf)

  • Women and Health Care: A National Profile

    Report

    A new national survey of women on their health finds that a substantial percentage of women cannot afford to go to the doctor or get prescriptions filled. Although a majority of women are in good health and satisfied with their health care, many have health problems and do not get adequate levels of preventive care. The report also examines women’s health status, health care costs, insurance, access to care, prevention, and their role in family…

  • Women and Health Care: A National Profile – Report

    Report

    Report - Women and Health Care: A National Profile Women and Health Care: A National Profile is a nationally representative telephone survey of 2,766 women ages 18 and older. A shorter companion survey of 507 men was also conducted. Full Report (.pdf) Report Highlights (.pdf) Introduction and Methods (.pdf) Chapter 1: The Demographics of Women (.pdf) Chapter 2: The Health of Women (.pdf) Chapter 3: Women and Health Insurance Coverage (.pdf) Chapter 4: Women's Access…

  • The California Medicaid Program at a Glance

    Fact Sheet

    This fact sheet provides an overview of California's Medicaid program, Medi-Cal, the population that it serves, and the services it covers. Fact Sheet (.pdf)

  • The Distribution of Assets in the Elderly Population Living in the Community

    Issue Brief

    Individuals cannot qualify for Medicaid nursing home care or home and community-based services unless they meet their state's asset eligibility standards. Currently, states are required to examine all transfers for less than fair market value that occurred within 36 months prior to an individual's application for Medicaid. This issue paper examines the assets of elderly people living in the community, focusing on those most at risk of using nursing home care. The paper finds that…

  • National Survey of the Public’s Views About Medicaid

    Poll Finding

    National Survey of the Public's Views About Medicaid This national survey of the public reveals that Americans view the Medicaid program positively and are reluctant to see state and federal cuts to the program. The survey also asked the public about their knowledge of the Medicaid program. Chartpack Toplines

  • National Survey of the Public’s Views About Medicaid – Toplines

    Poll Finding

    National Survey of the Public's Views About Medicaid - Toplines This toplines document provides key findings from the national survey of the public on their views about Medicaid. The survey was conducted in April and May of 2005. The survey includes findings on Americans' personal experience with Medicaid, their knowledge of the program, and their opinion about the program's coverage and funding by the state and federal government. Survey Toplines (.pdf)

  • National Survey of the Public’s Views About Medicaid – Chartpack

    Report

    This chartpack provides key findings from the national survey of the public on their views about Medicaid. The survey was conducted in April and May of 2005. The survey includes findings on Americans' personal experience with Medicaid, their knowledge of the program, and their opinion about the program's coverage and funding by the state and federal government. Chartpack (.pdf)