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An Early Look at States’ Differing Approaches to Implementing Medicaid Work Requirements Amid Cost and Time Constraints and Uncertainty

A new KFF survey of state Medicaid officials and focus groups in eight states captures the different choices states are making about how to implement Medicaid work requirements, with seven states planning for a more restrictive approach to verifying work or exemption status or to implement work requirements early. These implementation plans are taking shape as states encounter time, cost, and other constraints as well as uncertainty about how to define and verify certain exemptions due to delayed federal guidance.

Medicaid Work Requirements

Tracking 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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  • Transitions 2005

    Video

    Transitions is a video that explores some of the issues and challenges “dual eligibles” may face during the transition from Medicaid drug coverage to Medicare.

  • The Implications of the Medicare Prescription Drug Benefit for Dual Eligibles

    Other Post

    Three new reports focus on one of the biggest challenges in the implementation of the Medicare Modernization Act, the transitioning of drug coverage for individuals dually eligible for Medicaid and Medicare, who now get their drug coverage from Medicaid, to the new Medicare benefit. The New Medicare Prescription Drug Law: Issues for Enrolling Dual Eligibles into Drug Plans Medicare's New Prescription Drug Benefit: The Voices of People Dually Covered by Medicare and Medicaid Implications of…

  • What Has Caused the Growth in Medicaid Spending in Recent Years?

    Event Date:
    Event

    A new study published in Health Affairs explains what caused Medicaid spending to rise from 2000-2003 and confirms the role Medicaid played in covering people during the recent economic downturn, and that Medicaid per enrollee spending grew at a slower rate than private insurance spending. The Kaiser Commission on Medicaid and the Uninsured and Health Affairs cosponsored a briefing to discuss the findings of the study. News Release Understanding the Recent Growth in Medicaid Spending,…

  • Medicaid:  Issues In Restructuring Federal Financing

    Issue Brief

    Medicaid: Issues In Restructuring Federal Financing This brief analysis summarizes how the possible restructuring of Medicaid financing could impact states, providers, and beneficiaries. Issue Brief (.pdf)

  • Medicaid Section 1115 Waivers: Current Issues

    Fact Sheet

    This fact sheet provides a brief introduction to Section 1115 waivers in the Medicaid program and highlights policy issues related to recent waiver activity. Fact Sheet (.pdf)

  • The Impact of Medicaid Reductions in Oregon:  Focus Group Insights

    Report

    The Impact of Medicaid Reductions in Oregon: Focus Group Insights Oregon is one state that has significantly restructured its Medicaid program, known as the Oregon Health Plan (OHP), in response to budget pressures. As part of these changes, it has implemented significant benefit reductions and increased premiums and cost sharing in it’s program for poor parents and other adults. This report presents findings from five focus groups conducted of current and former enrollees in Oregon’s…

  • State Fiscal Conditions and Medicaid – UPDATE

    Fact Sheet

    State Fiscal Conditions and Medicaid This fact sheet updates the current fiscal situation facing states, the impact the recent downturn in the economy had on Medicaid growth, and the cost containment actions being taken by states to curb Medicaid spending. Fact Sheet (.pdf)