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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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  • CHIP TIPS: Medicaid Performance Bonus

    Issue Brief

    This brief, the first in a series, examines the new federal "performance bonus" available to states that do an especially good job of signing up eligible children for Medicaid. The bonus, created by a provision in the Children's Health Insurance Program Reauthorization Act of 2009, is designed to help states cover the added costs that result when states are very successful in enrolling eligible children in Medicaid above target levels specified in the law. It…

  • CHIP TIPS: Citizenship Documentation Changes

    Issue Brief

    This brief, the third in a series, examines changes to citizenship documentation requirements under the Children's Health Insurance Program Reauthorization Act of 2009. The law extends the requirement to document citizenship that applied in Medicaid to CHIP as well. At the same time, it modifies current requirements to reduce the paperwork burden on families and states and helps ensure that eligible children and others are enrolled and receive needed health care without delay. Brief (.pdf)

  • How Will The Uninsured Be Affected By Health Reform?

    Issue Brief

    This brief examines who the uninsured are and explores how they could be affected by health reform, including estimates of how many might qualify for coverage under a Medicaid expansion, how many would be eligible for subsidies and how many would not be eligible for such help. Issue Brief (.pdf)

  • Efforts in States to Promote Medicaid Community-Based Services and Supports

    Issue Brief

    This brief summarizes lessons in offering more home and community-based services from states at the forefront of the effort. It describes current options for state Medicaid programs and draws on interviews with state officials to provide details about specific policies and procedures in states. Brief (.pdf)

  • Medicaid and Managed Care: Key Data, Trends, and Issues

    Issue Brief

    This brief provides a snapshot of the Medicaid program's use of managed care to deliver services to beneficiaries. It examines the prevalence of managed care in state Medicaid programs; the various approaches states have used, including primary-care case management; managed care for long-term services and for beneficiaries dually eligible for Medicaid and Medicare; and evidence of cost-savings.   ISSUE BRIEF Download

  • Expanding Medicaid to Low-Income Childless Adults Under Health Reform: Key Lessons From State Experiences

    Issue Brief

    The health reform law will expand Medicaid to millions of low-income adults, including many childless adults who have historically been ineligible for the program, necessitating one of the largest enrollment efforts in the program's history. This report, based on interviews with officials in seven states and the District of Columbia and national experts, examines lessons learned from past state experience covering childless adults through waiver and state-funded programs and profiles the programs included in the…

  • Article and Policy Forum Examine Medicare, Health Reform and the Challenges Facing People With Disabilities

    Event Date:
    Event

    Wednesday, Sept. 8, the Foundation held a policy workshop examining Medicare, health reform and the challenges facing people with disabilities. Younger Medicare beneficiaries with disabilities are much more likely than seniors in the program to report problems accessing and paying for needed medical services, Kaiser Family Foundation researchers report in this Health Affairs article. Based on a national random-sample survey of people on Medicare, the study finds that half of nonelderly disabled beneficiaries report problems…

  • More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

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    Event

    In the debates around the health reform law and its implementation, little attention has been given to the law's provisions supporting long-term care. This briefing offered an overview of these provisions, such as the CLASS Act, a new national, voluntary insurance program to help working adults finance services and supports that they may need in the future, and the Community First Choice Option, which helps Medicaid recipients get attendant care at home. This October 1…

  • Medicaid and HIV: A National Analysis

    Report

    This report considers Medicaid’s current role in providing health coverage for people with HIV. It analyzes national enrollment and spending patterns for Medicaid enrollees with HIV, looking at key demographics, Medicaid eligibility pathways, services and geographic distribution. It also compares Medicaid enrollees with HIV to their counterparts without the disease, as well as to the population of people living with HIV in the U.S. The report finds that while Medicaid enrollees with HIV represent less…

  • Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues To Consider

    Issue Brief

    There is increased interest among states in operating Medicaid managed long-term services and support (MLTSS) programs rather than paying for long-term services and supports (LTSS) on a fee-for-service basis, as has been the general practice. This issue brief examines key issues for states to consider if they are contemplating a shift to covering new populations and LTSS benefits through capitated payments to traditional risk-based managed care organizations (MCOs). It draws on current literature as well…