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What to Watch

Medicaid: What to Watch in 2026

Medicaid: What to Watch in 2026

In this brief, KFF explores how state fiscal pressures are likely to converge with the implementation of the 2025 reconciliation law to affect Medicaid coverage, financing, and access to care over the next year, especially leading up to the midterm elections.

Work Requirements

Challenges with Implementing Work Requirements

Many states are anticipating a variety of implementation challenges, including the need for complex system changes, a compressed implementation timeline, and limited staff capacity.

What is the Medicaid Hardship Exception?

The number of Medicaid expansion enrollees who ultimately qualify for the high unemployment hardship exception will depend on how the exception is implemented and how unemployment rates changes.

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

KFF’s interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.

2025 Medicaid Home Care survey

Payment Rates Ahead of 2025 Reconciliation Law

This issue brief describes Medicaid payment rates for home care and other workforce supports that are in place in 2025, before the majority of the 2025 reconciliation law provisions start taking effect.

Home Care Support for Family Caregivers in 2025
number of responding states, including DC, that allow payments for family caregivers by type of home care program and type of caregiver.

This issue brief describes the availability of self-directed services and supports for family caregivers in Medicaid home care in 2025, before most provisions in the reconciliation law take effect.

States’ Management of Home Care Spending

This issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

Waiting Lists for Medicaid Home Care, 2016 to 2025
A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025

This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect.

Eligibility and coverage

  • Eligibility, Enrollment, and Renewal Policies

    KFF's survey findings capture state actions that seek to improve the accuracy and efficiency of Medicaid and CHIP enrollment and renewal processes, as of January 2025.

  • Seniors and People with Disabilities

    More than 1 in 3 people with disabilities (15 million) have Medicaid (35%). In comparison, only 19% of people without disabilities have Medicaid.

  • Children with Special Needs

    Amid debates about proposed cuts to federal Medicaid spending, this brief analyzes key characteristics of children with special health care needs and explores how Medicaid provides them with coverage.

  • People With Intellectual and Developmental Disabilities

    Among the estimated 8 million people with intellectual and developmental disabilities (I/DD), over three million have Medicaid coverage.

  • Adults with Chronic Conditions

    Among working age adults enrolled in Medicaid, approximately three quarters have one or more chronic conditions, and nearly one-third have three or more.

The Essentials

  • 5 Facts: Immigrants and Medicaid

    This brief provides five key facts on Medicaid and immigrants as context for understanding the potential impacts of policy changes under the Trump administration.

  • 5 Facts: Medicaid and Hospitals

    This brief explains the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid, the share of births covered by the program, and how Medicaid expansion has impacted hospital finances.

  • Medicaid Financing: The Basics

    Medicaid is a major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.

  • 5 Facts: Medicaid’s Share of National Health Spending

    This brief explores how Medicaid spending contributes to national health spending and how different service areas contribute to Medicaid costs.

  • 5 Facts: Medicaid and Nursing Facilities

    The substantial Medicaid savings in the reconciliation bill could have major implications for nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them.

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  • Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency

    Issue Brief

    Provisions in the Families First Coronavirus Response Act (FFCRA) require states to maintain continuous Medicaid enrollment for enrollees until the end of the month when the COVID-19 public health emergency (PHE) ends. When the continuous enrollment requirements end and states resume redeterminations and disenrollments, individuals with LEP may be at increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers completing these processes, even if they remain eligible for coverage.

  • How Many Medicaid Enrollees Moved In 2020 And What Are The Implications For Unwinding the Public Health Emergency?

    Issue Brief

    Once states resume redeterminations and disenrollments at the end of the public health emergency (PHE), Medicaid enrollees who moved within a state during the pandemic but are still eligible for coverage are at increased risk of being disenrolled if their contact information is out of date. We analyzed federal survey data for 2020 and found that roughly 1 in 10 Medicaid non-elderly enrollees (9%) moved in-state in 2020. A much smaller share, just 1%, moved to a different state in the U.S. Individuals that move within state may continue to be eligible for Medicaid, while a move out of state would make them no longer eligible for Medicaid coverage in their previous residence. States can take a number of actions to update enrollees’ addresses and other contact information to minimize coverage gaps and losses for eligible individuals after the end of the PHE, particularly for individuals who may have moved within a state.

  • Medicaid Spending and Enrollment: Updated for FY 2022 and Looking Ahead to FY 2023

    Issue Brief

    In February 2022, the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) fielded a rapid, mini-survey of Medicaid directors in all 50 states and the District of Columbia as a follow-up to the annual Medicaid Budget Survey conducted in summer 2021. This brief explores Medicaid enrollment and spending growth estimates for FY 2022 and projections for FY 2023, as reported by state Medicaid directors.

  • States Look to Bolster Maternal Health

    Feature

    Starting April 1, states have a new option to extend Medicaid postpartum coverage from 60 days to 12 months without having to seek a waiver.

  • Help with Medicare Premium and Cost-Sharing Assistance Varies by State

    Issue Brief

    This data note provides an overview of programs that help beneficiaries with modest incomes with their Medicare costs, including the Medicare Savings Programs and the Part D Low-Income Subsidy, and highlights findings from corresponding state-level profiles of eligibility and enrollment.

  • Nursing Facility Staff Vaccinations, Boosters, and Shortages After Vaccination Deadlines Passed

    Issue Brief

    This analysis uses nursing facility-level data reported by the federal government to track the increase in vaccination rates among nursing facility staff nationally and by state between August 2021 (when the vaccine mandate was first announced) and March 27th, 2022 (after the vaccine deadline for health workers had passed in all states). Additionally, this analysis provides state-level information on booster rates among nursing home staff and the prevalence of staffing shortages after all vaccination deadlines had passed.

  • COVID-19 Vaccination Rates Among Nursing Home Staff Have Risen by 25 Percentage Points Since the Biden Administration Announced a Vaccination Mandate for Health Care Workers Last Year

    News Release

    In a new analysis, KFF researchers find that COVID-19 vaccination rates among nursing home staff increased by 25 percentage points nationally (63% to 88%) from when the Biden administration announced the vaccine mandate for health care workers in August 2021 to after vaccination deadlines passed in March 2022.

  • Mitigating Childhood Lead Exposure and Disparities: Medicaid and Other Federal Initiatives

    Issue Brief

    Exposure to lead can seriously harm a child’s health, including damage to the brain and nervous system, slowed growth and development, learning and behavior problems, and hearing and speech problems. The effects of lead on the nervous system can cause lower IQ, decreased ability to pay attention, and under performance in school.

  • How Community Health Centers Are Serving Low-Income Communities During the COVID-19 Pandemic Amid New and Continuing Challenges

    Issue Brief

    Community health centers are a national network of safety-net primary care providers serving low-income, medically underserved communities. Based on findings from a national survey of health centers, this brief examines how the pandemic has affected health center patients and services as well as the ongoing challenges health centers and their patients face.