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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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  • Medicaid Long-Term Services Reforms in the Deficit Reduction Act

    Issue Brief

    The Deficit Reduction Act of 2005 (DRA) was signed by the President in February 2006 and included major changes to the Medicaid program. This brief provides an overview of the changes to the rules and direction of Medicaid long-term care services as enacted in the DRA. Issue Brief (.pdf)

  • Outreach Strategies for Medicaid and SCHIP: An Overview of Effective Strategies and Activities

    Report

    Outreach Strategies for Medicaid and SCHIP: An Overview of Effective Strategies and Activities This paper highlights key components of effective outreach strategies to enroll children in Medicaid and SCHIP and also to get them access to care once enrolled. In addition, the paper examines how these strategies have been implemented in states and the challenges of continuing to push for enrollment as states face continued fiscal pressures and barriers to participation are resurrected. Report (.pdf)

  • New Publications Summarize and Explain Trends in Medicaid Spending and Enrollment

    Fact Sheet

    A new fact sheet and report analyze Medicaid spending and enrollment trends for 2000-2004. Medicaid trends are related to the state of the nation's economy, and as the economy has strengthened, increases in enrollment and spending have slowed. Rising enrollment and health care inflation produced most of Medicaid's spending increases. Even with a stronger economy, however, Medicaid's enrollment pressures remain due to demographic trends and continued declines in employer-sponsored insurance. Medicaid Enrollment and Spending Trends…

  • West Virginia Medicaid State Plan Amendment: Key Program Changes and Questions

    Fact Sheet

    This fact sheet summarizes the key changes West Virginia has approved for its Medicaid program as a result of the new flexibility available through the Deficit Reduction Act of 2005. West Virginia will change the benefit package for children and parents, parents will sign a member agreement for themselves and on behalf of their children to access certain benefits, and providers and managed care plans will monitor and report to the state their patients’ status…

  • National Survey of Pharmacists 2006: Full Topline Results

    Poll Finding

    National Survey of Pharmacists 2006: Full Topline Results These toplines provide additional findings from a 2006 national survey of pharmacists on their views and experiences on a wide range of health care issues. Toplines (.pdf)

  • Medicaid 1915(c) Home and Community-Based Service Programs: Annual Data Update

    Issue Brief

    Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last two decades and the focus of Medicaid policy debates recently. While the majority of Medicaid long-term care dollars go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 1992 to 2003. This report presents a summary of the main trends to emerge from the data for…

  • A Decade of SCHIP: Experience and Issues for Reauthorization

    Issue Brief

    A Decade of SCHIP: Experience and Issues for Reauthorization As the SCHIP program is due for reauthorization in 2007, this brief explores some lessons learned and highlights key policy issues for the upcoming debate. Issue Brief (.pdf)

  • Health Coverage for Low-Income Parents

    Fact Sheet

    The fact sheet summarizes the health coverage of low-income parents, including recent trends, and discusses the current policy challenges related to expanding care for this population. Fact Sheet (.pdf)

  • The State Children’s Health Insurance Program: Lessons and Outlook

    Event

    The State Children's Health Insurance Program: Lessons and Outlook Barbara Lyons, a vice president of the Foundation and deputy director of the Foundation's Commission on Medicaid and the Uninsured, testified before a field hearing of the U.S. Committee on Finance about lessons learned from ten years of the State Children's Health Insurance Program and the outlook for the program's future. Testimony (.pdf)

  • Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Children

    Issue Brief

    Largely due to a high uninsured rate, low-income, non-citizen children have very poor access to care, with many lacking a regular provider and going without preventive care. This brief examines health coverage and access to care for low-income, non-citizen children to provide insight into the challenges they face in obtaining health insurance and accessing care. Issue Brief (.pdf)