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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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  • Financing Health Coverage:  The State Children’s Health Insurance Program Experience

    Issue Brief

      Financing Health Coverage: The State Children's Health Insurance Program Experience Enactment of SCHIP sought a balance between increasing funds available for coverage and limiting total federal outlays. While SCHIP has had widespread support and success in helping to provide coverage for uninsured children, its capped financing system has also created challenges for states, including inequities among states and projected federal funding shortfalls. This issue brief explores three basic sets of issues associated with SCHIP’s…

  • Navigating Medicare and Medicaid: A Resource Guide for People with Disabilities, Their Families, and Their Advocates

    Report

    Navigating Medicare and Medicaid: Resource Guides for People with Disabilities, Their Families, and Their Advocates These guides explain the critical role Medicare and Medicaid have come to play in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and give people with disabilities new information to help them get the most from these programs. Navigating Medicare and Medicaid, 2005 Keeping Medicare and Medicaid When You Work, 2005

  • Medicaid:  An Overview of Spending on “Mandatory” vs. “Optional” Populations and Services

    Issue Brief

    Medicaid: An Overview of Spending on "Mandatory" vs. "Optional" Populations and Services This issue brief provides an overview of Medicaid’s optional beneficiaries and services. The brief demonstrates that although “optional” populations account for only 29 percent of Medicaid enrollment, 60 percent of all Medicaid expenditures for both “mandatory” and “optional” populations are “optional,” and the majority of these (86 percent) pay for services provided to the elderly and disabled. 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…

  • Who Stays and Who Goes Home: Using National Data on Nursing Home Discharges and Long-Stay Residents to Draw Implications for Nursing Home Transition Programs

    Report

    This report analyzes survey data to describe the characteristics of two groups of nursing home residents who are 65 years or older: those who are discharged back to the community over a one year time period and those who remain in nursing homes for 90 days or longer. Over the last several years, some states have turned their attention to returning nursing home residents to community settings through nursing home transition programs. The findings provide…

  • Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006

    Poll Finding

    The 50-state annual survey of about budget conditions and Medicaid cost containment actions in FY2005-06 shows that all states implemented and planned more Medicaid cost-containment actions, but are also implementing expansions as the gap between Medicaid spending growth and state tax revenue narrowed. Report (.pdf) Executive Summary (.pdf)

  • 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…