Medicaid

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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  • 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.

  • Medicaid Home & Community-Based Services: People Served and Spending During COVID-19

    Issue Brief

    This issue brief presents FY 2020 state-level data on the number of people receiving Medicaid HCBS and HCBS spending. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related brief presents the latest data and highlights themes in key state policy choices about optional HCBS.

  • How Could the Build Back Better Act Affect Uninsured Children?

    Issue Brief

    This brief examines characteristics of uninsured children in 2020 and discusses how current policy proposals, including outreach efforts, continuous eligibility requirements, and closing the coverage gap, could affect children’s health coverage. Recent efforts to expand coverage for adults could benefit children’s coverage, especially for children in non-expansion states if the coverage gap is filled as proposed by the Build Back Better Act (BBBA).

  • Analysis Examines How States Can Use Medicaid Programs to Facilitate Access to Vaccines for Low-Income Children

    News Release

    As states expand COVID-19 vaccination efforts to reach newly eligible children ages 5 to 11, a new KFF analysis highlights several tools state Medicaid programs have at their disposal to increase access to, and take up of, vaccines among lower-income children. Among the key findings: States can request Medicaid administrative federal matching funds for state-funded monetary incentives to encourage uptake of the vaccine. In recent months, several states reported activities and incentives within contracted Medicaid…

  • More Than 6 in 10 of the Remaining 27.4 Million Uninsured People in the U.S. are Eligible for Subsidized ACA Marketplace Coverage, Medicaid or the Children’s Health Insurance Program

    News Release

    Recent policy attention has focused on efforts to reduce the number of uninsured people in the U.S. by expanding eligibility for coverage assistance, including enhanced premium subsidies in the Affordable Care Act (ACA) Marketplace and filling the Medicaid “coverage gap.” A new KFF analysis shows that a majority of the 27.4 million people who remained uninsured in 2020 already are eligible for financial assistance for coverage through Medicaid/CHIP or the Marketplace, suggesting that policies in…

  • Build Back Better Would Reduce Disproportionate Share Hospital (DSH) Payments and Limit Uncompensated Care (UCC) Pools in Non-Expansion States

    Policy Watch

    The Build Back Better (BBB) Act proposes reducing disproportionate share hospital (DSH) allotments by 12.5% starting in federal fiscal year (FFY) 2023 and places limits on Medicaid uncompensated care (UCC) pools for non-expansion states. This policy watch explains what these payments are, what changes have been tied to the ACA, and examines potential implications of changes included in the BBB.

  • Medicaid Enrollment Churn and Implications for Continuous Coverage Policies

    Issue Brief

    Recent policy actions and proposals in Medicaid have renewed focus on the problem of churn, or temporary loss of coverage in which enrollees disenroll and then re-enroll within a short period of time. We find that 10% of full-benefit enrollees have a gap in coverage of less than a year, and rates are higher for children and adults compared to aged and people with disabilities. Churn has implications for access to care as well as…