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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.

Dual Eligibles

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  • Economic Stress and the Safety Net: A Health Center Update

    Issue Brief

    The issue paper provides data on the demographic profile of health center patients and the revenue sources available for financing their care, including recent increases in federal discretionary funding. It examines the impact of the recent economic downturn on health centers in selected communities, exploring the effect of elevated unemployment levels among lower wage workers, declining private health insurance coverage, and widespread cutbacks in Medicaid--the single most important source of health center financing. Issue Paper…

  • Olmstead at Five:  Assessing the Impact

    Report

    This report examines the impact of Olmstead v. L.C. five years after the United States Supreme Court’s 1999 landmark decision. The analysis brings together new research with a synthesis of research undertaken over the past five years, to help policymakers and program administrators understand the meaning of the Americans with Disabilities Act for health programs in Olmstead’s aftermath. Report (.pdf) Related Olmstead Materials

  • The “Clawback:” State Financing of Medicare Drug Coverage

    Issue Brief

    This issue paper describes the origins of the clawback, the formula by which each state’s clawback amount is calculated, and the clawback’s implications for states and for low-income Medicare beneficiaries. Issue Paper (.pdf)

  • Issues Surrounding the “Clawback” or State Contributions Towards Medicare Drug Coverage:  A Conference Call Discussion

    Other Post

    Issues Surrounding the “Clawback” or State Contributions Towards Medicare Drug Coverage: A Conference Call Discussion As part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 signed into law last year, Congress included a financing provision that requires a monthly payment from each state to the Medicare program beginning in January 2006. MMA’s clawback provision will recapture most of the savings that states would realize when Medicare assumes prescription drug costs for…

  • Additional Help with Rx Drug Costs For Low-Income People on Medicare

    Other Post

    Additional Help with Prescription Drug Costs For Low-Income People on Medicare (For 2007 Benefits and Cost-Sharing) As of 2007, Medicare helps pay for outpatient prescription drugs. Medicare provides additional help with drug costs to beneficiaries who qualify based on low incomes and limited resources. The information below describes the different levels of assistance available to people who meet the eligibility requirements. People on Medicare Who Also Have Full Medicaid Benefits (Dual Eligibles) pay: No premium…

  • Medicaid Prescription Drug Spending and Use

    Issue Brief

    This issue paper provides the latest data and trend analysis on Medicaid prescription drug spending and utilization. In 2002, Medicaid programs spent $30 billion for prescribed drugs. Issue Paper (.pdf)

  • The U.S. Supreme Court’s Olmstead Decision:  Five Years Later

    Event Date:
    Event

    The U.S. Supreme Court's Olmstead Decision: Five Years Later Five years after the Supreme Court’s landmark Olmstead decision applying the Americans with Disabilities Act to the right of individuals with disabilities to receive health care in a community-based setting, the Kaiser Commission on Medicaid and the Uninsured releases two new reports and a video examining what progress has been made and the impact on the Medicaid program. Policy Brief - Olmstead v. L.C.: The Interaction…

  • Olmstead: I Did It

    Video

    This Kaiser Commission on Medicaid and the Uninsured video segment returns to the plaintiffs of the Olmstead case five years after the landmark U.S. Supreme Court decision. It reports on the impact of the decision for individuals with disabilities and some of the challenges that remain in the implementation of the court ruling.

  • The Impact of Recent Changes in Health Care Coverage for Low-Income People:  A First Look at the Research Following Changes in Oregon’s Medicaid Program

    Issue Brief

    The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon's Medicaid Program Oregon recently restructured its Medicaid program through a Section 1115 waiver and other program changes, largely in response to particularly difficult state budget problems. This report summarizes key findings on the impact of Oregon's changes, based on work conducted by a research collaborative within the state. The experience in Oregon may…