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An Early Look at States’ Differing Approaches to Implementing Medicaid Work Requirements Amid Cost and Time Constraints and Uncertainty

A new KFF survey of state Medicaid officials and focus groups in eight states captures the different choices states are making about how to implement Medicaid work requirements, with seven states planning for a more restrictive approach to verifying work or exemption status or to implement work requirements early. These implementation plans are taking shape as states encounter time, cost, and other constraints as well as uncertainty about how to define and verify certain exemptions due to delayed federal guidance.

Medicaid Watch

Featuring policy research, polling and news about how Medicaid is changing, and the impact of those changes due to the tax and spending cuts law

Medicaid Work Requirements

Tracking Medicaid Work Requirements: u003cbru003eData and Policies

To implement Medicaid work requirements, states will need to make important policy and operational decisions, implement needed system upgrades or changes, develop new outreach and education strategies, and hire and train staff, all within a relatively short timeframe. The information tracked here can serve as a resource to understand Medicaid work requirements and state options, gauge readiness, and track implementation of the requirements.

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 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.

5 Facts: 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 in 2025

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.

5 Facts: 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.

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.

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  • Health Coverage and Access Challenges for Low-Income Women

    Issue Brief

    This issue brief examines low-income women’s health insurance coverage, experience with health plans and providers, and access to care. The analysis is based on data from the 2001 Kaiser Women’s Health Survey, a nationally representative survey of nearly 4,000 women between the ages of 18 and 64. Issue Brief (.pdf)

  • Two New Reports Show Progress On Health Coverage Is Threatened As States Continue To Face Growing Pressures To Control Costs

    Report

    Two New Reports Show Progress on Health Coverage is Threatened as States Continue to Face Growing Pressures to Control Costs Two new KCMU 50-state surveys show states continue to face budget pressures that could limit public coverage. One survey shows all states plan more Medicaid cost-containment actions in FY2005 and the second shows that after recent gains, securing Medicaid and SCHIP coverage is more difficult for low-income families in 23 states. News Release The Continuing…

  • Covering New Americans:  A Review of Federal and State Policies Related to Immigrants’ Eligibility and Access to Publicly Funded Health Insurance

    Report

    Covering New Americans: A Review of Federal and State Policies Related to Immigrants' Eligibility and Access to Publicly Funded Health Insurance This brief provides an overview of health coverage challenges facing immigrants, the federal rules regarding immigrants’ eligibility for Medicaid and SCHIP, and state efforts to provide replacement coverage for immigrants who are ineligible for Medicaid and SCHIP. Report (.pdf)

  • Spotlight on Uninsured Parents: How a Lack of Coverage Affects Parents and Their Families

    Issue Brief

    Providing health coverage for the entire family can both help to increase coverage of children and assist low-income families in obtaining more affordable health care services. This brief uses data from the 2005 Kaiser Low-Income Coverage and Access Survey to examine health coverage, access and the financial impacts of health care for low-income parents and their families. Issue Brief (.pdf)

  • Coverage Gains Under Recent Section 1115 Waivers: A Data Update

    Issue Brief

    This brief assesses the extent to which recent Section 1115 waivers have helped reduce the number of uninsured people and finds that there has been a net gain in coverage of 426,329 people under recent waivers. Issue Paper (.pdf)

  • Building an On-Ramp to Children’s Health Coverage:  A Report on California’s Express Lane Eligibility Program

    Report

    Building an On-Ramp to Children's Health Coverage: A Report on California's Express Lane Eligibility Program This report documents the results from California’s Express Lane Eligibility (ELE) initiative through the school lunch program (now one year into implementation), which has been piloted in 72 schools in 5 school districts in the state. ELE is an enrollment strategy that targets large numbers of uninsured children, who are eligible for the federal-state programs Medicaid and SCHIP, where they…

  • Dual Eligibles:  Medicaid’s Role for Low-Income Medicare Beneficiaries

    Fact Sheet

    Dual Eligibles: Medicaid's Role for Low-Income Medicare Beneficiaries This fact sheet and set of tables describe the over 7 million “dual eligibles,” the low-income elderly and persons with disabilities who are enrolled in both Medicare and Medicaid. The fact sheet describes why this population needs Medicaid, what services they receive from Medicaid, and the current policy challenges related to dual eligibles, including the new Medicare prescription drug benefit. The set of tables, prepared by the…

  • Dual Eligible Home and Community-Based Waiver Program Participants and the New Medicare Drug Benefit

    Issue Brief

    Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan. This paper offers state and federal policymakers…

  • State Financing of the Medicare Drug Benefit:  New Data on the “Clawback”

    Issue Brief

    State Financing of the Medicare Drug Benefit: New Data on the "Clawback" Beginning in 2006, states will be obligated to finance part of the new Medicare prescription drug benefit via a monthly "clawback" payment to the federal government. This issue update analyzes the latest data and provides an overview of the state financing of the Medicare drug benefit. Issue Brief (.pdf)