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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 Work Requirements

Tracking Medicaid Work Requirements: Data 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 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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  • Implications of Congress Eliminating Major Biden Era Regulations for Medicaid

    Policy Watch

    The Biden administration finalized several major Medicaid regulations with the intent of improving access to Medicaid services. Collectively, the rules span hundreds of pages of text, are extremely complex, and were set to be implemented over several years, with measurable increases in federal Medicaid spending. Overturning the rules would reduce regulation of managed care companies, nursing facilities, and other providers; increase barriers to enrolling in and renewing Medicaid coverage, and roll back enrollee protections, payment…

  • On Medicaid Expansion, History Matters

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman discusses the history of the battles over the ACA’s provisions that were designed to expand coverage for the uninsured, which helps explain the effort to cut federal funding for the Medicaid expansion today. The real underlying issues, he says, are the same divisions that have always plagued the debate about covering the uninsured.

  • Medicaid Covers at Least One in Five Hospital Inpatient Days in Nearly Every State

    Issue Brief

    This analysis examines the share of inpatient hospital days that are covered by Medicaid nationally and by state at a time when Congress is considering potential cuts to the program. It finds that Medicaid covered at least one in five inpatient hospital days in 48 states and the District of Columbia in 2023.

  • KFF examines and compares states across a range of measures that may make it harder for states to respond to potential federal Medicaid cuts.

    Responding to Federal Medicaid Reductions: Which States Are Most at Risk?

    Issue Brief

    A new KFF analysis examines a range of measures that may make it harder for states to respond to possible federal Medicaid cuts and finds that six states (Kentucky, Mississippi, Missouri, New Mexico, South Carolina, and West Virginia) rank in the top five for multiple risk categories. Across four broad categories of measures that could affect demand for Medicaid and states’ abilities to raise revenue or reduce spending—population demographic characteristics, health status of Medicaid enrollees,…

  • States that were approved under the Biden administration "HRSN framework," as well as states that received approval for DSHP funding authority.

    Section 1115 Waiver Watch: Early Signs Point to New Directions Under Trump Administration

    Issue Brief

    Recent actions from the Trump administration could signal limits to curtail Medicaid waivers related to social determinants of health and to limit waiver financing tools and flexibility. Two major changes demonstrate this shift: (1) rescinding Biden-era guidance on covering health-related social needs (HRSN) services, and (2) phasing out federal funding for “Designated State Health Programs” (DSHP) in waivers.

  • Most of the Public Oppose Major Federal Cuts to Health Agencies and Programs and Say They Have Been Made “Recklessly”

    News Release

    As the Trump administration and Congress pursue broad cuts to federal health agencies and budgets, most of the public, including some Republicans, oppose deep budget and staffing cuts to federal health programs and agencies, a new KFF Health Tracking Poll finds. Across a range of questions, large majorities of Democrats and independents oppose the Trump administration’s major cuts to federal health agencies and programs, while Republicans are more supportive. Those who identify with President Trump’s…