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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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  • Making Child Health Coverage a Reality: Lessons From Case Studies of Medicaid and CHIP Outreach and Enrollment Strategies

    Report

    Recent expansions in public health insurance for children and changes in welfare laws present states with the challenge of identifying and enrolling the large population of uninsured children in their Medicaid and Children's Health Insurance Programs (CHIP). This study describes and analyzes the outreach and enrollment strategies and systems in place in four states at the county level, highlighting issues and challenges states face during implementation. The study sites selected were Santa Clara County (San…

  • Profiles of Disability: Employment and Health Coverage

    Report

    This Background Paper presents information on the disabled population, as well as alternative definitions of disability and the resulting impact on population estimates of the disabled population. In addition, this paper presents a profile of non-elderly persons with disabilities, including work status and health insurance coverage, and concludes with a discussion of policy issues related to facilitating participation in the workforce for persons with disabilities and improving access to health insurance coverage. Background Paper (.pdf)

  • Managed Care and Low-Income Populations:  Four Years’ Experience with TennCare

    Report

    Managed Care and Low-Income Populations: Four Years' Experience with TennCare This report updates an earlier study of Tennessee's experience with restructuring their Medicaid programs. It is one of a series of reports from The Kaiser/ Commonwealth Low-Income Coverage and Access Project. This project examines how changes in the Medicaid program have affected health insurance coverage and access to care for the low-income population in eight states: California, Florida, Maryland, Minnesota, New York, Oregon, Tennessee and…

  • Managed Care and Low-Income Populations: Four Years’ Experience with the Oregon Health Plan

    Report

    This report updates an earlier study of Oregon's experience with restructuring their Medicaid programs. It is one of a series of reports from The Kaiser/Commonwealth Low-Income Coverage and Access Project. This project examines how changes in the Medicaid Program have affected health insurance coverage and access to care for the low-income population in eight states: Maryland, California, Florida, Minnesota, New York, Oregon, Tennessee and Texas. Report

  • The Medicaid Eligibility Maze: Coverage Expands, but Problems Persist

    Report

    This report examines Medicaid eligibility policies and operations in five states - California, Colorado, Florida, Minnesota and Wisconsin - following initial changes introduced by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 and the new Children's Health Insurance Program (CHIP). The study findings suggest that eligibility policy expansions alone may not prevent Medicaid enrollment declines. The report discusses several problem areas affecting Medicaid eligibility and enrollment operations including challenges in severing Medicaid…

  • Managed Care for Low-Income Populations with Special Needs: The Oregon Experience

    Report

    This report focuses on Oregon's experience in moving their disabled Medicaid beneficiaries into managed care. It is one of a series of reports from The Kaiser/Commonwealth Low-Income Coverage and Access Project. This project examines how changes in the Medicaid program have affected health insurance coverage and access to care for hte low-income population in eight states: California, Florida, Maryland, Minnesota, New York, Oregon, Tennessee and Texas. Report

  • Medicaid and HIV/AIDS Policy: A Basic Primer

    Report

    The Medicaid Primer presents in depth information on Medicaid, the federal/state program that provides health coverage for low-income families and people with disabilities and is the largest source of public financing for HIV/AIDS care in the U.S. The Medicaid Primer is designed to help policymakers and advocates navigate through the complexities of Medicaid with regard to the program's role for people with HIV/AIDS. REPORT Download

  • A Profile of the Low-Income Uninsured

    Issue Brief

    This policy brief provides an overview of the low-income, uninsured population. Based on an analysis of the March 1998 Current Population Survey, the report discusses the demographic characteristics of this vulnerable population. It also presents information detailing health insurance coverage for low-income children and adults, as well as trends in insurance coverage over the past decade. It concludes with a discussion of recent coverage expansions and policy changes that have affected low-income Americans. The policy…

  • Access To Health Care:

    Report

    Promises and Prospects For Low-Income Americans This book explores critical issues affecting access to health care for low-income Americans by assessing the importance of expansions of health coverage for the poor, the emerging challenges providers who serve low-income and uninsured populations face in a rapidly evolving health care delivery system, and the effects of these changes on particularly vulnerable populations. Articles include: IntroductionMarsha Lillie-Blanton, Rose Marie Martinez, Barbara Lyons, Diane Rowland A Review Of The…