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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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  • Privatization of Public Hospitals

    Report

    This report examines the trends in the closure of public hospitals and their conversion to private ownership. It also provides case studies of communities where major privatizations have occurred. Report (.pdf) Summary of Findings (.pdf)

  • Report and Summary of Findings

    Other Post

    Privatization of Public Hospitals Full Report available in PDF format.Summary available in PDF format.Return to top Privatization of Public HospitalsReport

  • How Well Does the Employment-Based Health Insurance System Work for Low-Income Families?

    Other Post

    Part 2 Even when insurance is offered to low-wage workers, its costs to these workers may be substantial, and, for some, a barrier to coverage. In 1996, workers had to contribute an average of $1,615 per year for family coverage, or about 30% of the total premium.5 Thus, a worker who earned $10 an hour in 1996, with annual wages of about $20,000, would have had to spend 8% of earnings to buy family coverage.*…

  • How Well Does the Employment-Based Health Insurance System Work for Low-Income Families?

    Other Post

    Part 3 What Explains the Coverage Decline? Rapidly rising health care costs-or, more precisely, employers' responses to costs-have contributed to the widespread erosion of employer coverage. As employers have shifted costs to workers, participation has dropped. Low-wage workers have been disproportionately affected by rising costs, losing access to coverage as well as finding participation more difficult. Their problems have been exacerbated by structural changes in labor markets, which have weakened the tie between jobs and…

  • Medicaid Eligibility for Families and Children

    Report

    This paper provides an overview of Medicaid eligibility policy and examines two groups of Americans in particular - low-income children and nondisabled adults under 65 - and summarizes the statutory and regulatory pathways to Medicaid eligibility available to them as individuals. The paper concludes with a discussion of policy options available to states under current law for increasing Medicaid eligibility for these two groups. Issue Paper Issue Paper

  • How Well Does the Employment-Based Health Insurance System Work for Low-Income Families? – Issue Paper

    Report

    How Well Does the Employment-Based Health Insurance System Work for Low-Income Families? September 1998 Most Americans receive health insurance coverage through the workplace. Unfortunately, however, many workers are left out, especially low-wage workers and their families. Being a low paid worker does not mean just that wages are low. It also means a lower likelihood of receiving health insurance protection on the job. Low-wage workers have never been as likely as the better paid to…

  • Medicaid Eligibility for Families and Children

    Other Post

    Part 5 Appendix Table 1: Medicaid Eligibility Levels for Pregnant Women and Children Pregnant Women, Infants and Children(as of May 20, 1998) Other Eligibility Categories Pregnant Women and Infants Children Under Age 6 Children Ages 6 to 14 Children Ages 14 to 19 Asset Test Required for Children (4) Max. AFDC Payments (7/16/96) (5) Medically Needy, 1996 (percent of Federal Poverty Level) United States 133 133 100 45 49 Alabama 133 133 100 100 No…

  • The Decline in Medicaid Spending Growth in 1996: Why Did It Happen? – Issue Paper

    Report

    The Decline In Medicaid Spending Growth In 1996:Why Did It Happen? September 1998 Medicaid spending grew by only 2.3 percent in 1996, the lowest rate of growth in the history of the program. After a period of explosive growth between 1988 and 1992, averaging over 20 percent per year, Medicaid spending slowed to 9-10 percent per year between 1992 and 1995.1 In 1996, Medicaid financed acute and long-term care services for 41.3 million people at…