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What to Watch

Medicaid: What to Watch in 2026

Medicaid: What to Watch in 2026

In this brief, KFF explores how state fiscal pressures are likely to converge with the implementation of the 2025 reconciliation law to affect Medicaid coverage, financing, and access to care over the next year, especially leading up to the midterm elections.

Work Requirements

Challenges with Implementing Work Requirements

Many states are anticipating a variety of implementation challenges, including the need for complex system changes, a compressed implementation timeline, and limited staff capacity.

What is the Medicaid Hardship Exception?

The number of Medicaid expansion enrollees who ultimately qualify for the high unemployment hardship exception will depend on how the exception is implemented and how unemployment rates changes.

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

KFF’s interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.

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.

The Essentials

  • 5 Facts: Immigrants and Medicaid

    This brief provides five key facts on Medicaid and immigrants as context for understanding the potential impacts of policy changes under the Trump administration.

  • 5 Facts: Medicaid and Hospitals

    This brief explains the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid, the share of births covered by the program, and how Medicaid expansion has impacted hospital finances.

  • Medicaid Financing: The Basics

    Medicaid is a major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.

  • 5 Facts: Medicaid’s Share of National Health Spending

    This brief explores how Medicaid spending contributes to national health spending and how different service areas contribute to Medicaid costs.

  • 5 Facts: Medicaid and Nursing Facilities

    The substantial Medicaid savings in the reconciliation bill could have major implications for nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them.

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  • Unwinding of Medicaid Continuous Enrollment: Key Themes from the Field

    Issue Brief

    Data are important to help monitor how unwinding is going across states, but trackers and dashboards only tell part of the unwinding story. This brief examines the perspectives of state officials and others involved in the unwinding process. The brief provides information on outreach and engagement, renewal processes and coverage transitions, providing lessons for the ongoing unwinding process, as well as for how to conduct more effective Medicaid renewals generally in the future.

  • Another Year of Record ACA Marketplace Signups, Driven in Part by Medicaid Unwinding and Enhanced Subsidies

    Policy Watch

    Open enrollment for the Affordable Care Act (ACA) Marketplaces is about to wrap up with another record high number of people signing up for coverage. Factors that contribute to this increase include unwinding of the Medicaid continuous enrollment, increased subsidies from the American Rescue Plan and Inflation Reduction Act, and increased marketing, outreach, and enrollment assistance.

  • A Look at Substance Use and Mental Health Treatment Facilities Across the U.S.

    Issue Brief

    This brief uses 2022 data from the National Substance Use and Mental Health Services Survey (N-SUMHSS), an annual survey sent to all substance use and mental health treatment facilities to assess the supply and characteristics of these facilities at a national and state level. Despite the escalation of mental health needs and the increasing and evolving opioid epidemic, accessing treatment continues to be difficult--as indicated by consumer surveys and national data. Factors like the decline in psychiatric beds, financing barriers, difficulty accessing outpatient treatment, and the growing workforce shortages have led to more reports of unmet need and psychiatric boarding in emergency departments. Overall, there are approximately 14,700 facilities providing substance use treatment services and about 9,500 facilities that offer mental health services. More than eight in ten substance use treatment facilities and mental health facilities provide outpatient services; smaller shares offers more intensive inpatient services. Substance use treatment and mental health bed availability varies across states. Most substance use and mental health treatment facilities are non-profit; however, for-profit ownership is more common among substance use treatment facilities, whereas public ownership is more common among mental health facilities. Most facilities report high participation with private insurance and Medicaid, but lower for Medicare and there is variation across states. Reported Medicaid participation by substance use treatment facilities varies across states.

  • Halfway Through the Medicaid Unwinding: What Do the Data Show?

    Policy Watch

    Ten months into the unwinding of the Medicaid continuous enrollment provision, KFF tracking shows that states have reported outcomes for roughly half of the people expected to undergo renewals during the unwinding period. This policy watch examines the latest data and key issues to watch during the next phase of the unwinding.

  • KFF Health Tracking Poll May 2024: Voters’ Views of Health Policy Issues in Context of Presidential Campaigns

    Feature

    Voters are split largely along partisan lines in terms of who they trust in regard to various health care issues, but Biden captures more than Trump trust from Independent voters. Biden is also more trusted by older adults when it comes to entitlement programs. Voters are still largely unaware of the drug pricing provisions of the Inflation reduction Act. Large majorities of voters, particularly Democratic voters, support a federal right to abortion.