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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 Medicaid Managed Care Work:  An Action Plan for Persons Living with HIV

    Other Post

    Making Medicaid Managed Care Work: An Action Plan for Persons Living with HIV This report, by the National Association of People with AIDS (NAPWA) with support from The Kaiser Family Foundation, describes nine key points for people living with HIV to keep in mind when trying to influence the development of a managed care system that will serve them effectively. Senator John Chafee (R-RI), an acknowledged ally of NAPWA, gratefully accepted the report upon its…

  • Managed Care and Low-Income Populations: A Case Study Of Managed Care In Florida

    Report

    This study is part of a larger initiative, the Kaiser/Commonwealth Low-Income Coverage and Access project funded by both the Henry J. Kaiser Family Foundation and The Commonwealth Fund, to gauge the impact of health restructuring on access and health insurance coverage for low-income populations in seven states through surveys, focus groups and case studies. The aim of the studies is to provide early insights and timely analyses that will assist other states and other efforts…

  • Restructuring Medicaid: Key Elements and Issues in Section 1115 Demonstration Waivers

    Issue Brief

    This policy brief provides background on Section 1115 Medicaid waiver activity, discusses the common provisions of the approved and proposed Section 1115 waivers since 1993, and briefly summarizes the current application of Section 1115 AFDC waivers. It also examines implications of the Section 1115 waivers on the Medicaid program and its beneficiaries. Policy Brief: Restructuring Medicaid: Key Elements And Issues In Section 1115 Demonstration Waivers

  • Where is Medicaid Spending Headed?

    Other Post

    Enrollment Another important factor is that Medicaid enrollment increases slowed substantially. After increasing by 7.9 percent annually between 1988 and 1992, enrollment growth slowed to 5.3 percent per year in the following three years (Table 2). Table 3 shows that the rate of growth in enrollment of Medicaid beneficiaries slowed between 1991 and 1995. Enrollment growth increased by 11 percent in 1992 but by only 1.8 percent in 1995. Enrollment growth among the aged slowed…

  • Where is Medicaid Spending Headed? – Fact Sheet

    Fact Sheet

    Medicaid Enrollment and Spending Growth Overview In 1995, Medicaid provided health and long-term care for 34.8 million low-income, elderly, and disabled Americans at a cost of $157.3 billion, $151.8 billion for services and $5.5 billion for administration. After expanding considerably in the early 1990's, Medicaid spending and enrollment growth have slowed markedly. Medicaid spending growth has declined from 22.4 percent per year to 9.5 percent per year between 1992 and 1995. Preliminary data suggest the…

  • Where is Medicaid Spending Headed? – Report

    Report

    Where is Medicaid Spending Headed? Prepared for: The Kaiser Commission on the Future of Medicaid Prepared by: John Holahan and David Liska, The Urban Institute December 1996 In 1995, the United States witnessed a major debate over the future course of the Medicaid program. At the heart of this debate were the individual entitlement to benefits, the desire to limit federal spending, and the degree of control and flexibility given to states over their separate…

  • Where is Medicaid Spending Headed?

    Fact Sheet

    This content package page includes a report providing an overview of the changes in Medicaid expenditures since 1988, including an analysis of the slowdown in Medicaid growth since 1992. Also included in the package is a press release, chart pack and fact sheet on Medicaid spending and enrollment trends. News Release News Release: Medicaid Spending Growth Rate Slows Fact Sheet Fact Sheet Report Report