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Medicaid work requirements

Medicaid and the Road Ahead: Spending Cuts, Work Requirements and What’s Next for States, Providers and Families

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Passed last year, President Trump’s One Big Beautiful Bill Act made significant changes to Medicaid—the primary insurance provider for health and long-term care for people with low incomes. These changes are expected to lead to coverage loss for many current enrollees and will reduce funding for Medicaid, placing new financial pressures on states and health care providers. On July 23, KFF and States Newsroom hosted an event focused on the impacts of work requirements and other federal policy changes on states, health care systems, and people.

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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  • How do Medicaid Home Care Programs Support Family Caregivers?

    Issue Brief

    This issue brief provides new information about family caregivers from KFF’s most recent survey of state Medicaid HCBS programs, including a discussion of paying family caregivers, self-direction, and supports available for family caregivers.

  • A Per Capita Cap for Medicaid: Solution in Search of a Problem?

    Quick Insights

    A per capita cap in Medicaid may be a solution in search of a problem. However, if a cap substantially reduced federal Medicaid spending over time, it would put states at financial risk and force cuts to services and rates paid to physicians, hospitals, and nursing homes.

  • Section 1115 Waiver Watch: A Look at the Use of Contingency Management to Address Stimulant Use Disorder

    Policy Watch

    Contingency management is an evidence-based psychosocial intervention that uses motivational incentives, such as vouchers or gift cards, to encourage recovery behaviors like stimulant abstinence and treatment session (e.g., cognitive behavioral therapy, group therapy) attendance. The Biden administration has approved five state contingency management waivers (California, Delaware, Hawaii, Montana, and Washington); two additional state contingency management requests are currently pending federal review.

  • Hospital Margins Rebounded in 2023, But Rural Hospitals and Those With High Medicaid Shares Were Struggling More Than Others

    Issue Brief

    This data note examines trends in hospital margins from 2018 through 2023 and how operating margins varied across different types of hospitals in 2023. It shows the industry overall experienced a rebound in 2023 after margins fell sharply the previous year, though some hospitals – particularly those in rural areas and those who see many Medicaid patients – continue to struggle.

  • Making Sense of Medicaid Work Requirements

    From Drew Altman

    In this column, KFF President and CEO Drew Altman examines the data and history around adding work requirements to Medicaid and why the administrative burdens it imposes may offset any savings even for states that ideologically favor such an approach.

  • With or Without ACA Repeal, ACA and Medicaid Cuts are Looming

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt explores why the incoming Trump administration and Republican majorities in Congress are likely to pursue budget cuts in Medicaid and the Affordable Care Act and why such efforts are likely to boost the number of uninsured Americans.

  • Medicaid Expansion is a Red and Blue State Issue

    Issue Brief

    With President-elect Trump returning to the White House and Republicans controlling Congress, significant changes to the Medicaid expansion are expected. This data note provides key facts on the Medicaid expansion, highlighting the financial and coverage impacts of any changes across states that voted for President-elect Trump and those that voted for Vice President Harris.