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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.

2025-2026 Medicaid Budget Survey

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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  • Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations

    Report

    This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.

  • The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States

    Issue Brief

    This brief examines the early state budget effects of the ACA Medicaid expansion in three states: Connecticut, New Mexico, and Washington State. States were asked about savings and costs in Medicaid, behavioral health, corrections, uncompensated care spending, etc. as well as revenues. Findings from a study looking at Kentucky are also included.

  • Medicaid Moving Forward

    Issue Brief

    Medicaid is the nation’s main public health insurance program for people with low incomes, and it is the single largest source of health coverage in the U.S., covering nearly 70 million Americans. Medicaid also finances 16% of total personal health spending in the nation. States design and administer their own Medicaid programs within federal requirements, and states and the federal government finance the program jointly. As a major payer, Medicaid is a core source of financing for safety-net hospitals and health centers that serve low-income communities, including many of the uninsured. It is also the main source of coverage and financing for both nursing home and community-based long-term care.

  • Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals

    Issue Brief

    This issue brief provides an overview of Medicaid’s role in financing behavioral health services. It includes information on eligibility, benefits, service delivery, access to care, and spending. It also discusses the potential impact of Medicaid restructuring as proposed in the Better Care Reconciliation Act.

  • Ten Things to Know About Medicaid’s Role for Children with Behavioral Health Needs

    Fact Sheet

    Medicaid currently provides federal matching funds with no pre-set limit to help states cover children with behavioral health needs. Restructuring Medicaid financing as proposed in the American Health Care Act could limit states’ ability to care for these children. The following series of graphics highlights Medicaid’s role for children with behavioral health needs.

  • Trends in Medicaid Spending Leading up to ACA Implementation

    Issue Brief

    This paper presents data on Medicaid spending during the years leading up to the implementation of the Affordable Care Act (ACA). It uses administrative data to first examine overall spending trends and trends by service type. We then draw on additional data to analyze per enrollee spending growth during this period, both by service type and by eligibility group, to understand what drove Medicaid spending.