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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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  • Financing Health Coverage:  The Fiscal Relief Experience

    Issue Brief

    Financing Health Coverage: The Fiscal Relief Experience This paper provides an overview of the context which prompted federal fiscal relief to the states in 2003 and discusses the implications of this experiment in federal intervention for financing the Medicaid program. Policy Brief (.

  • A Historical Review of How States Have Responded to the Availability of Federal Funds for Health Coverage

    Issue Brief

    This historical review finds that the availability of federal funds has served as an effective incentive for states to provide health coverage to meet the health and long-term care needs of their low-income residents despite state budget pressures. The brief examines the history of earlier experiences and provides important context for how states may respond as they weigh the costs and benefits of expanding their Medicaid programs in 2014 as called for under the Affordable Care Act.

  • Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences

    Issue Brief

    Over the past few years, a number of states have implemented new or increased existing out-of-pocket costs for beneficiaries in their Medicaid, SCHIP, or other public coverage programs. This brief reviews the key findings from this recent activity, including the impact on enrollment in public coverage programs, access to care, and providers. Issue Paper (.

  • Health Care and the 2004 Elections: Health Care for Americans with Disabilities

    Issue Brief

    Health Care for Americans with Disabilities Download a printable .pdf of Health Care and the 2004 Elections: Health Care for Americans with Disabilities. IssueBackgroundHealth CoveragePrescription Drugs Under Public ProgramsCoverage of Long-Term Services and SupportsFinancing Medicaid and MedicareAssessing Candidate Positions Issue More than 50 million individuals, or roughly one in five Americans, have a disability.

  • The New Health Reform Law and Medicaid

    Event Date:
    Event

    This briefing, cosponsored by the Alliance for Health Reform and the Kaiser Family Foundation, explores the provisions of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA).

  • Survey of People with Disabilities

    Poll Finding

    People with disabilities are at risk in the health-care system because of their wide-ranging health-care needs, their relatively heavy use of prescription drugs, health-care and support services, and typically low incomes. A new survey of people with permanent mental and/or physical disabilities explores their health-care experiences and challenges in accessing and paying for care.

  • New Interactive Data Tool Tracks Medicaid Managed Care Market

    News Release

    The Medicaid Managed Care Market Tracker, a new feature of the Foundation’s State Health Facts data center, provides the latest data on key dimensions of risk-based Medicaid managed care for the 39 states that contract with MCOs – these states are home to more than 90 percent of all Medicaid beneficiaries nationwide. On Thursday, December 11 at 12:30 p.m. ET, the Foundation will host an interactive web briefing with Medicaid managed care expert Julia Paradise, an Associate Director of the Foundation’s Kaiser Commission on Medicaid and the Uninsured.