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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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  • How Do Dual-Eligible Individuals Get Their Medicare Coverage?

    Issue Brief

    People who are dually eligible for both Medicare and Medicaid coverage can get their Medicare coverage in a variety of ways. The brief breaks out the data for traditional Medicare, Medicare Advantage plans that are available to all Medicare beneficiaries, and plans that are designed specifically for dual-eligible beneficiaries.

  • New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

    Policy Watch

    Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied,…

  • Health Care Issues in the Early Stages of the 2024 Election

    Perspective

    In this JAMA Health Forum column, Larry Levitt examines differences in the Republican presidential candidates’ records and positions on health issues, including Medicaid and abortion, that could play a role in the primaries and would set up a sharp contrast in the general election against President Biden.

  • New KFF Analysis Examines Rapidly Evolving Federal Policies For Substance Use Disorder Treatment for the Opioid Epidemic  

    News Release

    A new KFF analysis finds that 24 percent more buprenorphine, a medication to treat opioid use disorder, was dispensed in 2022 than in 2019, the year before the pandemic brought a surge of opioid overdose deaths – and a focus on how to expand access and treatment. This upward trend in buprenorphine distribution, already in motion before the pandemic, continued throughout the COVID public health crisis, suggesting continued improvements in access to treatment even as…

  • Addressing the Opioid Crisis: A Look at the Evolving Landscape of Federal OUD Treatment Policies

    Issue Brief

    Federal policies governing substance use disorder treatment have undergone rapid changes during the pandemic; however, the extent to which these changes can address the surge in opioid overdose deaths is unclear. Some of these policy adjustments are permanent, while others could revert to pre-pandemic regulations. In this brief, we examine the following 5 key federal policies and implications for access and treatment for OUD.

  • Medicaid Expansion Has Had Beneficial Effects on Some Sexual and Reproductive Health Outcomes 

    News Release

    A new KFF review of more than three dozen studies published between April 2021 and June 2023 finds that Medicaid expansion under the Affordable Care Act is associated with beneficial effects on a range of sexual and reproductive health outcomes. The studies, which echo findings of previous research, find that Medicaid expansion is associated with increased health insurance coverage prior to and after pregnancy, as well as increased access to, and utilization of, both prenatal…

  • States Received Over $117 Billion in Enhanced Federal Medicaid Funding for Pausing Disenrollments During the Pandemic; Non-Expansion States Received a Disproportionate Share 

    News Release

    A new KFF analysis finds that states received over $117 billion in enhanced federal Medicaid funding in exchange for pausing disenrollments during the first three years of the pandemic. The injection of federal money enabled states to spend less of their own funds on Medicaid even as enrollment rose by more than 23 million people nationally and total Medicaid spending increased by billions of dollars. Pandemic-era enrollment protections expired in March, and in April states…