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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.

Medicaid Budget Survey

Medicaid Home Care

Using data from the 23rd KFF survey of officials administering Medicaid home care programs, 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.

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. The data come from KFF’s 23rd survey on Medicaid home care programs in all 50 states and DC.

KFF regularly surveys states about their Medicaid home- and community-based services (HCBS) programs and their eligibility policies for people who are eligible for Medicaid on the basis of having a disability or being 65 and older.

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This issue brief provides an overview of what Medicaid home care (also known as “home- and community-based services” or HCBS) is, who is covered, and what services were available in 2024.

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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  • The Impact of the COVID-19 Recession on Medicaid Coverage and Spending

    Issue Brief

    Unlike previous recessions in modern history, this past recession was spurred by the spread of a virus (COVID-19), which created a public health crisis with unique health implications. This brief describes the broader impacts of this most recent recession – which lasted from February 2020 to April 2020 -- and also explores how trends in Medicaid spending and enrollment differed from past recessions and what that might mean for state Medicaid programs moving forward.

  • Nursing Home Staff Vaccination Rates Vary Widely by State as Vaccination Mandates Take Effect

    Issue Brief

    Due to the disproportionate impact of COVID-19 on nursing home residents and staff, this population was prioritized to receive the vaccine when the vaccine rollout began in Winter 2020-2021. Since then, CMS has implemented a health care worker vaccination mandate for providers that participate in Medicare and/or Medicaid. Although some states have sued to challenge this rule, it was recently allowed to take effect by the Supreme Court. This data note presents completed vaccination and booster rates among nursing home staff, by state.

  • Medicaid Coverage for Women

    Issue Brief

    This data note presents key data points describing the current state of the Medicaid program as it affects women.

  • People With HIV in Non-Medicaid Expansion States: Who Could Gain Coverage Eligibility Through Build Back Better or Future Expansion?

    Issue Brief

    In this analysis, we explore the implications of the Build Back Better Act's current coverage provisions for people with HIV in select non-expansion states. We estimate the size of the population that could gain eligibility as well as their socio-demographic characteristics, examine their affordability barriers and assess the potential impact on the Ryan White HIV/AIDS Program. We also explore what Medicaid expansion could mean in these non-expansion states for people with HIV.

  • Medicaid Financing and the U.S. Territories: Implications of The Build Back Better Act

    Policy Watch

    The U.S territories have faced an array of longstanding fiscal and health challenges that were exacerbated by recent natural disasters and the COVID-19 pandemic. This policy watch examines how Medicaid funding for the territories works, the current allotments, and how the Build Back Better Act (BBA) would change Medicaid funding for the territories going forward. While a version of BBBA has passed the house, its fate in the Senate remains uncertain.

  • Community Health Centers Are A Key Source of COVID-19 Rapid At-Home Self-Tests For Hard-To-Reach Groups

    Policy Watch

    As part of an effort to promote equitable access to tests, the Biden administration launched a testing supply program that has set aside 25 million rapid at-home self-test kits for distribution by community health centers. Under the program, health centers will be distributing self-tests to patients and community members, with a focus on populations at greatest risk from adverse outcomes related to COVID-19.

  • What to Watch in Medicaid Section 1115 Waivers One Year into the Biden Administration

    Issue Brief

    Section 1115 demonstration waivers provide states an avenue to test new approaches in Medicaid and generally reflect changing priorities from one presidential administration to another. This issue brief summarizes waiver priorities and actions under the Biden Administration as well as pending waiver themes and other issues to watch. If the Build Back Better Act (BBBA) fails to pass or is narrowed significantly, Medicaid waivers and other administrative actions may be a key tool for the Biden Administration to advance policy priorities absent legislation.