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5 Facts: Medicaid Fraud, Waste, Abuse and Improper Payments

Program integrity efforts work to prevent and detect fraud, waste, and abuse; increase program transparency and accountability; and recover improper payments. This brief explains what we know about these issues and efforts to address program integrity.

Medicaid: What to Watch in 2026

Medicaid: What to Watch in 2026

In this brief, KFF explores how state fiscal pressures are likely to converge with the implementation of the 2025 reconciliation law to affect Medicaid coverage, financing, and access to care over the next year, especially leading up to the midterm elections.

Medicaid Watch

Featuring policy research, polling and news about how Medicaid is changing, and the impact of those changes due to the tax and spending cuts law

Medicaid and work

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 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.

5 Facts: 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 in 2025

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.

5 Facts: 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.

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.

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  • How Community Health Centers Are Serving Low-Income Communities During the COVID-19 Pandemic Amid New and Continuing Challenges

    Issue Brief

    Community health centers are a national network of safety-net primary care providers serving low-income, medically underserved communities. Based on findings from a national survey of health centers, this brief examines how the pandemic has affected health center patients and services as well as the ongoing challenges health centers and their patients face.

  • Community Health Centers Are Taking Actions to Prepare for the Unwinding of the Public Health Emergency

    Policy Watch

    Community health centers, a national network of safety-net primary care providers, are poised to be on the front lines of the unwinding of the Medicaid continuous enrollment requirement when the public health emergency (PHE) ends. Health centers can be effective in raising awareness about Medicaid renewal requirements and in providing the help needed for enrollees to maintain Medicaid or transition to other coverage.

  • 10 Things About Long-Term Services and Supports (LTSS)

    Issue Brief

    Medicaid paid for more than half of the $415 billion that the US spent on long-term services and supports in 2022, most of which went to home and community-based services as well as to care in nursing homes and other institutional settings.

  • Medicaid: What to Watch in 2022

    Issue Brief

    As 2022 kicks off, a number of issues are at play that could affect coverage and financing under Medicaid. This issue brief examines key issues to watch in Medicaid in the year ahead.

  • 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.

  • State Policies Expanding Access to Behavioral Health Care in Medicaid

    Issue Brief

    On KFF’s 21st annual Medicaid budget survey, all responding states reported at least one initiative to expand behavioral health care in Medicaid, including crisis service and other benefit expansions, initiatives to expand telehealth and address equity, and managed care changes.

  • Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey

    Report

    This 18th annual survey of the 50 states and the District of Columbia (DC) provides data on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal, and cost sharing policies as of January 2020. The survey findings highlight state variation in policies that affect individuals’ ability to access coverage and care amid the COVID-19 public health crisis. They also provide examples of actions states can take to expand eligibility and simplify enrollment to respond to the COVID-19 epidemic.

  • Eligibility for ACA Health Coverage Following Job Loss

    Issue Brief

    As unemployment claims skyrocket amid the coronavirus (COVID-19) crisis, this analysis examines the potential loss of job-based coverage among people in families where someone lost employment between March 1 and May 2 and estimate their eligibility for ACA coverage as of May and January 2021, when most will have exhausted their unemployment benefits.