Medicaid

Medicaid work requirements

Medicaid and the Road Ahead: Spending Cuts, Work Requirements and What’s Next for States, Providers and Families

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Passed last year, President Trump’s One Big Beautiful Bill Act made significant changes to Medicaid—the primary insurance provider for health and long-term care for people with low incomes. These changes are expected to lead to coverage loss for many current enrollees and will reduce funding for Medicaid, placing new financial pressures on states and health care providers. On July 23, KFF and States Newsroom hosted an event focused on the impacts of work requirements and other federal policy changes on states, health care systems, and people.

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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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  • 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…

  • 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.

  • Analysis Finds The Share of Nursing Home Staff Who Have Been Vaccinated Against COVID-19 Varies Substantially by State

    News Release

    The share of nursing home staffers who have been fully vaccinated against COVID-19 varies considerably by state, from 70 percent in Ohio to 99 percent in Maine, Rhode Island, New York and Massachusetts, a new KFF analysis finds. The national average is 84 percent. The analysis of federal nursing home data for the week ending Jan. 30 comes as providers strive to comply with a federal mandate that health care workers whose employers participate in…

  • 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…