Medicaid

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Spending on Medicaid State Directed Payments Before New Limits Take Effect

Forty states and DC currently receive $93 billion in annual federal Medicaid spending through state directed payments (SDPs) and may be at risk due to forthcoming limits on these payments, according to new KFF estimates. Annual federal spending on SDPs is highest in California (an estimated $10.6 billion)—followed by Texas ($6.3 billion), North Carolina ($5.2 billion), and Illinois ($5.1 billion).

Forthcoming Policy Changes to Medicaid State Directed Payments

Changes to Medicaid State Directed Payments

The 2025 reconciliation law cut federal Medicaid spending by an estimated $911 billion from 2025 through 2034, some of which stems from new restrictions on Medicaid state directed payments (SDPs) for hospital and other health care services. This issue brief describes SDPs and forthcoming policy changes stemming from the 2025 law and the proposed regulation to implement those requirements and make other changes.

Medicaid Work RequiremEnts

Tracking the 2025 Reconciliation Law’s 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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  • The Landscape of Medicaid Demonstration Waivers Ahead of the 2020 Election

    Issue Brief

    As the Trump administration reaches the end of its first term, this issue brief considers the landscape of approved and pending Section 1115 Medicaid demonstration waivers under this administration and how the November 2020 presidential election may impact this landscape.

  • Looking Ahead to the End of the Medicaid Continuous Enrollment Requirement

    Event Date:
    Event

    On Wednesday, March 16, 2022, KFF hosted a web briefing focused on the implications of the end of the PHE and the Medicaid continuous enrollment requirement. State Medicaid programs’ existing enrollment and renewal procedures, as well as their differing approaches to the unwinding of the continuous enrollment requirement, will have major impacts on Medicaid enrollment and broader health coverage trends.

  • 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…

  • Medicaid Enrollment Churn and Implications for Continuous Coverage Policies

    Issue Brief

    Recent policy actions and proposals in Medicaid have renewed focus on the problem of churn, or temporary loss of coverage in which enrollees disenroll and then re-enroll within a short period of time. We find that 10% of full-benefit enrollees have a gap in coverage of less than a year, and rates are higher for children and adults compared to aged and people with disabilities. Churn has implications for access to care as well as…

  • How Many Uninsured Adults Could Be Reached If All States Expanded Medicaid?

    Issue Brief

    As more people lose their jobs and accompanying ESI, more may fall into the coverage gap, particularly starting in 2021 after unemployment benefits expire for many who have lost their jobs and incomes are likely to drop below the minimum threshold for marketplace subsidies. This analysis estimates how many uninsured adults—including those uninsured even before the pandemic and those who could become uninsured as a result of it— could become eligible for Medicaid if states…

  • Olmstead: I Did It

    Video

    This Kaiser Commission on Medicaid and the Uninsured video segment returns to the plaintiffs of the Olmstead case five years after the landmark U.S. Supreme Court decision. It reports on the impact of the decision for individuals with disabilities and some of the challenges that remain in the implementation of the court ruling.