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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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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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  • Supporting Work without the Requirement: State and Managed Care Initiatives

    Issue Brief

    The Centers for Medicare and Medicaid Services (CMS) continues to promote state adoption of work and reporting requirements as a condition of Medicaid eligibility for certain nonelderly adults, although several such waivers have been set aside by federal courts. While most Medicaid adults are already working, some states and health plans have developed voluntary work support programs for nonelderly adults who qualify for Medicaid through non-disability pathways. These programs offer services that support work without…

  • Medicaid Program Integrity and Current Issues

    Issue Brief

    Medicaid is a large source of spending in both state and federal budgets, making program integrity efforts important to prevent waste, fraud, and abuse and ensure appropriate use of taxpayer dollars. This brief explains what program integrity is, recent efforts at the Centers for Medicare and Medicaid Services (CMS) to address program integrity, and current and emerging issues.

  • Why it Matters: Tennessee’s Medicaid Block Grant Waiver Proposal

    Issue Brief

    On November 20, 2019, Tennessee submitted an amendment to its longstanding Section 1115 Waiver that would make major financing and administrative changes to its Medicaid program. The Centers for Medicare and Medicaid Services (CMS) certified the waiver as complete and opened a federal public comment period through December 27, 2019. Most significantly, Tennessee is requesting to receive federal funds in the form of a “modified block grant” and to retain half of any federal “savings”…

  • Analysis of Recent Declines in Medicaid and CHIP Enrollment

    Fact Sheet

    This fact sheet provides analysis of this recent enrollment decrease and discusses potential implications for coverage rates. It is based on Kaiser Family Foundation analysis of the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data.

  • Two Medicaid-Related Initiatives That Help Promote Long-Term Care at Home and in the Community, Rather Than in Institutions, Are Set To Expire at the End of December

    News Release

    Two initiatives that for years have helped shift Medicaid enrollees away from nursing homes in favor of long-term care at home and in the community face year-end deadlines that could undercut that trend, according to two new KFF issue briefs. While there does not appear to be substantive disagreement over the initiatives like there is with many other federal health programs, their expiration is coming at a time when Congress is engaged in a contentious…

  • Medicaid’s Money Follows the Person Program: State Progress and Uncertainty Pending Federal Funding Reauthorization

    Issue Brief

    Medicaid’s Money Follows the Person (MFP) demonstration has helped seniors and people with disabilities move from institutions to the community by providing enhanced federal matching funds to states since 2007. The program operates in 44 states and has served over 90,000 people as of June 2018. The program is credited with helping many states establish formal institution to community transition programs that did not previously exist by enabling them to develop the necessary service and…

  • Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

    Issue Brief

    To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when…

  • From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?

    Issue Brief

    The Utah legislature significantly changed and limited the Medicaid coverage expansion that was adopted by the voters through a ballot initiative in November 2018. This issue brief explains new provisions in Utah's recently amended Section 1115 Medicaid waiver and the additional amendments that the state has submitted to CMS, including most recently a request for enhanced ACA federal matching funds for an expansion to 138% FPL with an enrollment cap.

  • Opioid Use Disorder among Medicaid Enrollees: Snapshot of the Epidemic and State Responses

    Issue Brief

    As the largest payer of substance use disorder services in the United States, Medicaid plays a central role in state efforts to address the opioid epidemic. In addition to increasing access to addiction treatment services through the expansion of Medicaid under the Affordable Care Act (ACA), states are expanding Medicaid addiction treatment services, increasing provider reimbursements, restricting opioid prescribing, and implementing delivery system reforms to improve the quality of treatment services. While many states have…