Medicaid

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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.

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 describes states’ current provider taxes and explores how rules governing provider taxes are changing.

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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  • About 1 in 5 Nursing Facilities Would Currently Meet Proposed Requirements for Nursing Staff Hours

    News Release

    Eighty-one percent of nursing facilities would need to hire additional staff to comply with new nursing staff requirements that the Centers for Medicare and Medicaid Services (CMS) proposed earlier this month, according to a new analysis from KFF. Under the proposed rule, 19% of nursing facilities would currently meet the minimum staff hours for registered nurses and nurse aides.A smaller share of for-profit facilities would meet the proposed staffing requirements. Compared to 60% of non-profit…

  • Proposed Work Requirements Could End Federal Medicaid Coverage for 1.7 Million People

    News Release

    A new KFF analysis finds that an estimated 1.7 million Medicaid enrollees could become ineligible for federal Medicaid under proposed work requirements and presents state-by-state projections, based on estimates of coverage loss from the Congressional Budget Office (CBO). States could continue to provide Medicaid to those enrollees but would not receive federal matching funds for doing so. It is unclear if any states would choose to do that, though CBO estimated over half of enrollees…

  • Medicaid Balancing Incentive Program: A Survey of Participating States

    Report

    The Balancing Incentive Program provides enhanced federal matching funds, allowing states to advance their efforts to rebalance Medicaid long-term services and supports (LTSS) spending and expand access to home and community-based services as an alternative to institutional care. This report highlights participating states' efforts to implement the program's three structural requirements and use the enhanced federal funds in support of other Medicaid LTSS rebalancing efforts.

  • Medicaid Delivery System and Payment Reform: A Guide to Key Terms and Concepts

    Fact Sheet

    There is wide state variation in Medicaid health care delivery and payment systems, as states design and combine service delivery models and payment approaches in a multitude of ways. To help those interested in understanding the diversity of Medicaid reform initiatives underway or in development in states across the country, this guide defines key terms.

  • Analysis Examines Insurance Coverage, Affordability and Access to Home and Community-Based Services for Children with Special Health Care Needs

    News Release

    A new KFF analysis examines key characteristics of children with special health care needs, the affordability and adequacy of their health coverage, and the implications for such children of potential new federal Medicaid money to assist families in caring for them. Medicaid is a significant source of coverage for medical, behavioral health, and long-term services and supports for children with special health care needs, including home and community-based services (HCBS) that they need to live…

  • In Focus Groups, Direct Care Workers and Unpaid Caregivers Describe Low-Wage, Physically-Challenging Work That is Often Mentally Overwhelming and Marked By Uncertainty

    News Release

    In recent focus group interviews, 32 paid direct care workers and unpaid caregivers who assist seniors and people with disabilities with self-care and household activities describe daily work defined by low pay, physical demands and mental stress that has been made worse by the pandemic. KFF conducted the four focus groups in July and August 2021 with 24 direct care workers and eight unpaid caregivers to help provide context for the ongoing debate in Congress…

  • State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey

    Issue Brief

    This issue brief presents early findings from the most recent KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. It focuses on state policies adopted in response to challenges posed by the pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ initial plans for the new American Rescue Plan Act 10 percentage point temporary increase in federal Medicaid matching funds for HCBS available from April 2021…

  • The Pandemic Has Exacerbated Long-Standing Health Care Challenges Faced By Puerto Rico and Other U.S. Territories as the End of Temporary Federal Medicaid Funding Approaches

    News Release

    A new KFF analysis examines how the coronavirus pandemic is affecting U.S. territories as well as issues related to the upcoming expiration of temporary Medicaid funding for the territories at the end of September. Prior to the pandemic, the U.S territories –– American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) -- faced an array of longstanding fiscal and health challenges that were exacerbated by…

  • Implementing the ACA’s Medicaid-Related Health Reform Provisions After the Supreme Court’s Decision

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). A majority of the Court also found the ACA’s Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary’s enforcement authority. The practical effect of the Court's decision makes the Medicaid expansion optional for states. This brief addresses questions…