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Map shows Medicaid expansion enrollment in counties that meet the criteria for the high unemployment hardship exception to work requirements, using 12-month average unemployment rates from June 2024 to May 2025.

What is the Medicaid Hardship Exception and How Could it Affect Who’s Required to Work?

The budget reconciliation law allows states to request a hardship exception for individuals who live in counties with high unemployment rates. The number of counties and Medicaid expansion enrollees that will ultimately qualify for the hardship exception will depend on how unemployment rates change, how the exception is implemented, and how many states request it. Nationally, 7% of Medicaid expansion enrollees (1.4 million) could potentially qualify because they live in counties with high unemployment.

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Explore the latest national and state-specific data and policies on women’s health, including health status, insurance coverage, use of preventive services, and more.

Most "dual-eligible" individuals (8.9 million in 2024) are eligible for Medicaid benefits that are not otherwise covered by Medicare, including long-term care.

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  • Why Does Medicaid Spending Vary Across States: A Chartbook of Factors Driving State Spending

    Report

    This detailed chartbook provides an illustrative overview of some of the key factors that contribute to the substantial variation in Medicaid spending across states today. The chartbook provides a broad range of state-by-state data on subjects including state revenue and spending, the demand for public services, health care markets, and state Medicaid policy choices.

  • National and State-By-State Impact of the 2012 House Republican Budget Plan for Medicaid

    Report

    This analysis of the House Budget Plan that was passed in 2012 finds that repealing the Affordable Care Act (ACA) and converting Medicaid to a block grant would trigger significant decreases in federal Medicaid spending and could result in substantial reductions in enrollment and payments to providers compared to current projections.

  • Coverage of Preventive Services for Adults in Medicaid

    Issue Brief

    This brief highlights data from a survey of coverage of 42 recommended preventive services for adults in Medicaid fee-for-service programs as of October 2010. Medicaid programs must cover preventive services for children as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, but generally are not required to cover such services for adults.

  • A Historical Review of How States Have Responded to the Availability of Federal Funds for Health Coverage

    Issue Brief

    This historical review finds that the availability of federal funds has served as an effective incentive for states to provide health coverage to meet the health and long-term care needs of their low-income residents despite state budget pressures. The brief examines the history of earlier experiences and provides important context for how states may respond as they weigh the costs and benefits of expanding their Medicaid programs in 2014 as called for under the Affordable Care Act.

  • Program Integrity in Medicaid: A Primer

    Issue Brief

    Medicaid covers more than 60 million Americans and accounts for about one in six dollars spent on health care in the United States.