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Key Issues for the Medical Frailty Exemption from Medicaid Work Requirements

CMS has released new guidance on Medicaid work requirements. For background on the medical frailty exemption, one of the key issues in the new rule, check out KFF's explainer. KFF is closely tracking how states are approaching implementation of Medicaid work requirements and navigating related challenges.

State by State Data

More than 800 up-to-date, state-level health indicators can be mapped, ranked, and downloaded.

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.

Use this tool to build a custom report compiling health-related data for a single state or multiple states.

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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. Understanding this variation can be important for assessing state fiscal issues, the differences across states and their implications for federal and…

  • The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis

    Report

    A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population. This analysis uses the Urban Institute’s Health Insurance Policy…

  • Health Insurance Market Reforms: Pre-Existing Condition Exclusions

    Fact Sheet

    Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing condition permanently or over a period of time. Beginning January 1, 2014, insurers in the individual and group markets will be prohibited from imposing pre-existing…

  • 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. The analysis, conducted by the Urban Institute for the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, updates a similar study from May…

  • Medicaid Financing: An Overview of the Federal Medicaid Matching Rate (FMAP)

    Issue Brief

    Since its enactment in 1965, the Medicaid program has used the Federal Medical Assistance Percentage (FMAP) to determine the federal government's share of the cost of covered services in state Medicaid programs. On average, the federal share has been 57 percent. Beginning in 2014, the Affordable Care Act (ACA) establishes highly enhanced FMAPs for the cost of services to low-income adults with incomes up to 138% of the Federal Poverty Level (FPL) who are not…

  • 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. The Affordable Care Act (ACA) provides states the opportunity to earn a one percentage point increase in their federal matching…

  • Health Homes for Medicaid Beneficiaries with Chronic Conditions

    Issue Brief

    This brief profiles four states that were the first to receive federal approval to take up a state option under the Affordable Care Act to implement health homes for Medicaid beneficiaries with chronic conditions. Almost half of the 9 million people who qualify for Medicaid on the basis of disability suffer from mental illness and 45 percent have three or more diagnosed chronic conditions. Health homes provide an important tool for states trying to manage…

  • 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…

  • 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. Multiple agencies at the state and federal levels are involved in efforts to prevent waste, fraud and abuse in the program and ensure appropriate use of taxpayer dollars, and many program integrity initiatives are yielding positive results. The Affordable Care Act (ACA) builds on earlier efforts through the Deficit Reduction Act to…