Financing

Medicaid financing is complex. This policy watch explains how Medicaid financing works, describes various conservative proposals to change Medicaid financing, and explores the implications of those changes for states and enrollees.

The U.S territories – American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) – have faced longstanding fiscal and health challenges exacerbated by recent emergencies. This issue brief provides background on how Medicaid financing differs between U.S. territories and states and what these differences mean for funding as well as health care coverage and access.

This page provides access to the reports stemming from the 50-state Medicaid budget surveys published annually since 2000 by the Kaiser Family Foundation (KFF). It tracks trends in Medicaid spending and enrollment, as well as Medicaid policy actions around eligibility and enrollment, provider rates, provider taxes/fees, premiums and cost-sharing, benefits and pharmacy, long-term care and delivery system and payment reform.

This brief analyzes Medicaid enrollment and spending trends for FY 2024 and FY 2025, based on data provided by state Medicaid directors as part of the 24th annual survey of Medicaid directors.

This report highlights certain policies in place in state Medicaid programs in FY 2024 and policy changes implemented or planned for FY 2025, which began on July 1, 2024 for most states.

States expect national Medicaid enrollment to decline by about 4% and state Medicaid spending to rise by 7% in fiscal year (FY) 2025. These rates follow a larger but anticipated enrollment decline and state spending increase in FY 2024, as pandemic-era policies and federal funding expired, according to KFF’s 24th…

This KFF tracker provides up to date information on U.S. pledges thus far to four multilateral health replenishments (the Pandemic Fund, WHO, Gavi, and the Global Fund) and U.S. government support to date.

In his latest column, KFF President and CEO Drew Altman explains why Medicaid, despite former President Donald Trump’s silence on the topic, warrants greater attention given the potential for drastic changes or cuts to it should Republicans win control in the election.

Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, so long as the approach is likely to “promote the objectives of the Medicaid program.” As with broader Medicaid policy, the future landscape of Section 1115 waivers depends on the outcome of the November 2024 presidential election as a new administration could focus on different priorities, rescind existing guidance, or withdraw already-approved waivers. This waiver watch summarizes five key areas of difference in 1115 waiver policy and waiver approvals under the Trump and Biden-Harris administrations.

This brief examines the two presidential candidates’ records and other recent policy proposals that could inform starkly different directions for the program across key areas, including Affordable Care Act (ACA) Medicaid expansion, financing, eligibility, benefits, and cost-sharing, prescription drugs, long-term services and supports, and managed care.