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What to Watch

Medicaid: What to Watch in 2026

Medicaid: What to Watch in 2026

In this brief, KFF explores how state fiscal pressures are likely to converge with the implementation of the 2025 reconciliation law to affect Medicaid coverage, financing, and access to care over the next year, especially leading up to the midterm elections.

Work Requirements

Challenges with Implementing Work Requirements

Many states are anticipating a variety of implementation challenges, including the need for complex system changes, a compressed implementation timeline, and limited staff capacity.

What is the Medicaid Hardship Exception?

The number of Medicaid expansion enrollees who ultimately qualify for the high unemployment hardship exception will depend on how the exception is implemented and how unemployment rates changes.

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements

KFF’s interactive tracks key data and policies that will affect how states implement Medicaid work requirements, which are required under the 2025 budget reconciliation law starting in January 2027. The tracker includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.

2025 Medicaid Home Care survey

Payment Rates Ahead of 2025 Reconciliation Law

This issue brief describes Medicaid payment rates for home care and other workforce supports that are in place in 2025, before the majority of the 2025 reconciliation law provisions start taking effect.

Home Care Support for Family Caregivers in 2025
number of responding states, including DC, that allow payments for family caregivers by type of home care program and type of caregiver.

This issue brief describes the availability of self-directed services and supports for family caregivers in Medicaid home care in 2025, before most provisions in the reconciliation law take effect.

States’ Management of Home Care Spending

This issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

Waiting Lists for Medicaid Home Care, 2016 to 2025
A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025

This data note provides new information about waiting lists in Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect.

The Essentials

  • 5 Facts: Medicaid and Provider Taxes

    This brief describe states’ current provider taxes and how the 2025 reconciliation law changed the federal rules governing them, including potential impacts across states.

  • Medicaid Financing: The Basics

    Medicaid is a major source of financing for states to provide health coverage and long-term services and supports for low-income residents. This brief examines key questions about Medicaid financing and how it works.

  • 5 Facts: Immigrants and Medicaid

    This brief provides five key facts on Medicaid and immigrants as context for understanding the potential impacts of policy changes under the Trump administration.

  • 5 Facts: Medicaid and Hospitals

    This brief explains the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid, the share of births covered by the program, and how Medicaid expansion has impacted hospital finances.

  • 5 Facts: Medicaid and Nursing Facilities

    The substantial Medicaid savings in the reconciliation bill could have major implications for nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them.
Eligibility and coverage

  • Eligibility, Enrollment, and Renewal Policies

    KFF's survey findings capture state actions that seek to improve the accuracy and efficiency of Medicaid and CHIP enrollment and renewal processes, as of January 2025.

  • Seniors and People with Disabilities

    More than 1 in 3 people with disabilities (15 million) have Medicaid (35%). In comparison, only 19% of people without disabilities have Medicaid.

  • Children with Special Needs

    Amid debates about proposed cuts to federal Medicaid spending, this brief analyzes key characteristics of children with special health care needs and explores how Medicaid provides them with coverage.

  • People With Intellectual and Developmental Disabilities

    Among the estimated 8 million people with intellectual and developmental disabilities (I/DD), over three million have Medicaid coverage.

  • Adults with Chronic Conditions

    Among working age adults enrolled in Medicaid, approximately three quarters have one or more chronic conditions, and nearly one-third have three or more.

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  • 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.

  • How Have State Medicaid Expansion Decisions Affected the Experiences of Low-Income Adults? Perspectives from Ohio, Arkansas, and Missouri

    Issue Brief

    This brief examines the experiences of low-income adults in three states that have made varied Medicaid expansion decisions: Ohio, which adopted the ACA Medicaid expansion, Arkansas which implemented the Medicaid expansion through a “Private Option” waiver, and Missouri, which has not adopted the expansion. While Arkansas and Ohio implemented the expansion in different ways, participants in both states described how obtaining coverage improved their ability to access care, contributing to improvements in their ability to work and family relationships. In contrast, participants in Missouri remained uninsured limiting their ability to obtain needed care, creating significant stress and anxiety in their lives, and interfering with their ability to work and care for their families.

  • Children’s Coverage: What Matters Most to Parents Results from Focus Groups in 6 Cities

    Issue Brief

    This report is based on based on focus group discussions with parents with moderate incomes enrolled in private coverage (employer sponsored or Marketplace) who had children in public coverage (primarily CHIP) or children with private coverage. This report is based on 14 focus group discussions conducted by the Kaiser Family Foundation and John Snow, Inc. in six cities during February and March 2015. Sites included Birmingham, AL, Chicago, IL, Denver, CO, Philadelphia, PA, and Tampa, FL. Each of these states operate separate CHIP programs. An additional 4 focus groups were conducted in Los Angeles, CA (two in English and two in Spanish). The purpose of the groups was to gain insight into what low and middle-income families value in their children’s coverage, their experiences with CHIP and private insurance, and on parents’ perspectives on the future of CHIP. The information gathered can help inform policy questions such as would private coverage (either employer sponsored coverage or Marketplace) or Medicaid work for children who currently are enrolled in CHIP?

  • 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.

  • Kaiser–Commonwealth Fund Survey: Most Primary Care Providers Report Seeing More Medicaid or Newly Insured Patients Since January 2014, But Little Change in Ability to Provide Quality Care

    News Release

    As with the Public, Physicians' Views on Affordable Care Act Split Along Party Lines The first in a series of reports on a comprehensive new survey finds most primary care doctors, nurse practitioners, and physician assistants report an increase in Medicaid or newly insured patients since the Affordable Care Act's (ACA) major coverage provisions took…

  • Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States

    Issue Brief

    This brief provides an on-the-ground view of ACA implementation after completion of the second open enrollment period. It is based on 40 in-person interviews conducted in five states that have made different implementation choices, including three states (Colorado, Kentucky, and Washington) that have developed a State-based Marketplace and adopted the Medicaid expansion and two states (Utah and Virginia) that rely on the Federally-facilitated Marketplace (FFM) for enrollment of individuals into qualified health plans (QHPs) and that have not adopted the Medicaid expansion to date. The interviews were conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured and Perry Undem Research/Communication with a range of stakeholders in each state, including Medicaid and Marketplace officials, consumer advocates, assisters, and hospital and community health center representatives, during April and May 2015. The report presents key findings related to enrollment systems; enrollment and renewal; outreach, marketing, and enrollment assistance; and access to and utilization of care. It concludes with key priorities identified by stakeholders looking ahead.

  • Filling the Coverage Gap: Policy Options and Considerations

    Issue Brief

    This issue brief examines some of the other options policymakers may consider to extend coverage to people in the gap, including increased fiscal incentives for states, a narrower public option, and making people with incomes below the poverty level eligible for enhanced ACA premium subsidies.