Federal financing changes, funding cuts, and administrative actions, including withholding federal Medicaid funds for potential fraud, are contributing to fiscal uncertainty for states.
More in our updated Medicaid financing explainer: https://on.kff.org/4rQ8iuX
Line graph of percent change in Medicaid enrollment and total spending shows Medicaid enrollment is expected to flatten, growing by 0.2%, as total spending grows by 7.9% in FY 2026.
Increasing spending demands, slower revenue growth, and fiscal uncertainty have created a more tenuous fiscal climate for states in FY 2026.
States are also preparing for H.R.1's federal Medicaid cuts, which will exacerbate existing budget challenges. https://on.kff.org/4oJnA3e
Chart titled 'States Report a Variety of Challenges With Implementing New Medicaid Work Requirements'. The chart lists challenges by categories: System Changes, Implementation Timeline, Staff Capacity, Fiscal Impact, and Applicant and Enrollee Issues. Each category details specific implementation challenges faced by states according to a 2019-2020 KFF survey of state Medicaid officials. Examples include system upgrades, pressure to make system changes in a short timeline, training needs for staff, potential increased cost due to accelerated timelines and changes, and potential confusion among applicants and enrollees.
State Medicaid programs shared insights into the challenges they anticipate when implementing work requirements next year: https://on.kff.org/3LLhQHu
Over half of small employers that don’t offer health benefits say Medicaid is an important source of coverage for their workers — 34% say it’s very important, while 22% say it’s somewhat important.
More in our latest survey: https://on.kff.org/ehbs2025
Major federal changes to Medicaid and other health-related policies could impact children’s health in the coming years.
Our new brief lays out the 5 issues to watch: https://on.kff.org/4hgyhHH
NEW: We analyzed recent state actions on vaccine policy, given narrowing federal guidelines. Overall, 26 states have taken some action; of these, 23 have Democratic governors, signaling a growing red/blue divide in vaccine access. @kff.org Key findings in next post ⬇️
www.kff.org/covid-19/tra...
KFF map titled, “47 States Allow Exemptions From School Vaccination Requirements for Religious and/or Personal Beliefs.” The map shows the type of non-medical exemption(s) from school vaccination requirements permitted by state: none (4 states), personal belief (1 state), religious (30 states), and religious and personal beliefs (16 states). The map notes that Florida has announced that they plan to eliminate school vaccine requirements but have not enacted any legislation, and West Virginia Governor Patrick Morrisey signed an executive order in January 2025 allowing religious and personal belief exemptions. Litigation is ongoing.
All states allow exemptions from school vaccination requirements for medical reasons and almost all states (47 including D.C.) allow exemptions for religious and/or personal beliefs: https://on.kff.org/4pbWQJg
FL's recent announcement of plans to eliminate school vaccination requirements would make them the first and only state to do so.
Our NEW @kff.org piece examines school vaccine requirements (and exemptions to requirements) and recent changes across the states: www.kff.org/state-health...
New data for the 2024-25 school year show routine vaccination rates for kindergarten children continue to decline, while exemptions from school vaccination requirements, particularly non-medical exemptions, have increased.
Check out @kff.org's UPDATED brief: www.kff.org/medicaid/iss...
As vaccine skepticism escalates and the number of U.S. measles cases grows, we examine what it means to eliminate measles, whether the current measles outbreak could threaten the country’s measles elimination status, and what losing that status might mean.
New: The Republican tax and spending mega-law will cut Medicaid in every state, but the effects are biggest in states that have expanded Medicaid under the ACA.
www.kff.org/medicaid/iss...
The Senate reconciliation bill would cut federal #Medicaid spending by over $200 billion more than the House bill though the increases vary by state.
In 14 states, the Senate bill would reduce federal Medicaid spending by at least $5 billion more than the House bill.
www.kff.org/quick-take/s...
KFF graphic featuring a quote from Elizabeth Williams, KFF Senior Policy Manager, Program on Medicaid & Uninsured. It says, “All states and the District of Columbia will lose more federal Medicaid funding under the Senate-passed bill than under the House-passed bill. In 14 states, the Senate bill would reduce federal Medicaid spending by at least $5 billion more than the House bill would have.”
⚡ KFF’s @liz-williams.bsky.social compares the increases in the federal Medicaid cuts in the Senate-passed reconciliation bill with the House-passed bill across states. #QuickTake on.kff.org/44zOKRr
The Senate reconciliation bill would reduce federal #Medicaid spending by $1 trillion over 10 years.
Provisions that only apply to ACA expansion states account for $526 billion of the federal spending reductions.
NEW @kff.org analysis looks at the impact across states: www.kff.org/medicaid/iss...
NEW RURAL BRIEF @kff.org : Senate reconciliation bill would cut federal Medicaid funding in rural areas by $155B—$36B more than the House bill. www.kff.org/policy-watch...
Work requirements and Medicaid: What’s in the House Reconciliation bill CBO Estimates: Implementing work requirements would account for the largest share of federal Medicaid savings — and cause the largest increase in the number of people without health insurance. Verification requirements: States would be required to verify at application and renewal that ACA expansion enrollees meet 80 hours of work activities per month or qualify for an exemption. States could also require more frequent verification. Implementation timeline: HHS must release guidance by end of 2025, giving states limited time to develop or change implementation plans, protocols, and systems before the Dec. 2026 implementation deadline. State implementation choices: State choices to impose stricter requirements than the minimum federal requirements — like more frequent verification or longer look-back periods — and state capacity to automate processes will affect how many people could lose coverage. Comparison to other waivers and proposals: The bill’s work requirement policies are more stringent than past Congressional proposals or state waivers, with no exemptions for older age and more barriers to getting and keeping coverage.
The work requirements proposed in the “One Big Beautiful Bill Act” are more stringent than previous policies considered by Congress and implemented at the state level.
As the Senate debates the bill, our analysis explains the proposals in the House-passed version.
Image depicts the following text: Box 1. The impact of choosing different “look-back” periods John lost his job and was out of work in April and May. In June, he started in a new seasonal position and worked 80 hours during the month. In July, John applies for Medicaid in an expansion state, as he qualifies for Medicaid on the basis of his income. State A uses a 1-month look-back period when determining compliance with work requirements at application. John would be able to enroll in Medicaid (provided he meets all other program requirements). State B uses a 3-month look-back period when determining compliance with work requirements at application. John would not qualify for Medicaid, as he was out of work in two of the three months.
A unique feature of the proposed Medicaid work requirements in the reconciliation bill is that states could choose to require individuals to work for *multiple* months prior to applying for Medicaid - meaning people with employment gaps would not qualify for Medicaid, even if currently working
#Medicaid provisions that only apply to ACA expansion states account for roughly half ($427 billion) of total federal spending cut in the House-passed reconciliation bill and changes in the Senate Finance language would further cut federal spending for expansion states: www.kff.org/policy-watch...
My annotation of the new distributional analysis from the Congressional Budget Office of the One Big Beautiful Bill.
www.cbo.gov/publication/...
KFF bar chart titled “Nearly 9 in 10 Medicaid enrollees say they are at least somewhat worried that federal funding cuts to Medicaid would negatively impact their and their families’ access to health care.” The chart shows the percent of Medicaid enrollees — including by party ID — who say that if the federal government significantly reduces its spending on Medicaid, they are very or somewhat worried it would lead to more adults and children becoming uninsured (85% Medicaid enrollees, 91% Democrats, 94% Independents, 69% Republicans); negatively impact hospitals, nursing homes, and other health care providers in your community (85% Medicaid enrollees, 93% Democrats, 96% Independents, 65% Republicans); and negatively impact their or their family’s ability to get and pay for health care (86% Medicaid enrollees, 90% Democrats, 92% Independents, 76% Republicans).
As Congress weighs spending cuts and other changes to Medicaid, our latest poll shows three-quarters of MAGA supporters and other Republicans enrolled in Medicaid are worried about the potential impact of federal spending reductions on their families.
on.kff.org/4mPUFd9
See updated @kff.org state-level analysis of CBO estimates for #Medicaid spending and Medicaid coverage reductions from provisions in the House Passed Reconciliation Bill: www.kff.org/medicaid/iss...
Medicaid is the primary payer for maternity care in the U.S. It finances about 4 in 10 (41%) births nationally — nearly half in rural communities (47%).
Our new brief covers more facts you may find surprising.
KFF infographic showing coverage of opioid use disorder treatments among nonelderly adults. It details Medicaid's share compared to other payers in four categories: Adults with OUD (Medicaid 47%, Other 53%), Medication for OUD (Medicaid 56%, Other 44%), Outpatient OUD Treatment (Medicaid 64%, Other 36%), and Peer Support Services for SUD (Medicaid 64%, Other 36%).
Medicaid covers 47% of nonelderly adults with opioid use disorder and is the main source of coverage for those receiving treatment services.
It covers 56% of those receiving medication and 64% of those getting outpatient treatment and peer support services: on.kff.org/43kNyAB
From new Medicaid work requirements to lowering expansion match rates for states that use their own funds to cover undocumented immigrants, the reconciliation bill could reshape how states fund and manage #Medicaid.
We outline the proposed provisions:
With legislative proposals under discussion that would affect the ACA #Medicaid expansion group, new @kff.org analysis looks are some more characteristics of this population. www.kff.org/medicaid/iss...
If states maintained ACA #Medicaid expansion coverage and spending, a per capita cap on the expansion population would erode the effective enhanced federal match rate over time and shift $246B in costs to states over 10 years.
More in our NEW @kff.org analysis here: www.kff.org/medicaid/iss...
Options under consideration in Congress to reduce #Medicaid spending to help pay for tax cuts could have major implications for children with special health care needs.
NEW @kff.org brief explores 5 key facts about children with special health care needs and Medicaid: www.kff.org/medicaid/iss...
Large federal spending cuts for #Medicaid could have implications for nursing facilities bc Medicaid covers 63% of nursing home costs. Federal cuts could lead to reductions in Medicaid payment rates making it harder for nursing facilities to bolster staffing to improve the quality of patient care.
Here’s a short explainer of what the senate budget resolution does and what that could mean for Medicaid:
www.kff.org/quick-take/u...
Check out our 23rd annual #Medicaid eligibility and enrollment survey report. Many states emerged from the unwinding with more efficient processes by maximizing the use of technology to verify income, reduce returned mail, and improve communications with enrollees. www.kff.org/medicaid/rep...