As Congress and the Trump administration consider significant changes to Medicaid, get the latest on the issues at play plus read Drew Altman’s new column on the two big decisions that will drive health policy.
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Medicaid

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Medicaid is in the crosshairs as Congress and the Trump administration consider significant changes to the program, which could include substantial cuts in federal funding, the implementation of work requirements, and a restructuring of Medicaid financing. New KFF resources on Medicaid include research and journalism about how the program works, who is covered, the potential impact of financing changes, an update on Medicaid and work, and more, including what may be ahead in Congressional debates.

 

Keep scrolling for more from across KFF on Medicaid.

Featured

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The Two Big Decisions That Will Drive Health Policy

 

In a new column, KFF President and CEO Drew Altman writes about the factors driving the biggest health policy decisions now—how to pay for tax cuts and whether President Trump wants another big fight about health care.

 

Any of the big Medicaid proposals floated so far—a per capita cap, drastic cuts in federal Medicaid expansion matching rates effectively killing the expansion in 40 states and DC, or significant cuts in the regular Medicaid matching rate, and Medicaid work requirements—will bring a divisive debate. With margins tight in the House, the President may not want to run the risk of another defeat on a big health care package, having suffered a dramatic defeat on the Affordable Care Act (ACA) repeal in his first term. Read more. 

 

Other recent columns from Drew include Making Sense of Medicaid Work Requirements and Could Trump Walk Away from Unpopular Health Proposals?

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What to Watch in 2025

 

As Congress considers changes to Medicaid, potentially to include funding cuts and work requirements, KFF explores the areas to watch, including potential administrative actions such as state demonstration waivers and regulations, and implications for state budgets and long-term care workforce challenges. We also looked at what administrative changes President Trump could make to Medicaid.

Medicaid Basics

 

In a year when many issues are at play that could affect Medicaid coverage, financing, and access to care, get a refresher on the Medicaid program with these new and updated key resources.

  • 10 Things to Know About Medicaid
  • 5 Key Facts About Medicaid Work Requirements
  • Medicaid Financing: The Basics
  • Medicaid Section 1115 Waivers: The Basics
  • 5 Key Facts About Immigrants and Medicaid
  • Key Facts About Medicaid Coverage for People with Disabilities and Medicaid Eligibility for Seniors and People with Disabilities
  • Health Policy 101 Chapter on Medicaid

Policy Research

Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates

A proposal to cut federal spending on the ACA Medicaid expansion could reduce total Medicaid spending by up to $1.9 trillion over 10 years and end coverage for as many as 20 million people. The impacts would be felt in both blue and red states and could effectively end the Medicaid expansion. 

 

Understanding the Intersection of Medicaid and Work

Data show that, in 2023, 92% of Medicaid adults were either working full or part-time (64%), or were not working due to barriers to work such as caregiving responsibilities, illness or disability, or school attendance — reasons that counted as qualifying exemptions from the work requirements under previous policies.

 

A Look at ACA Coverage through the Marketplaces and Medicaid Expansion Ahead of Potential Policy Changes

Forty-four million people enrolled in health coverage through the ACA’s Marketplaces and its expansion of the Medicaid program in 2024. That represents about 1 in every 6 people under age 65, or 16.4%.

 

How do Medicaid Home Care Programs Support Family Caregivers?

New information about family caregivers from KFF’s most recent survey of state Medicaid HCBS programs, including a discussion of paying family caregivers, self-direction, and supports available for family caregivers. For more, check out What is Medicaid Home Care (HCBS) and Payment Rates for Medicaid Home Care: States’ Responses to Workforce Challenges.

 

Community Health Center Patients, Financing, and Services

Community health center patients, services, experiences, and financing in 2023 and changes from before the covid pandemic.

 

A Look at Medicaid Enrollment and Finances of the Five Largest Medicaid Managed Care Plans

Trends in hospital margins from 2018 through 2023 and how operating margins varied across different types of hospitals in 2023.

 

Waiver Trackers: Keep up with the changes in how waivers are being utilized and legislated: 

  • Medicaid Work Requirements: Current Waiver and Legislative Activity
  • Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
  • Medicaid 1115 Waiver Watch: Round-up of Key Themes at the End of the Biden Administration
  • Section 1115 Waiver Watch: A Look at the Use of Contingency Management to Address Stimulant Use Disorder
  • Section 1115 Waiver Watch: Medicaid Services for Traditional American Indian and Alaska Native Health Care Practices

Polling

KFF Health Tracking Poll: Public Weighs Health Care Spending and Other Priorities for the Trump Administration

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With the Trump administration and Republican-led Congress looking to ways to reduce federal spending, this Poll finds that the Medicare and Medicaid programs remain broadly popular, and more people favor more spending on those programs than less spending. Among potential actions on health, the public sees price transparency and limiting chemicals in food as top priorities. Few say so about cuts to Medicaid and restrictions on abortion.

Health News

Republicans Are Eyeing Cuts to Medicaid. What’s Medicaid, Again?

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Republicans in Congress have suggested big cuts to Medicaid. The complex, multifaceted program touches millions of Americans and has become deeply woven into state budgets and the U.S. health care system. (KFF Health News)

Iowa Medicaid Sends $4M Bills to Two Families Grieving Deaths of Loved Ones With Disabilities

States are required to claw back health care costs from the estates of many Medicaid recipients. Some, including Iowa, are particularly aggressive in their pursuit. (KFF Health News) 

 

As States Mull Medicaid Work Requirements, Two Scale Theirs Back

As Republicans consider adding work requirements to Medicaid, Georgia and Arkansas — two states with experience running such programs — want to scale back the key parts supporters have argued encourage employment and personal responsibility. (KFF Health News) 

 

Wash, Dry, Enroll: Finding Medicaid Help at the Laundromat

State Medicaid and Affordable Care Act programs have long struggled to connect with lower-income Americans to help them access care. Now some are trying an alternative approach: meeting them at the laundromat. (KFF Health News) 

 

Across the South, Rural Health Care Has Become ‘Trendy.’ Medicaid Expansion Has Not.

State legislatures nationwide, including several in the South, are spending millions to improve rural health outcomes and access. For years, though, most Southern states have refused billions of federal dollars to provide public health insurance to more low-income adults. That isn’t likely to change with Trump back in office. (KFF Health News) 

 

Trump’s Return Puts Medicaid on the Chopping Block

Republicans in Washington are working on plans to shrink Medicaid, the nearly $900-billion-a-year government health insurance program that covers 1 in 5 Americans. (KFF Health News) 

 

Medicaid Expansion Debate Will Affect Other Health Policy Issues Before Montana Legislature

Legislative leaders say the decision whether to renew Montana’s Medicaid expansion program this year will loom over behavioral health spending and hospital regulation, among other topics. (KFF Health News) 

 

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