Medicaid Roundup: As States Prepare for Impact of Federal Medicaid Policy Changes, Many Implementation Questions Remain

Plus, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026.

View in browser Medicaid Looking ahead to 2026, states are preparing for major federal policy changes and $911 billion in federal Medicaid spending reductions stemming from the tax-and-spending law. While some states have already announced policy changes, many questions remain about how these federal policy changes will be implemented and what states will do in response to federal spending reductions. Additionally, Medicaid work requirements, which were the largest source of federal spending reductions, plus new limits on provider taxes, are estimated to lead to significant Medicaid coverage losses as well as implications for hospital reimbursement rates over the coming years.   Read more about KFF's policy analysis, polling, and journalism on top Medicaid issues. Featured Tracking Implementation of Medicaid Work Requirements   KFF's new interactive tracks key data and policies that will affect how states implement Medicaid work requirements and also includes state-level data on Medicaid enrollment and renewal outcomes as well as current state enrollment and renewal policies.    New Medicaid work requirements account for over one-third of federal spending cuts. More on the estimated $911 billion in cuts. A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes   As states completed the "unwinding" of pandemic-era continuous coverage, Medicaid enrollment fell 7.6% in FY 2025 and is expected to be largely flat in FY 2026, according to KFF's 25th annual Medicaid Budget Survey. At the same time, total Medicaid spending grew by 8.6% in FY 2025 and is expected to grow by 7.9% in FY 2026.    Additional analyses of the survey data look at Medicaid enrollment and spending trends for FY 2025 and FY 2026 and how the 2025 reconciliation law changed the federal rules governing provider taxes.   Health Policy in 2026 In a new column, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026 including that states that have expanded Medicaid will be gearing up for Medicaid work requirements, which kick in in 2027.    Read the column → Policy Research Challenges with Implementing Work Requirements: Findings from a Survey of State Medicaid Programs To better understand how states are preparing for Medicaid work requirements, states were asked to discuss anticipated challenges to implementing work requirements by the end of 2026, including related system changes and data matching.    Potential Impact of the High Unemployment Hardship Exception to Medicaid Work Requirements This issue brief describes the hardship exception for individuals living in counties with high unemployment and estimates the number of counties that could meet the criteria for this exception and the number of expansion enrollees living in those counties who could be exempt from work requirements.   5 Key Facts about Medicaid and Provider Taxes This issue brief uses data from KFF's 2025-2026 survey of Medicaid directors to describe states' current provider taxes, explore how the 2025 reconciliation law changed the federal rules governing provider taxes, and summarize potential impacts of the changes across states.   Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025 This data note provides new information about waiting lists for Medicaid home care before many of the provisions in the 2025 reconciliation law go into effect.    States' Management of Medicaid Home Care Spending Ahead of H.R. 1 Effects Using data from the 23rd KFF survey of officials administering Medicaid home care programs, 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.   A Closer Look at the $50 Billion Rural Health Fund in the New Reconciliation Law The reconciliation law includes a $50 billion rural health fund. This brief describes the rural health fund, explains what the law says about the allocation of funds, and highlights outstanding questions about how the funds will be distributed across and within states to pay rural hospitals and for other purposes.   Potential "Chilling Effects" of Public Charge and Other Immigration Policies on Medicaid and CHIP Enrollment This issue brief reviews the Department of Homeland Security (DHS) proposed rule that would rescind 2022 Biden-era public charge determination regulations. The proposed public charge changes along with other Trump administration policy changes will likely lead to decreased participation in public programs, including Medicaid, among a broad group of immigrant families, including citizen children in those families.   Medicaid and Children's Health: 5 Issues to Watch Amid Recent Federal Changes Learn about the major federal changes to Medicaid and other health-related policies that could impact children's health in the coming years.    5 Key Facts About Medicaid Coverage for People with Intellectual and Developmental Disabilities Among the estimated 8 million people with intellectual and developmental disabilities, over three million have Medicaid coverage.   Variation in Medicaid Spending Per Enrollee by Group and Across States Because states have flexibility in designing their programs, state Medicaid spending and enrollment varies across states. This data note provides an overview of total Medicaid spending per enrollee by eligibility group and state.  Polling Most Americans Have Some Connection to Medicaid This updated data note provides an overview of recent KFF polling on the public's views of and connections to Medicaid, the federal-state government health insurance for certain low-income adults and children and long-term care program for adults 65 and older and younger adults with disabilities. Health News Trump Wants Americans To Make More Babies. Critics Say His Policies Won't Help Raise Them. Reproductive rights groups and other advocacy organizations say these efforts to buttress the birth rate don't make up for broader administration priorities aimed at cutting federal programs such as Medicaid, its related Children's Health Insurance Program, and other initiatives that support women and children. (KFF Health News) They Need a Ventilator To Stay Alive. Getting One Can Be a Nightmare. Few nursing homes are set up to care for people needing help breathing with a ventilator because of ALS or other infirmities. Insurers often resist paying for ventilators at home, and innovative programs are now endangered by Medicaid cuts. (KFF Health News)    Medicaid Work Rules Exempt the 'Medically Frail.' Deciding Who Qualifies Is Tricky. People on Medicaid deemed "medically frail" won't need to meet new federal requirements that enrollees work 80 hours a month or perform another approved activity. But state officials are grappling with how to interpret who qualifies under the vague federal definition, which could affect millions. (KFF Health News)    More People Are Caring for Dying Loved Ones at Home. A New Orleans Nonprofit Is Showing Them How. Demand for home health care, including at-home hospice care, has skyrocketed since the onset of the covid pandemic. Medicaid cuts could prompt states looking to offset their added expenses to reconsider optional state Medicaid programs, such as the one that helps pay for at-home hospice care. (KFF Health News)    Trump's HHS Orders State Medicaid Programs To Help Find Undocumented Immigrants Federal health authorities have taken the "unprecedented" step of instructing states to investigate certain individuals on Medicaid to determine whether they are ineligible because of their immigration status, with five states reporting they've received more than 170,000 names collectively. (KFF Health News)    Officials Show Little Proof That New Tech Will Help Medicaid Enrollees Meet Work Rules The Trump administration says it's developing a digital tool to help people prove they're meeting new Medicaid work requirements. KFF Health News talked to officials from the two states running pilot programs and found little evidence of new — or effective — technology. 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