Medicaid
CMS is expected to release anticipated guidance on Medicaid work requirements by Monday, June 1, including key definitions and standards that states have been waiting to receive while preparing for the January 1, 2027 implementation deadline. Through a series of policy analyses, KFF’s interactive data tool, and news reporting, KFF is closely tracking how states are approaching implementation of Medicaid work requirements and navigating related challenges.
Read the latest from KFF on Medicaid policy research and journalism below.
Featured
The Medical Frailty Exemption from Medicaid Work Requirements: Key Issues to Watch for in Upcoming CMS Guidance
States are moving forward with key decisions over how to implement the medical frailty exemption even as they wait for formal guidance from CMS. The guidance is expected to address key issues related to defining medical frailty and verifying medical frailty status.
Also, learn more about states’ plans from KFF’s recent survey of Medicaid officials.
A Look at the High Unemployment Hardship Exception to Medicaid Work Requirements
In the 39 states that are adopting or may adopt the hardship exception, about 1.4 million or 7.5% of Medicaid expansion enrollees live in one of the 133 counties that currently meet the high-unemployment criteria and could be exempt from Medicaid work requirements.
KFF’s Medicaid Work Requirements Tracker
This interactive, regularly updated tool monitors how this historic and complex policy change is unfolding across affected states—tracking key state-level policy decisions as well as Medicaid enrollment and renewal outcomes, county unemployment rates, and other data.
Montana Hurries To Adopt Trump’s Medicaid Work Rules Amid Budget Woes
As KFF Health News reports, the state is ramping up to implement the federal work requirements six months ahead of the deadline. But Montana is one of several states already struggling to pay for health services.
Policy Research
More on Medicaid Work Requirements
Implementing Medicaid Work Requirements: Lessons from Unwinding
Strategies states adopted during the unwinding related to enrollee outreach, eligibility systems, and enrollment processes can help them better navigate the implementation of work requirements.
The Intersection of SNAP and Medicaid as States Implement Medicaid Work Requirements
We examine how states can use SNAP data to verify Medicaid eligibility and compliance with work requirements.
Medicaid Program Integrity
CMS’ New Approach to Federal Medicaid Spending in Cases of Potential Fraud
CMS is taking a new approach to fraud that relies more heavily on options to defer federal funding in cases of potential fraud, which could have broad implications for states and Medicaid enrollees.
Understanding Medicaid Home Care Amid CMS Focus on Potential Fraud and Abuse
We explain how Medicaid home care operates—including who is eligible and the systems in place to promote program integrity—and the challenges of using certain data to identify unusual billing patterns or potential fraud in the program.
The Medicaid Payment Error Rate Measurement (PERM) Program and Upcoming Changes and Impacts
This brief explains how the PERM program measures improper Medicaid payments, noting that the error rate is not a measure of fraud and that most errors are due to paperwork and administrative issues, and describes the new financial penalties for states with eligibility error rates above 3% starting in 2029.
Medicaid Prescription Drugs Costs
What to Know About the BALANCE Model for GLP-1s
This brief describes CMS’s efforts to expand access to GLP-1 obesity medications and examines the implications for Medicaid and Medicare beneficiaries and program budgets.
The GENEROUS Model and Factors That Could Impact Medicaid Drug Costs
We examine a voluntary CMS initiative that aims to lower Medicaid drug costs by negotiating prices based on what other countries pay—the impact from which remains unclear.
Recent Trends in Medicaid Outpatient Prescription Drugs and Spending
We examine recent growth in Medicaid prescription drug spending and analyze how federal actions, including Medicaid coverage cuts and new drug pricing models and demonstrations, could affect prescription drug access and spending.
Medicaid Finances and Access
Understanding Medicaid Cost Sharing and Policy Changes from the 2025 Reconciliation Law
This brief explains current Medicaid cost-sharing rules and the first-ever federal requirement, included in the 2025 reconciliation law, that states impose cost-sharing of up to $35 per service on ACA expansion adults, which will have implications for health care access and utilization.
Medicaid Mental Health and Substance Use
This brief examines how states have used Medicaid to expand behavioral health coverage and what new work requirements and fiscal pressures could mean for coverage and access to care going forward.
A Closer Look at Rural Nursing Homes
More than one in four certified nursing homes are in rural areas, and rural nursing homes have been decreasing faster than nursing homes in urban areas. Since Medicaid is the primary payer for nursing home care, reductions in federal spending from the 2025 reconciliation law, could have implications for access to care in rural areas and rural nursing homes.
Health News
Trump’s Medicaid Work Mandate Debuting in Nebraska to Much Dismay.
Nebraska became the first state to enforce Medicaid work requirements on May 1, 2026. Health policy experts and advocates worry that thousands of enrollees could lose coverage due to administrative burden and confusion about the new rules. (KFF Health News)
Medi-Cal Immigrant Enrollment Is Dropping. Researchers Point to Trump’s Policies.
A KFF Health News analysis found that nearly 100,000 immigrants without legal status left California’s Medi-Cal program in the second half of 2025—a trend some researchers attribute to fear of immigration enforcement and the Trump administration’s proposed public charge rule, rather than routine eligibility checks. (KFF Health News)
Trump Demands Medicaid Data for Deportation. Some States Go a Step Further.
A growing number of Republican-led states—including North Carolina, Indiana, Louisiana, Montana, and Wyoming—are requiring their public health agencies to report Medicaid recipients with unverified immigration status to the Department of Homeland Security, going beyond federal requirements. (KFF Health News)
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