KFF

This bar chart shows the distribution of adult workers with and without Medicaid by their relationship to employer-sponsored health insurance, in 2024. Most adults with Medicaid work for an employer that does not offer job-based coverage (52%) or are not eligible for their employer’s coverage (13%).

For workers with Medicaid, job-based health insurance is often unavailable or unaffordable.

Our new analysis examines who is offered, eligible for, and enrolled in job-based insurance: https://on.kff.org/4rW1LPG

Bar chart illustrating reasons immigrant parents delayed or skipped children's healthcare in the past 12 months. Categories include "Due to cost or lack of insurance," "Could not find services at a convenient time or location," and "Concerned about a family member's immigration status." Groups broken down into "Naturalized citizens," "Lawfully present immigrants," and "Likely undocumented immigrants." The chart shows that 3 in 10 immigrant parents say their child skipped or delayed health care (for any of those reasons) in the past 12 months. Data source: KFF/New York Times.

Three in ten (30%) immigrant parents say any of their children missed, delayed, or skipped health care in the past 12 months due to any of a variety of reasons.

This includes 14% who say they did so due to immigration-related fears, a fall 2025 KFF/NYT poll shows. https://on.kff.org/40KYB5b

How States Verify Citizenship and Immigration Status in Medicaid | KFF This brief describes federal citizenship and immigration status eligibility and eligibility verification requirements for Medicaid. Eligibility for federally-funded coverage under Medicaid and the Chi...

In August, CMS announced it will require states to reverify citizenship or satisfactory immigration status for certain individuals with Medicaid.

Here is how states verify citizenship and immigration status to determine eligibility and the new reverification process: https://on.kff.org/4d3Odgf

Map shows which states, among those that will be subject to Medicaid work requirements, use Supplemental Nutrition Assistance Program (SNAP) information to help determine Medicaid eligibility, as of January 2025.

Due in part to the overlap in eligibility between the two programs, many states use information from SNAP to assist with determining Medicaid eligibility.

More on the intersection of SNAP and Medicaid in our new brief: https://on.kff.org/470uL0j

Map shows which states, among those that will be subject to Medicaid work requirements, use Supplemental Nutrition Assistance Program (SNAP) information to help determine Medicaid eligibility, as of January 2025.

Among states subject to Medicaid work requirements, 15 enroll/renew individuals in Medicaid using SNAP income determinations, and 33 use SNAP info to identify potential changes in eligibility, including 10 states and DC that do both: https://on.kff.org/470uL0j

Nearly half (47%) of immigrant parents report experiencing negative health impacts due to immigration-related worries since January 2025.

About one in five (18%) say that their child’s well-being has been affected, per KFF/NYT polling from fall 2025: https://on.kff.org/40KYB5b

Map shows which states, among those that will be subject to Medicaid work requirements, use Supplemental Nutrition Assistance Program (SNAP) information to help determine Medicaid eligibility, as of January 2025.

States can use information from SNAP to identify individuals who may be exempt from Medicaid work requirements and those who are meeting the requirements.

Learn about these and other program intersections in our new brief: https://on.kff.org/470uL0j

A flowchart titled "Verification of Immigration Status in Medicaid" outlines the process for determining Medicaid eligibility based on immigration documentation. It involves verifying with DHS SAVE system if documentation is provided or denying eligibility if the applicant is ineligible.

Federal rules limit Medicaid eligibility to U.S. citizens and certain lawfully present immigrants; undocumented immigrants aren't eligible for federally funded coverage.

A look at how states verify citizenship & immigration status to determine eligibility: https://on.kff.org/4d3Odgf

Medicaid Financing: The Basics | KFF Medicaid represents $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term services and supports for low-income re...

Medicaid represents nearly $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term care to low-income residents: https://on.kff.org/4rQ8iuX

KFF-Peterson Health System Tracker chart shows the share of total health spending by percentile in 2023. The bar chart shows that most health spending comes from a small share of the population, including older adults and people reporting fair or poor health.

In 2023, nearly half of all health spending came from 5% of the U.S. population.

Those in the top 5% spent an average of $72,918 on health care annually; while those in the top 1% spent an average of $150,467 per year: https://on.kff.org/4u6zqYj

Bar chart showing prescription drug plan enrollment for top 5 sponsors from February 2025 to February 2026. Centene increases from 7.81M to 8.71M. CVS Health decreases from 4.14M to 3.88M. UnitedHealth Group rises from 3.53M to 3.75M. Humana grows from 2.28M to 3.66M. Health Care Service Corp decreases from 3.2M to 2.7M. Note explains enrollment method and assumptions. Source: KFF.

Humana and Centene gained the most enrollees in stand-alone Medicare Part D drug plans (PDPs) between Feb. 2025 and Feb. 2026.

This is likely due to reducing monthly premiums for some PDPs in many regions and offering low or zero premium options. https://on.kff.org/4u6KDbi

Map shows which states, among those that will be subject to Medicaid work requirements, use Supplemental Nutrition Assistance Program (SNAP) information to help determine Medicaid eligibility, as of January 2025.

New Medicaid work requirements and changes to SNAP work requirements are expected to impact enrollment in both programs.

Learn about the program intersections and more in our new brief: https://on.kff.org/470uL0j

This graph from KFF shows the enrollment trends in Medicare drug plans from 2006 to 2026. The green line depicts non-group Medicare Advantage drug plans (MA-PD), showing a steady increase from about 5 million in 2006 to a projected 27.6 million in 2026. The blue line represents non-group Medicare Part D stand-alone prescription drug plans (PDP), with enrollment peaking around 2010 and flattening at roughly 18.1 million by 2026. The x-axis marks the years, while the y-axis indicates the enrollment numbers in millions.

New Medicare data shows 56.1 million people have Part D drug coverage in early 2026, with more choosing MA-PDs over PDPs. Enrollment in individual and employer group PDPs increased over 2025, while MA-PD group enrollment decreased.

See the analysis: https://on.kff.org/4u6KDbi

Medicaid Financing: The Basics | KFF Medicaid represents $1 out of every $5 spent on health care in the U.S. and is the major source of financing for states to provide health coverage and long-term services and supports for low-income re...

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

At our event on shifting U.S. vaccine policy, KFF’s Liz Hamel highlighted our latest polling that shows changing levels of trust in CDC vaccine information since the COVID-19 pandemic across political parties.

Explore trends in trust with KFF’s polling dashboard: https://on.kff.org/4cWJoVW

Constrained Budgets Lead States to Restrict HIV Drug Access Through Ryan White | KFF States are facing constrained budgets, putting pressure on HIV programs, including the Ryan White HIV/AIDS Program. This Policy Watch explores how state Ryan White AIDS Drug Assistance Programs (ADAPs...

Ryan White AIDS Drug Assistance Programs face new federal and state budget pressures that are resulting in several states restricting eligibility or reducing the scope of services offered with possible implications for public health.

Our experts explain: https://on.kff.org/4cq460q

KFF-Peterson Health System Tracker chart shows the share of total health spending by percentile in 2023. The bar chart shows that most health spending comes from a small share of the population, including older adults and people reporting fair or poor health.

In any given year, a small portion of the population is responsible for a very large percentage of total health spending.

See how spending varies by health status, age, sex and more: https://on.kff.org/4u6zqYj

Understanding Medicaid Home Care Amid CMS Focus on Potential Fraud and Abuse | KFF This issue brief describes how Medicaid home care operates—including who is eligible and the systems in place to promote program integrity in its delivery—and the challenges of using new CMS data to i...

Amid recent reports of fraud in Medicaid home care, KFF describes the safeguards that exist and why all 50 states and DC choose to provide Medicaid home care services despite potential program vulnerabilities: https://on.kff.org/3OM76u1

Peterson-KFF Health System Tracker stacked bar chart titled “on average, patients with high needs have higher spending across all types of health care.” The chart shows the average total health spending per person, by type of healthcare and percentile of total health spending in 2023.

People in the top 5% of out-of-pocket spending made up 90% of home health, 80% of inpatient, and 51% of ambulatory out-of-pocket spending: https://on.kff.org/4u6zqYj

KFF-Peterson Health System Tracker chart shows the share of total health spending by percentile in 2023. The bar chart shows that most health spending comes from a small share of the population, including older adults and people reporting fair or poor health.

KFF’s updated analysis explores how health spending varies across the U.S. population.

Hint: Health spending is concentrated in key populations: https://on.kff.org/4u6zqYj

Constrained Budgets Lead States to Restrict HIV Drug Access Through Ryan White | KFF States are facing constrained budgets, putting pressure on HIV programs, including the Ryan White HIV/AIDS Program. This Policy Watch explores how state Ryan White AIDS Drug Assistance Programs (ADAPs...

States are facing budget constraints that are putting pressure on HIV programs like Ryan White’s AIDS Drug Assistance Program (ADAP), with several states scaling back access to HIV treatment.

Our new brief tackles what this means: https://on.kff.org/4cq460q

Filling in the Gap in Federal Medicaid Funding to Planned Parenthood: State Responses | KFF This brief examines efforts in 11 states to fill in funding gaps created by the 2025 federal budget reconciliation law, which prohibits federal Medicaid funding for reproductive-health care services p...

While Planned Parenthood and certain other abortion providers are blocked from receiving federal Medicaid reimbursements, 11 states have committed to filling in funding gaps. In an update, our experts share more details about what states are doing. https://on.kff.org/4qmsNis

Since the pre-COVID school year, more families are opting out of required vaccines — primarily through nonmedical exemptions.

At our event on shifting U.S. vaccine policy, KFF’s @jenkatesdc.bsky.social discussed these trends and state-level decisions that could follow. https://on.kff.org/471xV3z

A chart by KFF titled "Of the 1.1 Million Beneficiaries Who Received At Least One WISeR Service in 2024, Over 900,000 Received Some Type of Orthopedic Pain Management Service." The chart shows traditional Medicare beneficiaries who received WiSeR services from 2019 to 2024. In 2024, 1,055,700 received any WiSeR service, and 908,000 received orthopedic pain management.

The vast majority of traditional Medicare beneficiaries who got a service that is subject to prior authorization under the WISeR model received orthopedic pain management services to treat conditions such as back and knee pain. https://on.kff.org/4r2zqpF

Filling in the Gap in Federal Medicaid Funding to Planned Parenthood: State Responses | KFF This brief examines efforts in 11 states to fill in funding gaps created by the 2025 federal budget reconciliation law, which prohibits federal Medicaid funding for reproductive-health care services p...

In an update, our experts examine additional state commitments to fill funding gaps created by the 2025 federal budget reconciliation law, which blocks federal Medicaid payments to certain abortion providers for all services they provide. https://on.kff.org/4qmsNis

How AI Can Both Detect and Enable Fraudulent Research - The Monitor | KFF A new study finds that nearly 10% of cancer research papers showed signs of being fabricated by “paper mills”. The problem may intensify as generative AI becomes more sophisticated, prompting lawmaker...

From The Monitor: Claims that doctors are financially incentivized to promote vaccines may be contributing to vaccine hesitancy and declining trust, even as recent analyses show doctors typically break even or lose money when administering vaccines. https://on.kff.org/4u5nB4L

Filling in the Gap in Federal Medicaid Funding to Planned Parenthood: State Responses | KFF This brief examines efforts in 11 states to fill in funding gaps created by the 2025 federal budget reconciliation law, which prohibits federal Medicaid funding for reproductive-health care services p...

In a new update, our experts provide more details about how 11 states are responding to the year-long ban on federal Medicaid payments to Planned Parenthood created by the 2025 budget reconciliation law. https://on.kff.org/4qmsNis

This bar chart illustrates spending trends from 2019 to 2024 on various WiSeR service types within traditional Medicare. It shows significant growth in spending on skin substitutes with relatively flat spending for opioid pain management, stimulators, incontinence control devices, and impotence diagnosis/treatment. The y-axis represents spending in billions of dollars, while the x-axis depicts each year from 2019 to 2024. Data sources are credited to KFF, CMS, and other research.

Medicare’s new prior authorization initiative targets services that account for a small but growing share of Part B spending in traditional Medicare, rising from 1.1% in 2019 to 5.3% in 2024.

The growth was driven by spending on skin substitutes. https://on.kff.org/4r2zqpF

The image is a line graph from KFF titled "The Medicaid Payment Error Rate Measurement (PERM) Program Finds that Medicaid Pays Most Outlays Properly." It displays a comparison of Medicaid overall improper payment rate estimates, showing two lines: "Proper payments" in blue and "Improper payments" in green. The graph covers the years 2009 to 2025 on the x-axis, with a percentage scale from 0% to 100% on the y-axis. A note at the bottom clarifies that "improper payments" are not indicative of fraud.

Federal audits show most Medicaid payments (94% in 2025) meet requirements and that most improper payments are due to insufficient documentation.

More on Medicaid payment errors as well as upcoming changes and impacts: https://on.kff.org/3MAirwJ

The Midterms Lurk Behind Every Health Policy Move Now In his latest column, President and CEO Dr. Drew Altman discusses how midterm political strategy will shape health policy in 2026, focusing on recent moves by President Trump. He writes: “Democrats st...

“The goal for Trump & Republicans is not to ‘win’ the health care issue, but to erode the Democratic advantage on it by talking a lot about drug costs & villainizing drug companies.”

KFF’s @drewaltman.bsky.social on how midterm strategy will shape health policy this year: https://on.kff.org/4tYaVMG