The Role of Medicaid in Health & Mental Health Care

Learn more about the role and impact of Medicaid. 
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What's the latest with Medicaid? 

Learn more from KFF about what is expected for Medicaid in 2026. 
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Medicaid Expansion

To date, 41 states (including DC) have adopted Medicaid expansion and 10 states have not adopted expansion.
Learn more about the status of expansion in each state.

In the ten years since the Patient Protection and Affordable Care Act (ACA) passed, over 400 studies have demonstrated the impact of expanding Medicaid. Read more about the effect of expansion on coverage, access to care, utilization, quality of care, health outcomes, provider capacity, affordability, and financial security.

From the Kaiser Family Foundation, 2026

Learn more about the "unwinding" of Medicaid post-COVID

In April 2023, states began the process of unwinding the Medicaid continuous enrollment provision, a pandemic-era policy that protected Medicaid coverage for millions of enrollees. During the unwinding, states redetermined eligibility for everyone on the program and disenrolled those who were no longer eligible or who did not complete the renewal process, leading to a 10% overall reduction in beneficiaries (with large variation between states). 
Learn more about current Medicaid enrollment. ​

Medicaid waivers

Under existing federal Medicaid law, states can improve their Medicaid programs using tools such as Section 1115 waivers to best meet their state's particular needs. Visit KFF’s Medicaid Waiver Tracker to monitor approved and pending waivers by state, including those with work requirements. ​

The role of Medicaid in responding to the opioid epidemic

Nearly four in ten non-elderly adults with opioid use disorder (OUD) are covered by Medicaid.
Learn more about Medicaid's role in facilitating access to OUD treatment.
Read about policy responses to the opioid epidemic.

Expanded mobile crisis services for Medicaid beneficiaries 

CMS has awarded $15 million in planning grants to 20 states to support expanding community-based mobile crisis intervention services for Medicaid beneficiaries.​

"One-stop shop" on community-based services under Medicaid

CMS is offering a “one stop shop” with comprehensive information for state-level Medicaid agencies and stakeholders. This resource offers information about states’ plans to enhance, expand, and strengthen home- and community-based services across the country, using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).​

Medicaid and work requirements

Work requirement waivers generally require beneficiaries to verify their participation in certain activities, such as employment, job search, or job training programs, for a certain number of hours per week (or to verify an exemption), in order to receive or retain Medicaid coverage.
What do we know about Medicaid and employment?
What is the impact of work requirements on hospital finances, especially in rural areas?

​The bipartisan National Academy for State Health Policy notes that States will have numerous considerations about Medicaid and long-term care services, if Medicaid funding is reduced and/or expansion rolled back.

Considerations for States about Medicaid

1. The repeal of the ACA would result in millions of individuals losing Medicaid or CHIP coverage. The 39 States that expanded Medicaid will either need to pick up costs with all State dollars or shut down part of their Medicaid program. Specifically, they may have to:  a) dis-enroll individuals from Medicaid; b) review and address contracts that need to be modified or terminated; c) collect, process, and pay providers of expansion beneficiaries; and/or d) make eligibility and enrollment system changes that will be dependent upon repeal language. Regarding the latter point, will States need to change eligibility methodology from MAGI? How much will it cost to dismantle the integration with current marketplaces?

2. With individuals losing Medicaid coverage, what would be the magnitude of the increase in uncompensated care costs? What would be the financial impact on providers in States that expanded Medicaid, such as rural hospitals and community health centers? What would be the impact on individuals’ ability to access care?

3. Would care coordination initiatives, such as Medicaid Health Homes, remain in place even if the ACA is repealed? States may no longer receive enhanced funding matches for these services, so there would be additional costs to States.

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Considerations for States about HCBS​

1. Repealing the ACA could remove State flexibility for implementing home- and community-based services (HCBS) as a Medicaid option in State Plans. Would States continue to have flexibility to promote HCBS in Medicaid? If so, through what authority?

2. Would there be an enhanced federal match rate to support States’ efforts to provide community-based, long-term services and supports? If so, how would they be funded, and how would States access those enhanced funds?

​3. What are the implications, if any, for Medicaid managed care contracting, if changes are made to States’ options for promoting HCBS? Would States see an increase in demand for nursing home services? 

The Kaiser Family Foundation offers numerous policy research resources.

The National Association of Medicaid Directors offers an overview of key Medicaid financing issues for states to consider.

The National Academy for State Health Policy offers a variety of resources to help states understand the impact of current proposals for health care reform.

Views expressed on the Academy for Policymakers web site do not necessarily represent those of our Center or any federal agency. Our mission is to share the latest policy information and the perspectives of a variety of stakeholders without endorsement.