Liz Williams

@liz-williams.bsky.social

Senior Policy Manager | KFF's Program on Medicaid & Uninsured | she/her ✿ views are my own ✿

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

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...

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Increasing spending demands, slower revenue growth, and fiscal uncertainty have created a more tenuous fiscal climate for states in FY 2026. States are also preparing for H.R.1's federal Medicaid cuts, which will exacerbate existing budget challenges. https://on.kff.org/4oJnA3e

Line graph of percent change in Medicaid enrollment and total spending shows Medicaid enrollment is expected to flatten, growing by 0.2%, as total spending grows by 7.9% in FY 2026.

Over half of small employers that don’t offer health benefits say Medicaid is an important source of coverage for their workers — 34% say it’s very important, while 22% say it’s somewhat important. More in our latest survey: https://on.kff.org/ehbs2025

2025 Employer Health Benefits Survey | KFF

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, worker contributions, cost-sharing provisions, offer rates, and more. This year's report also looks at how employers are approa...

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NEW: We analyzed recent state actions on vaccine policy, given narrowing federal guidelines. Overall, 26 states have taken some action; of these, 23 have Democratic governors, signaling a growing red/blue divide in vaccine access. @kff.org Key findings in next post ⬇️ www.kff.org/covid-19/tra...

Tracking State Actions on Vaccine Policy and Access | KFF

With recent federal actions to curtail vaccine access, many states have announced actions intended to maintain broader access. This issue brief provides a snapshot of this rapidly changing landscape, ...

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FL's recent announcement of plans to eliminate school vaccination requirements would make them the first and only state to do so. Our NEW @kff.org piece examines school vaccine requirements (and exemptions to requirements) and recent changes across the states: www.kff.org/state-health...

A Look at Recent Changes to State Vaccine Requirements for School Children | KFF

This policy watch examines state-by-state school vaccine requirements and exemptions, including recent policy changes to them and the extent to which they may affect vaccination rates.

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New data for the 2024-25 school year show routine vaccination rates for kindergarten children continue to decline, while exemptions from school vaccination requirements, particularly non-medical exemptions, have increased. Check out @kff.org's UPDATED brief: www.kff.org/medicaid/iss...

Kindergarten Routine Vaccination Rates Continue to Decline | KFF

This issue brief provides an update on the latest trends in kindergarten children's routine vaccination and exemption rates. Over three-quarters (39) of states had measles, mumps, rubella (MMR)vaccina...

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As vaccine skepticism escalates and the number of U.S. measles cases grows, we examine what it means to eliminate measles, whether the current measles outbreak could threaten the country’s measles elimination status, and what losing that status might mean.

Measles Elimination Status: What It Is and How the U.S. Could Lose It | KFF

The United States is at risk of losing its measles elimination status. This post looks at what measles elimination means, how the current measles outbreak threatens this status, and what losing it…

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The work requirements proposed in the “One Big Beautiful Bill Act” are more stringent than previous policies considered by Congress and implemented at the state level. As the Senate debates the bill, our analysis explains the proposals in the House-passed version.

Work requirements and Medicaid: What’s in the House Reconciliation bill 
CBO Estimates: Implementing work requirements would account for the largest share of federal Medicaid savings — and cause the largest increase in the number of people without health insurance.
Verification requirements: States would be required to verify at application and renewal that ACA expansion enrollees meet 80 hours of work activities per month or qualify for an exemption. States could also require more frequent verification.
Implementation timeline: HHS must release guidance by end of 2025, giving states limited time to develop or change implementation plans, protocols, and systems before the Dec. 2026 implementation deadline.
State implementation choices: State choices to impose stricter requirements than the minimum federal requirements — like more frequent verification or longer look-back periods — and state capacity to automate processes will affect how many people could lose coverage.
Comparison to other waivers and proposals: The bill’s work requirement policies are more stringent than past Congressional proposals or state waivers, with no exemptions for older age and more barriers to getting and keeping coverage.

A unique feature of the proposed Medicaid work requirements in the reconciliation bill is that states could choose to require individuals to work for *multiple* months prior to applying for Medicaid - meaning people with employment gaps would not qualify for Medicaid, even if currently working

Image depicts the following text:
Box 1. The impact of choosing different “look-back” periods
John lost his job and was out of work in April and May. In June, he started in a new seasonal position and worked 80 hours during the month. In July, John applies for Medicaid in an expansion state, as he qualifies for Medicaid on the basis of his income.

State A uses a 1-month look-back period when determining compliance with work requirements at application. John would be able to enroll in Medicaid (provided he meets all other program requirements).
State B uses a 3-month look-back period when determining compliance with work requirements at application. John would not qualify for Medicaid, as he was out of work in two of the three months.

#Medicaid provisions that only apply to ACA expansion states account for roughly half ($427 billion) of total federal spending cut in the House-passed reconciliation bill and changes in the Senate Finance language would further cut federal spending for expansion states: www.kff.org/policy-watch...

Senate Finance Language Would Further Cut Federal Spending for Medicaid Expansion States | KFF

Prior KFF analysis allocated CBO’s federal Medicaid spending reductions and enrollment losses across the states, and this policy watch builds on that analysis to examine the potential impacts in expan...

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As Congress weighs spending cuts and other changes to Medicaid, our latest poll shows three-quarters of MAGA supporters and other Republicans enrolled in Medicaid are worried about the potential impact of federal spending reductions on their families. on.kff.org/4mPUFd9

KFF bar chart titled “Nearly 9 in 10 Medicaid enrollees say they are at least somewhat worried that federal funding cuts to Medicaid would negatively impact their and their families’ access to health care.” The chart shows the percent of Medicaid enrollees — including by party ID — who say that if the federal government significantly reduces its spending on Medicaid, they are very or somewhat worried it would lead to more adults and children becoming uninsured (85% Medicaid enrollees, 91% Democrats, 94% Independents, 69% Republicans); negatively impact hospitals, nursing homes, and other health care providers in your community (85% Medicaid enrollees, 93% Democrats, 96% Independents, 65% Republicans); and negatively impact their or their family’s ability to get and pay for health care (86% Medicaid enrollees, 90% Democrats, 92% Independents, 76% Republicans).

Medicaid covers 47% of nonelderly adults with opioid use disorder and is the main source of coverage for those receiving treatment services. It covers 56% of those receiving medication and 64% of those getting outpatient treatment and peer support services: on.kff.org/43kNyAB

KFF infographic showing coverage of opioid use disorder treatments among nonelderly adults. It details Medicaid's share compared to other payers in four categories: Adults with OUD (Medicaid 47%, Other 53%), Medication for OUD (Medicaid 56%, Other 44%), Outpatient OUD Treatment (Medicaid 64%, Other 36%), and Peer Support Services for SUD (Medicaid 64%, Other 36%).

From new Medicaid work requirements to lowering expansion match rates for states that use their own funds to cover undocumented immigrants, the reconciliation bill could reshape how states fund and manage #Medicaid. We outline the proposed provisions:

Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF

KFF is tracking the Medicaid provisions in the 2025 federal budget bill, including new Medicaid work and verification requirements and a reduction in the expansion match rate for states that use their...

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Options under consideration in Congress to reduce #Medicaid spending to help pay for tax cuts could have major implications for children with special health care needs. NEW @kff.org brief explores 5 key facts about children with special health care needs and Medicaid: www.kff.org/medicaid/iss...

5 Key Facts About Children with Special Health Care Needs and Medicaid | KFF

Amid debates about proposed cuts to federal Medicaid spending, this brief analyzes key characteristics of children with special health care needs and explores how Medicaid provides them with coverage.

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Large federal spending cuts for #Medicaid could have implications for nursing facilities bc Medicaid covers 63% of nursing home costs. Federal cuts could lead to reductions in Medicaid payment rates making it harder for nursing facilities to bolster staffing to improve the quality of patient care.

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A court overturned key elements of a federal nursing home staffing rule this week: - Have a registered nurse on duty 24/7 - Have at least 3.48 hours per resident day of total nursing care, including 0.55 hours of RN care & 2.45 hours of nurse aide care 🔗: on.kff.org/4lq0ZYc

KFF bar chart showing “For-Profit Nursing Facilities Were the Least Likely to Meet the Requirements in the Now-Overturned Rule.” The chart shows the share of nursing facilities meeting the minimum hours per resident day (HPRD) standards in the final staffing rule by ownership. 79% of all facilities did not meet the HPRD requirements, while 21% did. 88% of for-profit facilities did not meet the HRPD requirements, while 12% did. 53% of non-profit facilities did not meet the HRPD requirements, while 47% did. And 59% of government facilities did not meet the HRPD requirements, while 41% did.

Check out our 23rd annual #Medicaid eligibility and enrollment survey report. Many states emerged from the unwinding with more efficient processes by maximizing the use of technology to verify income, reduce returned mail, and improve communications with enrollees. www.kff.org/medicaid/rep...

Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies | KFF

A KFF survey of state Medicaid officials examines state Medicaid and CHIP eligibility, enrollment, and renewal policies in place as of January 2025 as states return to routine operations following the...

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