The 25th annual Medicaid Budget Survey conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD), was released on November 13, 2025 in the report A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2025 and 2026.
Following years of significant changes in Medicaid spending, enrollment, and policy during the COVID-19 public health emergency and the subsequent Medicaid unwinding period, state Medicaid programs returned to more routine operations in state fiscal year (SFY) 2025 and were focused on an array of other priorities, including improving access to care or addressing social determinants of health.
Heading into SFY 2026, however, states were facing a more tenuous fiscal climate and beginning to prepare for another major set of policy changes to the Medicaid program. The 2025 federal budget reconciliation law (OBBBA) includes substantial Medicaid policy changes and reductions in federal funding, though the impacts vary by state. While many of the provisions do not take effect until FY 2027 or later, states are anticipating the upcoming changes, assessing budgetary and programmatic impacts, and preparing for the implementation of multiple and complex policy changes.
In addition to navigating state budget challenges and implementing new federal policies, the report also addresses other Medicaid program priorities including expanding access, implementing initiatives that target specific populations (e.g., pregnant individuals, justice-involved), continuing delivery system efforts, and improving administrative systems and functions.
Serving over one in five people living in the United States and accounting for nearly one-fifth of health care spending (and over half of long-term care spending), Medicaid represents a large share of state budgets and is a key part of the overall health care system.
The report was prepared by Kathleen Gifford, Aimee Lashbrook, and Carrie Rosenzweig from HMA; and by Elizabeth Hinton, Elizabeth Williams, Jada Raphael, Anna Mudumala, Robin Rudowitz from KFF. The survey was conducted in collaboration with NAMD.
Read the report: https://www.kff.org/medicaid/50-state-medicaid-budget-survey-fy-2025-2026/
Other links:
2025 Press Release
Medicaid Enrollment & Spending Growth: FY 2025 & 2026
