The latest installment of health policy research organization KFF’s annual review of state Medicaid programs’ budgets highlights the stresses states are navigating with the full expiration of enhanced COVID-19 funding, pressures being felt from decreased revenues following years of relative prosperity and increased spending, and also reveals policy changes being implemented or planned for the coming year.

Findings from KFF’s Annual Medicaid Budget Survey for State Fiscal Year 2025 and 2026, released November 13, 2025, reveal a flattening of enrollment numbers and curtailing rate increases for providers.

For the survey period, more states included benefit increases than cuts, including significant investment in pharmacy formularies with sixteen states cover GLP-1 drugs, among other blockbuster cell and gene therapies.

Spending on behavioral health, long-term care and higher health care costs among all enrollees drove overall increases in total Medicaid spending by 8.6% in 2025.

Concerns with federal funding limitations included in HR 1 are top of mind as states consider austerity policies to maintain coverage for eligible individuals.

Now in its 25th year, the survey was completed by 48 states and Washington D.C. with support from the National Association of Medicaid Directors and Health Management Associates (HMA). The landing page for the survey contains many useful links like an issue brief and an option to toggle through detailed analysis of five core areas. The section on “provider rates and taxes” includes multiple tables for states to compare their anticipated rate and provider tax changes to those in other states for multiple provider classes.