Medicaid

Medicaid is free or low-cost insurance jointly funded and administered by states and the federal government. It pays for healthcare for low-income adults and children, the elderly, and disabled people. It’s also the main funder of long-term care in the US and of in-home care for seniors and disabled people.

Medicaid’s sibling program, the Children’s Health Insurance Program (CHIP),¹ covers healthcare for uninsured children and some pregnant women who don’t qualify for Medicaid based on income. As of early 2025, Medicaid and CHIP covered about 1 in 5 people in the US — nearly 78 million people² in total. About half of Medicaid enrollees are children.

Note: Medicaid is easy to confuse with Medicare, but they’re very different. Medicare is federally funded health insurance for people over 65 and people with certain disabilities or illnesses. It doesn’t cover long-term care, which is why millions of people rely on Medicaid to cover nursing-home stays, in-home care, and assisted living.

What is happening?

The Trump administration and Congress are:

• Slashing a trillion dollars in Medicaid funding despite official estimates that this would push at least 10 million people out of healthcare coverage. More on this
• Pushing millions of working people and families out of Medicaid coverage by forcing states to implement paperwork-heavy “work requirements” that have been repeatedly shown to exclude eligible people. More on this
• Cutting staff at the Centers for Medicare & Medicaid Services and closing regional offices. More on this

These attacks will have devastating effects on public health and access to care. The lives of the millions of people expected to lose healthcare coverage will get worse and more dangerous. Experts expect tens of thousands³ of excess deaths as a direct result of the cuts. But the people who lose coverage are not the only ones who will suffer, because Medicaid cuts are expected to lead to worse healthcare across the country, even for people covered by private insurance.

Here’s why: Healthcare systems in the US are already underfunded and overburdened. The withdrawal of a trillion dollars from these systems to fund tax cuts for the wealthy will trigger a domino effect⁴ that will tip many parts of the healthcare ecosystem from crisis into failure. The same is true for the country’s patchwork eldercare system, including nursing homes⁵ and in-home care.⁶

The crisis in hospitals: Medicaid is an economic necessity for hospitals and pays for nearly 20% of all hospital care⁷ on average — a figure that’s much higher in poorer and more rural communities. Hospitals that receive Medicaid reimbursements, meaning nearly all hospitals in the US, are also required by law⁸ to care for every patient who needs emergency treatment, whether they can pay or not. Medicaid defrays the cost of that care through direct payments to hospitals, which are now being cut.⁹

Many people pushed out of Medicaid coverage won’t be able to pay¹⁰ for the hospital care they receive, which will shift costs to hospitals and make services more expensive for everyone. Between Medicaid payment cuts and a growing number of patients who can’t pay, hospitals are set to lose $443 billion over ten years.¹¹ As a result, hundreds of rural hospitals¹² are now poised to close, and many more are reducing services and laying off staff. Mental health¹³ wards will close. Labor and delivery¹⁴ wards are already closing¹⁵ in several states.¹⁶

The crisis in long-term care: Medicaid is the primary payer¹⁷ for nursing homes and other skilled nursing facilities. Many state Medicaid programs also fund in-home care for seniors and for people with disabilities and even help pay for assisted living. Shrinking Medicaid will therefore produce an especially cruel pair of effects: States are likely to cut their “optional” in-home and community services, forcing millions of seniors and disabled people into residential care.¹⁸ And at the same time, the cuts will create funding shortfalls across the entire long-term care system, likely leading to the closure of hundreds of nursing homes¹⁹ just as more people need admission.

The crisis for patients: As states cope with massive federal funding cuts, families with disabled children will lose “optional” Medicaid services they need to keep their children alive²⁰ and at home. Seniors and disabled adults²¹ will also lose services they rely on to live independently. Disabled people will also be at greater risk of losing Medicaid entirely²² if they can’t repeatedly provide paperwork proving that they’re meeting new work-reporting requirements.

Millions of working Medicaid enrollees, including small-business owners and employees,²³ will face barriers to coverage as states’ hurriedly built work-reporting systems come online. Women²⁴ and people living in small towns and rural communities²⁵ with high unemployment are especially at risk of losing coverage because of the new rules.

When people are pushed out of healthcare coverage, they delay medically necessary care until their conditions become too severe to ignore. This leads to preventable deaths²⁶ among affected patients and to more overcrowded emergency rooms²⁷ and longer wait times for everyone. Long ER wait times aren’t simply an inconvenience: recent research shows that they can kill people.²⁸

These destructive outcomes were predicted from the moment Congress and the Trump administration revealed their proposed changes to Medicaid. Public policy experts, care providers, disability rights organizations, and religious groups worked tirelessly from December 2024 through the summer of 2025 to explain and oppose them. Congress passed the cuts anyway.

Attack: Slashing funding

Back in July, the Republican-controlled Congress passed a budget bill²⁹ that sharply cut spending³⁰ on healthcare, green energy programs, student loans, and food assistance, all to partly offset $4.5 trillion in tax cuts.³¹ The Congressional Budget Office estimates³² that the bill’s Medicaid cuts will push 10 million adults and kids³³ out of healthcare coverage by 2034.

When we also account for the expiring enhanced Affordable Care Act (ACA) subsidies and related Trump administration policy changes, the full number of people losing coverage will be up to 15 million.³⁴ This would eliminate most of the coverage gains produced by the ACA.³⁵

The upshot: People who rely on Medicaid to keep their families healthy, live independently, pay for nursing homes, and get indispensable care for sick and disabled children are already struggling. In other words, these cuts will fall hardest on the patients, families, and healthcare providers least able to bear them.³⁶ They’re also likely to have a catastrophic effect on hospital systems, which rely on Medicaid reimbursements for much of the care they provide.

If you want to dive deeper on the budget details, we highly recommend this summary of all the Congressional healthcare cuts³⁷ from KFF News, a nonprofit healthcare news organization. KFF’s implementation timeline³⁸ is also unmatched at explaining what will happen when. If you’re watching for a specific cut that will affect you or your community, this is the place to look.

Attack: Pushing working people out of Medicaid

Congress’s cuts reduce Medicaid spending in part by using “work requirements” to push people out of the program if they can’t repeatedly document their compliance with new work-reporting rules. About 92% of Medicaid enrollees under 65 already work³⁹ or aren’t working because they’re attending school, are full-time caregivers, or have a disability. Those who are able to work but unemployed are most often out of work for reasons beyond their control.⁴⁰

The scale of the predicted coverage losses is hard to comprehend: The new rules will apply to about 18.5 million people⁴¹ who have access to Medicaid through the Affordable Care Act Medicaid expansion. Of these people, between 5.2 million⁴² and 6 million⁴³ are likely to lose their insurance.

Now that work-reporting requirements are required nationally, states will have less than 16 months to design, test, and launch systems to implement the rules. Meanwhile, more than half of US states already struggle to manage existing Medicaid services and systems.⁴⁴ Public policy analysts report⁴⁵ that the ultra-compressed schedule mandated by Congress will probably produce ineffective and buggy systems and worsen some states’ services for all Medicaid enrollees.

The upshot: Work-reporting requirements make life even harder for low-income people trying to raise kids, care for elders, manage disabilities, and hold down jobs. The “savings” they achieve are the result of eligible people losing coverage when it becomes too hard for them to prove — and keep proving — that they’re eligible.

Attack: Purging Medicaid workers

Compared to the vast cuts to funding, layoffs have played a small role in the Trump administration’s attacks on Medicaid. But those layoffs did strike at several important parts of the Centers for Medicare and Medicaid Services (CMS).⁴⁶

In March 2025, the Trump administration fired at least 300 CMS workers.⁴⁷ This included the complete closure of CMS’s Office of Minority Health⁴⁸ and drastic reductions at an office focused on local implementation and oversight⁴⁹ of Medicare and Medicaid programs.

The upshot: Firing the federal workers who make Medicaid’s administrative partnership with the states work smoothly degrades the program’s operations — most notably for people who are eligible for both Medicare and Medicaid and for those who need in-home care. Many of the workers responsible for those aspects of Medicaid have been fired.⁵⁰

Who is pushing back, and how?

The action is mostly with the states

Much of the way the Medicaid cuts will play out over the next few years is up to the states. Some states⁵¹ will keep Medicaid programs funded by moving money from other parts of their budgets, though most probably won’t be able to fully replace federal dollars.⁵² The resulting “hand-to-hand combat”⁵³ for resources in statehouses across the US pits healthcare against other parts of the social safety net that are also losing federal funding.

Several state governments are already working to protect their hospitals⁵⁴ from the effects of the cuts, and we expect to see many similar efforts.

Lawsuits are underway, with a narrow focus

Planned Parenthood has sued the federal government⁵⁵ over the reconciliation bill’s highly targeted block on Medicaid funding to Planned Parenthood even for care unrelated to abortions.⁵⁶ The funding block remains in place⁵⁷ while the case proceeds.

Previous pushback

The Medicaid cuts in this summer’s budget bill were intended to be even worse, and more cruel. In late June 2025, after weeks of grassroots⁵⁸ “call your Senator”⁵⁹ campaigns, Senate Democrats successfully argued that several of the cruelest cuts to Medicaid were not eligible for the reconciliation process,⁶⁰ and the Senate Parliamentarian ruled out a provision defunding gender-affirming care for trans people of all ages. She also ruled out several other — though not all⁶¹ — restrictions targeting entirely state-funded Medicaid access for lawful immigrants and for the children of undocumented immigrants.

Protests against Medicaid cuts⁶² made the news⁶³ across⁶⁴ the⁶⁵ US⁶⁶ earlier this year. A broad coalition of disability rights organizations, religious institutions, and medical organizations also advocated to maintain Medicaid. Though Congress passed the cuts, these opposition campaigns left behind a wealth of analysis about the damage they’re likely to cause. We relied heavily on their work to make this page.

A fall 2025 government shutdown — the longest in history — was the result of resistance from Congressional Democrats. For 40 days, they refused to support resolutions to temporarily fund the federal government unless the GOP renewed expiring Affordable Care Act subsidies. Some Democrats also called for a reversal of the Medicaid cuts⁶⁷ the GOP forced through over the summer.

On November 9, 2025, a group of Senate Democrats⁶⁸ joined Republicans to approve a plan⁶⁹ to fund the government through January 2026 without extending the subsidies or reversing Medicaid cuts.