Medicaid

What do I need to know about Medicaid?

Healthcare coverage in the United States is complicated, in part because for many people, it is linked to employment. Two major kinds of healthcare coverage fully or partly funded by the federal government are Medicaid and Medicare.

Medicaid and the closely linked Children’s Health Insurance Program (CHIP) are publicly funded health and long-term-care insurance. They provide free or low-cost health coverage to low-income adults and children; pregnant women; the elderly; and people with disabilities. Medicaid is jointly funded by federal and state governments and is called by different names in different states. Medicare, on the other hand, is federal health insurance for people over 65 and people with certain disabilities or illnesses. Medicare is entirely funded by the federal government.

Key facts about Medicaid:

• Medicaid and CHIP cover about 1 out of 5 people in the US—more than 79 million people in total—and 8 of 10 poor children.*
• Medicaid is the primary funder of long-term care in the US, and accounts for more than 60% of all spending on long-term care.
• Medicaid is the number-one payer for in-home care for disabled people and seniors in the US, including caregiver stipends and other programs that help keep people in their own homes instead of chronically understaffed nursing homes. Medicare doesn’t cover this care.
• More than 90% of Medicaid enrollees under 65 already work or are not working because they attend school, serve as full-time caregivers, or are disabled.
• More than 80% of Americans want Congress to maintain or increase current levels of Medicaid spending.

What is happening?

The Trump administration and Congress are using the power of the executive and legislative branches to:

• Cut up to $880 billion in Medicaid funding through the Congressional budget reconciliation process now underway, using methods that will result in millions of people losing their sole healthcare coverage. More on this
• Purge workers at the Centers for Medicare & Medicaid and close regional offices. More on this
• Make it harder for us to understand and participate in decision-making by revoking transparency rules. More on this

On this page, we’ll break down those lines of attack, along with the countermoves and resilience efforts we’re seeing across American society.

Attack: Congressional Medicaid funding cuts

Last updated: May 21, 2025

The US House of Representatives and Senate, both controlled by Republican majorities, are attempting to pass a budget that slashes federal services to pay for up to $5 trillion in tax cuts. Even with cuts to federal services, the tax cuts included in the bill are expected to result in up to a $5.7 trillion increase in the deficit.

The budget passed by the House mandates $880 billion in cuts that the nonpartisan Congressional Budget Office confirms must come from either Medicare—which House leadership has ruled out—or from Medicaid. The House Energy and Commerce Committee, which oversees Medicaid spending, has advanced a plan for $625 billion in Medicaid cuts over ten years, which the Congressional Budget Office reports (pdf) will result in at least 7.6 million more people being uninsured in the US by 2034.

Among other things, the Committee’s current version of the plan will:

• Cut federal Medicaid funding to states that spend their own money providing coverage to both documented and undocumented immigrants. KFF has a detailed breakdown of the likely effects on immigrant families, and emphasizes that both undocumented and lawfully present US residents will be affected by this and other Medicaid changes focused on pushing immigrant children and adults out of the program—and in some cases, out of Medicare coverage as well.
• Institute rigid and red-tape-laden “work requirements” on many Medicaid enrollees, despite the fact that more than 90% of adults under 65 who are covered by Medicaid already work or don’t work because they’re in school, are disabled, or act as full-time caretakers. Research on state-imposed work-documentation requirements for Medicaid finds that they don’t increase employment—probably because the tiny fraction of Medicaid enrollees who don’t meet the requirements are unable to find work for reasons beyond their control. They do result in many more people who should be eligible for Medicaid (pdf) losing their coverage. They also penalize people who lose their jobs (pdf), whether it’s because they got sick or for any other reason. These requirements will also be expensive to implement, resulting in funds going to administrative and consulting fees rather than healthcare.

Where this stands

The interim spending bill that is keeping the government running expires on September 30, 2025. Although the House and Senate have both passed budget resolutions, the budget itself is far from complete. To pass a budget bill without Democratic support, the House and Senate must agree on a plan and then pass it through the filibuster-proof “reconciliation” process. The committee that oversees Medicaid advanced their part of the bill on May 14, and the larger budget bill that includes the cuts is currently stuck while members of the Republican majority fight over changes.

Who will be affected?

We don’t have precise estimates, for two reasons: First, because we don’t know exactly which Medicaid cuts will be in the final reconciliation bill. And second, because each state government will have to decide how to respond to federal funding shortfalls. (Some states will keep Medicaid funded by diverting funding from other parts of their budget; most will not.)

If the final bill includes the work documentation requirements in the plan advanced by the House Energy and Commerce Committee, millions of people are expected to lose all healthcare coverage. As noted above, an overwhelming majority of Medicaid enrollees are working or exempt from work requirements because they’re students, disabled, or caregivers. Work documentation requirements especially harm women, disabled people and caretakers, older people (pdf) with disabilities or chronic health conditions, Black people, people in rural communities, and unhoused people—because of the bureaucratic burden. New research focused on the population being targeted for work-documentation requirements suggests that losing Medicaid coverage is often a matter of life and death.

As noted above, the immigrant-targeting cuts will affect both undocumented adults forced out of Medicaid and undocumented children excluded from CHIP, as well as many lawful residents.

And any cuts to Medicaid are likely to fall on the individuals and families least able to do without them:

• Cuts in the federal share of Medicaid funding are likely to eliminate specific services for disabled people.
• Family caregivers and residents of nursing homes are also likely to be affected, compounding the US’s existing eldercare crisis.
• Rural hospitals, already in a decades-long crisis, are also likely to suffer, along with already dangerously overextended mental health units in hospitals.

Medicare advocates note that cuts to Medicaid will also negatively affect many Medicare recipients as well.

Countermoves: relevant history

We think it’s useful to consider what happened the last time US health coverage was seriously endangered. In 2017, the repeal of the Affordable Care Act (i.e., Obamacare)—which would have included Medicaid cuts—was halted at the last moment by the “no” votes of Republican Senators John McCain, Lisa Murkowski, and Susan Collins. In the runup to that vote, ordinary Americans—and especially sick and disabled Americans—put coordinated and sustained pressure on their representatives to vote against the rollback.

Could something similar happen this time around? We don’t know yet, but right now, Medicaid has strong bipartisan support: Current KFF polling suggests that 80% of Americans, including 47% of Republicans, support maintaining or increasing Medicaid spending. It’s not clear whether the slim Republican Senate majority will be able to build enough internal agreement to pass such heavy cuts

Countermoves: legislative actions

• On April 14, 2025, a dozen Republican members of the House submitted a letter to House Republican leaders that included the following statement: “We cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.” (Axios offers political context, including that one representative who signed the letter is in favor of stricter work requirements. Additional work requirements are expected to cause many fully eligible Medicaid enrollees to lose coverage because of the additional administrative burden the requirements impose.)
• On April 8, 2025, Rep. Brendan Boyle (D-PA) introduced a bill that would outlaw the use of budget reconciliation processes to cut Medicaid or SNAP.

Countermoves: community campaigns & resilience efforts

• Protests against Medicaid cuts are making the news across the US as the reconciliation process continues.
• The National Disability Rights Network (an organization established by Congress) is asking its members and allies to advocate for Medicaid.
• The Autism Self Advocacy Network has produced a very detailed explainer with background information, a glossary, and explanations of how to advocate in person and by phone and email with elected officials. They’ve also posted a coalition video call on the history of the successful 2017 pushback against ACA/Medicaid cuts.
• Protect Our Care has published general and district-level fact sheets on the effects of the proposed cuts.
• The Modern Medicaid Alliance, a coalition of advocacy organizations including the AARP, the American Academy of Pediatrics, the American Association of People with Disabilities, and the National Association of Counties, kicked off a campaign to protect Medicaid, including a Medicaid info and impact dashboard.
• The Coalition to Strengthen America’s Healthcare, an alliance of hospitals and healthcare providers across the country, launched a national campaign in support of Medicaid.
• The National Health Law Program, a nonprofit legal and policy advocacy organization, has published an explainer and primer for effective coalition-building in support of Medicaid.
• The Catholic Health Association of the U.S., Catholic Charities USA, and the United States Conference on Catholic Bishops have asked Congress to oppose Medicaid cuts.
• KFF’s Health Wonk Shop brought together a panel of experts including a former Inspector General at the Department of Health and Human Services to explain the reality of fraud, waste, and abuse in Medicaid in detail, and KFF published a detailed explainer about improper Medicaid payments and what they indicate.
• The #MEAction Network has published a guide to advocating for Medicaid.
• The Colorado Cross Disability Coalition has produced an action toolkit.
• More campaign launches and advocacy against cutting Medicaid: National Alliance to End Homelessness, Medicare Rights Center, ACLU.

Attack: Medicaid worker purges & office closures

Last updated: May 13, 2025

The Centers for Medicare and Medicaid Services (CMS) is an agency within the Department of Health and Human Services. CMS administers Medicare and works with states to jointly administer Medicaid and CHIP.

In March 2025, the Trump administration ordered the firing of at least 300 CMS workers. These firings appear to be part of a restructuring that eliminated CMS’s Office of Minority Health and fired its entire staff (approximately 40 workers). The Office of Minority Health had coordinated programs overseeing rural health and led efforts to prevent diabetes, among other efforts to address health disparities. CMS’s Office of Program Operations & Local Engagement was also closed—it had focused on implementing and overseeing Medicare and Medicaid programs and engaging with stakeholders at the local level. CMS’s parent department, HHS, also closed five of its regional offices, which had housed many CMS workers throughout the US.

DOGE and HHS Secretary Robert F. Kennedy Jr. have both been linked to the restructuring and purges. Politico reported that DOGE’s lead at HHS attempted to shield CMS from cuts, leading to an internal revolt that briefly delayed firings.

Where this stands

Two federal judges ruled in March that the mass firings of “probationary” workers (workers with fewer labor protections) are unlawful; one ruling applied directly to the Centers for Medicare and Medicaid and required that fired workers be reinstated by March 17, 2025, but the order was stayed on appeal. Since its functions are Congressionally mandated, legal experts have noted that the closure of CMS’s Office of Minority Health may be illegal. Our team posts summaries of major legal actions under “Countermoves” below, and the Just Security lawsuit tracker is keeping detailed track of related litigation.

Who will be affected?

Since it’s not clear who all the fired CMS workers were and how HHS’s regional office closures will affect the CMS workers who were headquartered there, it’s difficult to know how effects of the firings and closures will affect people covered by Medicaid. People with diabetes, people in rural areas, and people in racial and ethnic communities that experience disproportionate levels of health problems may be affected by the closure of the Office of Minority Health.

Countermoves: lawsuits & legislative actions

• In a case brought by American Federation Of Government Employees, the AFL-CIO, and others, a federal judge in San Francisco ruled that the mass firings of probationary employees across several federal agencies are unlawful, and issued a temporary order that they be rehired while the case proceeds. In March, the Ninth Circuit court of appeals declined to block the rehiring order, but in April, the Supreme Court granted the government a stay, allowing the administration to proceed with firing 16,000 federal workers. (The initial ruling didn’t directly affect the firings at CMS, but may be extended to cover them.)
• In a case brought by 20 US states, a federal judge in Maryland has ruled that the mass firings of probationary employees across many federal agencies—including HSS, the parent agency of CMS—are unlawful, and that the agencies must rehire fired workers by March 17, 2025. This order was stayed by a federal court of appeals in April.
• In March, Senators Ron Wyden (D-Oregon) and Angus King (I-Maine) wrote a letter to the acting administrator of CMS demanding information on the number of people fired at CMS, which roles they’d held, how they were chosen for firing, and what further job cuts to expect.

Attack: Elimination of transparency & public comment rules

Last updated: May 13, 2025

The administration’s moves to reduce transparency and public comment at HHS—which oversees Centers for Medicare and Medicaid Services—allows the administration to make major public policy decisions in the dark. Those changes may affect millions of Americans’ healthcare, potentially including major changes to Medicaid.

After emphasizing his commitment to “radical transparency,” HHS Secretary Robert F. Kennedy, Jr. has eliminated the “Richardson Waiver,” a longtime rule requiring that HHS announce and accept public comment on changes that relate to “agency management or personnel or to public property, loans, grants, benefits, or contracts.” This move is expected to allow the administration to push through changes that would otherwise be frustrated by public backlash, like imposing more onerous paperwork requirements for Medicaid enrollees. HHS will also be able to avoid public notice and comment in other areas for “good cause” when agency leadership decides that transparency and comment processes are “impracticable, unnecessary, or contrary to the public interest.”

HHS has also fired many of the workers who handled public communications and responded to Freedom of Information Act (FOIA) requests from members of the public. This move is expected to dramatically increase the wait time for releases of information required to be public to the public.

Where this stands

Legal experts expect to see challenges, and public health and open government advocates who have spoken against the change have noted that pushback from Congress or the public may play a role in the future of the policy.

Who will be affected?

Medicaid enrollees and potential enrollees may be affected directly if the administration uses its rule-changes to shove unpopular Medicaid cuts through without public comment. More broadly, this change—which affects many HHS agencies and offices—is part of a campaign of secrecy and opacity that will make the federal government’s actions less transparent and less accountable to the public.

Countermoves: relevant history

This isn’t the first time a benefits-slashing administration has tried to revoke transparency requirements. In the early 1980s, HHS attempted to revoke the same transparency rule that RFK’s HHS just rescinded during a period of threatened reductions to public benefits. STAT reporting has unearthed coverage of HHS’s walkback after pressure from members of Congress.

Countermoves: lawsuits & legislative actions

On May 1, 2025, Congressional Democrats introduced Senate and House resolutions demanding that HHS reverse its reduction of transparency and public comment, and although these resolutions are not expected to attract enough Republican support to pass in either chamber, they were endorsed by organizations including the National Rural Health Association, Children’s Hospital Association, American Academy of Family Physicians, American Cancer Society Cancer Action Network., American Academy of Pediatrics, Center for Medicare Advocacy, Planned Parenthood Federation of America, United Steelworkers, American College of Obstetricians and Gynecologists, and National Nurses United.