Medicaid

What is Medicaid?

Medicaid is free or low-cost insurance that pays for healthcare and long-term-care for low-income adults and children, the elderly, and disabled people. (Long-term care includes care in nursing homes and some home-based care and services.) The Children’s Health Insurance Program (CHIP)¹ works alongside Medicaid to cover healthcare for children and pregnant women who don’t qualify for Medicaid, but whose families can’t afford private insurance. Medicaid is jointly funded by federal and state governments and is called by different names² in different states.

As of early 2025, Medicaid and CHIP cover about 1 in 5 people³ in the US—more than 79 million people in total—and 8 of 10 poor children.⁴

Key facts about Medicaid:

• Medicaid is the primary funder of long-term care⁵ in the US, and accounts for more than 60% of all spending on long-term care.
• Medicaid pays for more than 4 in 10 births⁶ in the US, and nearly half of all births in rural communities.
• Medicaid is the number-one payer for in-home care⁷ 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 understaffed⁸ nursing homes. Medicare doesn’t cover this care.
• More than 90% of Medicaid enrollees under 65 already work⁹ or are not working because they attend school, serve as full-time caregivers, or are disabled.
• More than 80% of Americans¹⁰ want Congress to maintain or increase current levels of Medicaid spending.

Medicaid is easy to confuse with Medicare, but they’re very different programs. Medicare is federally funded health insurance for people over 65 and people with certain disabilities or illnesses, and does not include coverage for long-term care.

What is happening?

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

• Cut up to a trillion dollars in Medicaid funding through the Congressional budget reconciliation process, despite government estimates that the cuts would push at least 10.5 million people out of Medicaid coverage. More on this
• Purge workers at the Centers for Medicare & Medicaid Services and close regional offices. More on this
• Make it harder for the public 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: July 10, 2025

On July 3, 2025, the Republican-controlled Congress passed a budget reconciliation bill that slashes spending on healthcare, green energy programs, student loans, and food assistance¹¹ to partly offset for $4.5 trillion in tax cuts.¹² The bill’s tax cuts are expected to increase the deficit by 3.3 trillion dollars.¹³ The bill was signed into law¹⁴ on July 4.

The nonpartisan Congressional Budget Office (CBO) estimated¹⁵ that an earlier and less severe version of the bill would have pushed at least 10.5 million people out of Medicaid coverage in the US by 2034. We don’t yet have CBO estimates for the final bill, but the big picture is very grim: According to the healthcare policy experts at KFF, the bill’s Medicaid cuts, together with related executive-branch policy changes, would force about 17 million people out of healthcare coverage¹⁶ across both Medicaid and the Affordable Care Act (ACA), in the largest-ever loss of healthcare coverage due to federal actions. These changes would eliminate most of the gains in healthcare coverage produced by the ACA.¹⁷

In small but real mercies, the final did not include several earlier provisions targeting refugees, asylum seekers, and other non-citizens¹⁸ or the proposed ban on federal funding for gender-affirming care in Medicaid and CHIP.¹⁹

How do the cuts work?

The largest Medicaid cuts in the bill that passed the Senate²⁰ are in the form of “work requirements.” These are really work-reporting requirements that use paperwork burdens²¹ to push eligible Medicaid enrollees out of coverage. Other parts of the bill cut federal Medicaid spending by mandating time-consuming enrollment and re-verification requirements for people who need Medicaid, and by restricting financial mechanisms in ways that slash federal contributions to all Medicaid programs.²² This puts more of the burden of healthcare coverage onto states, which will have to either move money from elsewhere in their budgets to cover federal funding losses or cut back their Medicaid coverage—or both.

The bill also blocks Medicaid from reimbursing Planned Parenthood²³ for non-abortion care, which effectively eliminates them as care providers for millions of people who need low-cost or free reproductive care including prenatal care, birth control, vaccinations, STI screening, and fertility treatment. Federal funding for abortions was already illegal²⁴ except in very narrow circumstances, and has been since the 1970s.

More on work-reporting requirements

The bill that passed the House imposes rigid and red tape–laden new rules²⁵ on 18.5 million people who have access to Medicaid through the Affordable Care Act Medicaid expansion. About 5.2 million of these people are likely to lose their coverage,²⁶ according to the Congressional Budget Office. Another analysis suggests that more than six million adults in this group of 18.5 million Medicaid enrollees²⁷ will lose their coverage if work-reporting requirements become the law, even if they’re working or attending school. The version signed into law goes even further, extending this paperwork burden to parents²⁸ with children 14 or older at home. We don’t yet have an estimate of the number of people this deeper cut will push out of Medicaid.

“Work requirements” act as a broad and unfair cut to Medicaid benefits: Work-reporting rules require Medicaid enrollees to regularly document time spent at work or other alternatives, like school attendance or taking care of a child or disabled person. But 92% of Medicaid enrollees are already working, are in school, are disabled, or are taking care of others—and those who aren’t working are often out of work for reasons beyond their control.²⁹

Work-reporting rules in individual states have pushed eligible people out of Medicaid without actually getting more people working: State experiments with work-reporting rules³⁰ haven’t increased the number of people working, but they do result in many more people who should be eligible for Medicaid (PDF)³¹ losing their coverage.³² This was true in Arkansas, where rigid and unfriendly reporting systems unfairly pushed more than 18,000 people out of Medicaid³³ before federal courts ended the rules. It was also true in New Hampshire, where the state tried to set kinder and more flexible work-reporting requirements and still had to end the program because it would have pushed 68% of the state’s Medicaid enrollees out of coverage (PDF).³⁴

The upshot: Work-reporting requirements make life even harder for people and families struggling to raise kids, care for elders, manage disabilities, and hold down jobs. The “savings” they achieve are the result of people losing coverage because it’s become harder and harder for eligible people to prove—and keep proving—that they’re eligible.

Where this stands

The bill was signed into law on July 4, 2025.³⁵ Each state government will have to decide how to respond to federal funding shortfalls. Some states³⁶ will keep the Medicaid programs funded by moving funding from other parts of their budget, though most probably won’t be able to fully replace federal funding.³⁷ Several state governments are already working to save their hospital systems³⁸ from the effects of the cuts, and we expect to see many similar efforts.

When cuts kick in: Work reporting requirements will come into force after the midterm elections in 2026,³⁹ though some states may receive extensions. Adults who qualify for Medicaid under the ACA expansion will have to prove that they’re still eligible every six months starting in January 2026.⁴⁰ The Planned Parenthood exclusions were scheduled to take effect immediately,⁴¹ but have been paused by a federal judge.⁴² Medicaid “provider taxes,” a financial mechanism states use to get more federal Medicaid funding and which hospitals rely on, will be reduced starting in 2028.⁴³

The bill includes many other healthcare cuts; KFF’s excellent budget bill tracker⁴⁴ notes when each cut becomes effective and includes detailed analyses on the likely effects on people, families, and hospitals in the US.

Who will be affected?

The trillion-dollar Medicaid cut in the budget bill is likely to fall hardest on the people, families, and healthcare providers least able to bear them:

• Many people who lose coverage will receive less or worse care,⁴⁵ including fewer checkups and medications for chronic conditions like asthma and heart disease, less prenatal care, and less screening and worse outcomes for cancer.
• Cuts in the federal share of Medicaid funding are likely to eliminate crucial services for disabled people.⁴⁶
• Family caregivers and residents of nursing homes⁴⁷ are also likely to be affected, compounding the US’s existing eldercare crisis.⁴⁸
• US hospitals as a whole will suffer devastating cuts in their Medicaid funding.⁴⁹
• Rural hospitals, already in a decades-long crisis,⁵⁰ are especially likely to suffer,⁵¹ along with already dangerously overextended mental health units⁵² in hospitals.

Millions of people are expected to lose their healthcare coverage because of work-reporting requirements alone. As noted above, an overwhelming majority⁵³ of Medicaid enrollees are already working or are exempt from work requirements because they’re students, caregivers, or people with disabilities.

Work-reporting requirements especially harm women,⁵⁴ disabled people⁵⁵ and caretakers,⁵⁶ people over 50⁵⁷ with disabilities or chronic health conditions, Black people,⁵⁸ people in rural communities,⁵⁹ and unhoused people.⁶⁰ New research focused on the population being targeted for work-documentation requirements suggests that losing Medicaid coverage can be a matter of life and death.⁶¹

Countermoves: Legal and legislative actions

• Planned Parenthood has sued the federal government⁶² over the reconciliation bill’s highly targeted block on Medicaid funding to Planned Parenthood for care unrelated to abortions.⁶³ On July 7, a judge issued a temporary restraining order, ordering the government to continue funding for Planned Parenthood until a hearing on July 21.
• In late June, after weeks of grassroots⁶⁴ “call your Senator”⁶⁵ campaigns, Senate Democrats successfully argued that several of the cruelest cuts to Medicaid were not eligible for the reconciliation process.⁶⁶ The Senate Parliamentarian ruled out many of these provisions, and several—but not all⁶⁷—Medicaid restrictions targeting immigrants were stripped out of the bill, along with the provision defunding gender-affirming care for trans people.
• On June 12, 2025, Sen. Ron Wyden (D-OR) and other Senate Democrats released a series of alternative proposals⁶⁸ to make Medicaid work better⁶⁹ for people and families in the US while reducing actual fraud and abuse. Under Republican Senate control, these bills have essentially no chance at passing.⁷⁰
• On April 14, 2025, a dozen Republican members of the House submitted a letter⁷¹ 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,⁷² including that one representative who signed the letter is in favor of stricter work requirements. Additional work-documentation requirements are expected to cause many fully eligible Medicaid enrollees to lose coverage⁷³ because of the additional administrative burden the requirements impose.)
• On April 8, 2025, Rep. Brendan Boyle (D-PA) introduced a bill⁷⁴ that would outlaw the use of budget reconciliation processes to cut Medicaid or SNAP.

Countermoves: Community campaigns & resilience efforts

• Protests against Medicaid cuts⁷⁵ are making the news⁷⁶ across⁷⁷ the⁷⁸ US⁷⁹ 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.⁸⁰
• The Autism Self Advocacy Network has produced a very detailed explainer⁸¹ 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 call⁸² on the history of the successful 2017 pushback against ACA/Medicaid cuts.
• Protect Our Care has published general⁸³ and district-level fact sheets⁸⁴ on the effects of the proposed cuts.
• The Modern Medicaid Alliance,⁸⁵ 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.⁸⁶
• The Coalition to Strengthen America’s Healthcare, an alliance of hospitals and healthcare providers across the country, launched a national campaign⁸⁷ (video) in support of Medicaid.⁸⁸
• The National Health Law Program, a nonprofit legal and policy advocacy organization, has published an explainer and primer for effective coalition-building⁸⁹ 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.⁹⁰
• 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 Medicaid⁹¹ in detail, and KFF published a detailed explainer about improper Medicaid payments⁹² and what they indicate.
• The #MEAction Network⁹³ has published a guide⁹⁴ to advocating for Medicaid.
• The Colorado Cross Disability Coalition⁹⁵ has produced an action toolkit.⁹⁶
• More campaign launches and advocacy against cutting Medicaid: National Alliance to End Homelessness,⁹⁷ Medicare Rights Center,⁹⁸ ACLU.⁹⁹

Attack: Medicaid worker purges & office closures

Last updated: June 10, 2025

The Centers for Medicare and Medicaid Services (CMS)¹⁰⁰ 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.¹⁰¹ These firings appear to be part of a restructuring that eliminated CMS’s Office of Minority Health¹⁰² 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 closed¹⁰³—it had focused on implementing and overseeing Medicare and Medicaid programs and engaging with stakeholders at the local level. The Department of Health and Human Services, CMS’s parent department, also closed five of its regional offices,¹⁰⁴ which had housed many CMS workers throughout the US.

DOGE¹⁰⁵ and HHS Secretary Robert F. Kennedy Jr.¹⁰⁶ 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 revolt¹⁰⁷ that briefly delayed firings.

Where this stands

A lawsuit seeking to block the majority of the administration’s mass layoffs¹⁰⁸ paused layoffs while the case proceeded, but on July 8, the Supreme Court issued a stay on appeal,¹⁰⁹ clearing the way for large-scale reductions in force to continue. Earlier, many fired probationary workers across the federal government were rehired under court orders, and then re-fired¹¹⁰ after the Supreme Court¹¹¹ and a federal court of appeals¹¹² paused reinstatements. Meanwhile, a Merit Systems Protection Board administrative judge ruled in May¹¹³ that probationary employees can pursue reinstatement in a class action. We expect to see further litigation in that area.

Since its functions are Congressionally mandated, legal experts have noted that the closure of CMS’s Office of Minority Health may be illegal.¹¹⁴

Our team posts summaries of major related legal actions under “Countermoves” below, and the Just Security lawsuit tracker¹¹⁵ is keeping track of related litigation.¹¹⁶

Who will be affected?

Since it’s not clear who 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 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.¹¹⁷

Countermoves: Lawsuits & legislative actions

• In a case brought by the American Federation Of Government Employees, the AFL-CIO, and others,¹¹⁸ a federal judge in San Francisco blocked the Trump administration’s mass layoffs and reorganizations¹¹⁹ across 22 federal agencies. The Trump administration appealed to the Supreme Court,¹²⁰ and on July 8, the Supreme Court issued a stay,¹²¹ clearing the way for large-scale layoffs to continue.
• In an earlier case also brought by American Federation Of Government Employees, the AFL-CIO, and others,¹²² a federal judge in San Francisco ruled that mass firings of probationary employees across several federal agencies were unlawful¹²³, and ordered that the workers be rehired. In April, the Supreme Court allowed the administration to proceed with firing 16,000 federal workers.¹²⁴ (The initial ruling didn’t directly affect the firings at CMS, but might have been extended to cover them.)
• In a case brought by 20 US states,¹²⁵ a federal judge in Maryland blocked the mass firings of probationary employees¹²⁶ across many agencies—including HSS, the parent agency of CMS—and ordered the agencies to rehire fired workers. This order was blocked by a federal court of appeals¹²⁷ in April.
• In March, Senators Ron Wyden (D-OR) and Angus King (I-ME) wrote a letter¹²⁸ (PDF) 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: June 2, 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.¹²⁹ Those changes may affect millions of Americans’ healthcare, potentially including major changes to Medicaid.

After emphasizing his commitment to “radical transparency,”¹³⁰ HHS Secretary Robert F. Kennedy, Jr. has eliminated¹³¹ (PDF) the “Richardson Waiver,” a longtime rule¹³² 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 changes¹³³ that would otherwise be frustrated by public backlash, like imposing more onerous paperwork requirements¹³⁴ 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 workers¹³⁵ 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 change¹³⁶ 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 cuts¹³⁷ through without public comment. More broadly, this change—which affects many HHS agencies and offices—is part of a campaign of secrecy¹³⁸ and opacity¹³⁹ that will make the federal government’s actions less transparent¹⁴⁰ 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 rule¹⁴¹ that RFK’s HHS just rescinded during a period of threatened reductions to public benefits. STAT reporting¹⁴² has unearthed coverage¹⁴³ of HHS’s walkback after pressure from members of Congress.

Countermoves: Lawsuits & legislative actions

On May 1, 2025, Congressional Democrats introduced Senate¹⁴⁴ and House¹⁴⁵ resolutions demanding that HHS reverse its reduction of transparency and public comment.¹⁴⁶ 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.