The State of Medicaid Under the Second Trump Administration

A new presidential administration often brings shifts in health care policy, and Medicaid is no exception. As one of the largest health programs in the United States, Medicaid provides critical coverage to millions of low-income families, seniors, people with disabilities, and children. Polling data demonstrates that a huge number, two thirds of Americans, have a connection to Medicaid(1). Understanding the direction the Trump administration is taking on Medicaid is essential to protect and expand universal health care.

Medicaid’s Recent History

Medicaid, a federal-state program, has undergone significant changes over the past decade. The Affordable Care Act (ACA) of 2010 expanded Medicaid eligibility to cover millions of low-income adults and offered states the option to extend coverage with substantial federal funding. To date, 40 states and Washington, D.C., have adopted Medicaid expansion, improving health outcomes and reducing the uninsured rate.

However, in recent years we’ve seen efforts to reshape Medicaid at both state and federal levels. Medicaid policy was focused on less than Medicare during Trump’s campaign, but potential policies such as work requirements, budgetary cuts, and regulation cuts could limit access to care for vulnerable populations.

Potential Trump Administration Proposals:

1. Work Requirements

In January of 2018, CMS under the first Trump administration posted new guidelines called the Section 1115 Waiver policy that included, for the first time, a work requirement and reporting requirements to the Medicaid program. This policy was reversed under the Biden Administration, but it is likely that we will see these work requirements reinstated(4).

According to Medicaid’s reporting data, 91% of enrollees under 65 who are not on Medicare or social security work or cannot work due to illness, caregiving responsibilities, or school attendance(6). Increasing reporting requirements will result in steeper barriers to access and more time spent doing paperwork for people already enrolled.

2. Budgetary Cutbacks

While Trump has promised to leave the federal Medicare budget intact, no such promises have been made for Medicaid. In order to maintain his 2017 federal tax cuts, the administration will have to make significant budgetary cuts in other areas(2). These decisions may be made by the new Department of Government Efficiency, a proposed presidential advisory commission headed by Elon Musk and Vivek Ramaswamy.

By enacting policies such as work requirements, the administration will likely look to decrease enrollment to decrease expenditure. The 2016 Trump administration encouraged states to conduct more frequent eligibility verifications, decreasing the number of Medicaid enrollees(3). It would be realistic for a republican controlled federal government to do the same.

3. Deregulation

Another way Medicaid could change in the coming years is the maintenance, removal, or rewriting of Biden era regulations. Some of these regulations include rules about long term staffing minimum requirements, rules that increase patient access, and a requirement that at least 80% of spending on specific services goes to direct care workers. These policies aim to promote the quality of healthcare delivered to Medicaid enrollees.

In all likelihood, Trump and his administration will try to reverse policies that restrict the agency and require more federal money. Similar to what Trump has said about Medicare, the administration will likely push Medicaid into a more private, less regulated agency that decreases its effectiveness for the people that need it most.

What to do if Medicaid is Cut

If Medicaid is cut and you or someone you know is dropped from coverage, it is important to know there are other options like a tax credit for private health care plans that can support your health care premium costs. The Premium Tax Credit (PTC) is a credit that can be used to cover health insurance costs. There are certain requirements that must be met to receive this credit, but most people enrolled in Medicaid could potentially qualify.

Follow this link to find more information about the PTC

Follow this link to find more information about PTC eligibility

What’s at Stake

Medicaid covers over 85 million Americans—a number that grew significantly during the pandemic as unemployment rose and access to employer-sponsored insurance declined. Scaling back Medicaid’s reach would have devastating effects, particularly for vulnerable populations, like children, people with disabilities, and the elderly, who rely on the program for lifesaving care.

On the other hand, efforts to strengthen Medicaid could bring:

·         Lower uninsured rates across all demographics.

·         Improved health outcomes for individuals with chronic conditions, mental health challenges, and disabilities.

·         Economic benefits for states, hospitals, and local communities.

Medicaid has been a lifeline for millions of Americans, but its future depends on sustained advocacy and informed policymaking. Under the new administration, there is urgency to protect and strengthen this vital program.

1. 5 Charts About Public Opinion on Medicaid | KFF

2. What Does Future Hold For Affordable Care Act And Medicaid Under Trump

3. What Administrative Changes Can Trump Make to Medicaid? | KFF

4. Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and

Pending Waivers

5. The Premium Tax Credit – The basics | Internal Revenue Service

6. Medicaid Work Requirements: Current Waiver and Legislative Activity | KFF