House Republicans are pushing forward a sweeping proposal that would reshape the Medicaid program through a series of structural reforms affecting how millions of Americans access health coverage.
The legislation outlines stricter eligibility conditions, new administrative rules, and limits on services, including provisions that may have long-term implications for states and healthcare providers.
According to USA Today, the measure is part of a larger effort tied to fiscal policy goals and ongoing political negotiations. Medicaid currently insures more than 71 million low-income individuals, including about 40% of all children in the country, making it a key component of public health infrastructure.
Sweeping Eligibility Changes and Projected Coverage Losses
The legislation aims to reduce federal Medicaid spending by at least $625 billion over the next decade, according to early estimates by the Congressional Budget Office (CBO). This reduction would result in the loss of health coverage for an estimated 7.6 million individuals. Among the most impacted are seniors and people with disabilities who are dually enrolled in Medicare and Medicaid. The CBO projects that 1.3 million of these individuals would lose Medicaid access, potentially losing long-term care services not covered under Medicare.
The bill targets families of four earning between $35,365 and $44,367 per year — corresponding to 110% to 138% of the federal poverty level — who currently qualify for expanded Medicaid under the Affordable Care Act (ACA). These families would face new copays up to $35 per medical service, and some would lose coverage entirely.
Medicaid is absolutely critical for children, for families, for people with disabilities and seniors – said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
There’s a great deal at stake here.
Repeal of State Incentives and Expansion Rollback
Since its passage in 2010, the ACA expanded Medicaid eligibility to include more low-income adults. The federal government currently covers 90% of the cost, incentivizing states to opt in. To date, 41 states and Washington, DC, have implemented the expansion.
The new proposal would eliminate the financial incentive introduced under President Joe Biden‘s administration, and penalize states that fund care for undocumented residents by reducing their federal match rate from 90% to 80%.
New Work Requirements and Bureaucratic Obstacles
A centerpiece of the legislation is the introduction of work requirements for Medicaid recipients aged 19 to 64. Eligible individuals would need to log at least 80 hours per month in work, education, or community service. Pregnant women, individuals with disabilities, and caregivers of dependents would be exempt.
Large shares – almost half of the (bill’s) estimated savings – are coming from provisions to require states to impose work requirements – said Robin Rudowitz, vice president of KFF, a nonpartisan health policy organization.
We know from other analyses and earlier estimates of these provisions that they do result in significant coverage loss.
An earlier program in Arkansas led to approximately 25% of enrollees subject to work rules losing coverage, mostly due to administrative errors or failure to report employment status consistently. Despite this, the bill prohibits states from requesting waivers to opt out of these new requirements.
The measures are set to take effect in January 2029, though GOP hardliners have pressed for earlier implementation.
More Frequent Eligibility Checks and Provider Screening
The bill would double the frequency of eligibility reviews, requiring states to verify participant qualifications every six months instead of annually. States would be mandated to cross-check contact data, including addresses, and verify enrollees against the Master Death File.
States would also see a reduction in retroactive Medicaid coverage, currently set at 90 days, down to one month before a person formally applies. Providers would be subject to monthly eligibility checks to confirm continued participation in the program.
There are very big cuts to Medicaid here, and states will not have any good choices to make up these lost federal funds – Alker added.
States have to either raise taxes, cut people off, or restrict access and benefits.
Reproductive and Gender-Affirming Care Restrictions
The proposal bars Medicaid from reimbursing services at clinics that provide abortions, even if the service rendered is unrelated. This would directly impact organizations like Planned Parenthood, which deliver family planning services to 1 in 10 female Medicaid recipients aged 15 to 49, according to KFF.
Services offered include birth control, STD testing, pregnancy screenings, and routine gynecological exams. Current law already prohibits the use of federal funds for abortions.
Another clause would ban federal matching funds for gender-affirming care for individuals under 18 years old, including puberty blockers, hormone therapy, and surgical procedures.
Immigrant Coverage and Federal Penalties
Although undocumented immigrants are already barred from receiving federal Medicaid benefits, current law requires states to provide temporary coverage for up to 90 days while immigration status is being verified. The new bill eliminates that mandate and removes federal matching funds for this grace period.
Fourteen states currently use state funds to cover undocumented children, and seven extend this to adults. These states would face a reduction in federal support, further straining their Medicaid budgets.
Financing Restrictions and State Budget Impacts
States currently raise their share of Medicaid funds through provider taxes. The new bill would ban new provider taxes and prevent states from increasing existing rates. Lawmakers supporting this provision argue these taxes distort the true cost of state spending and inflate federal reimbursements.
Critics argue the measure would limit the ability of states to maintain current levels of care, forcing difficult decisions.
Political Debate and Fiscal Motivations
The bill was debated in a House committee hearing on May 13, where lawmakers exchanged accusations over the bill’s consequences.
Medicaid was created to provide health care for Americans who otherwise could not support themselves, but Democrats expanded the program far beyond this core mission – said Rep. Brett Guthrie, R-Kentucky, who chairs the House Energy and Commerce Committee.
We are cutting money and health care from people and families who are suffering to pay for tax cuts for the rich – responded Rep. Alexandria Ocasio-Cortez, D-New York.
The bill is part of a larger package designed to offset the effects of $4 trillion in tax cuts supported by former President Donald Trump and his allies. With Medicare cuts off the table, Medicaid has become the primary target for spending reductions among Republican lawmakers.
