** Medicaid:
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** The State Legislator’s Guide to the 2025 Federal Budget
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This is the new installment of a multi-part series, The State Legislator’s Guide to the 2025 Federal Budget ([link removed]) , where we’re unpacking the full impact of the federal budget bill and equipping state legislators with the resources and strategies they need to lead at this critical moment.
In July, Congress passed H.R. 1 (the Big Ugly Bill), a sweeping law that threatens to devastate health care for millions of Americans, especially vulnerable communities. By cutting federal Medicaid funding, it puts pressure on state budgets, forcing impossible choices on programs and services.
What this means
* $1.02 trillion cut from Medicaid and Children’s Health Insurance Program (CHIP) by 2034.
* At least 16 million people projected to lose coverage.
* States will be forced into impossible budget choices about which services to keep.
What’s at stake
* Cuts to home- and community-based care for seniors and people with disabilities—the services supporting independent living—could lead to more individuals being pushed into expensive institutional care.
* New complex paperwork may cause eligible residents to lose coverage, and rural hospitals relying on Medicaid face real closure risk, leaving communities without care.
* Maternal health care and reproductive services, including prenatal and postpartum care, contraception, and abortion access, are threatened, increasing risks for birthing parents.
* LGBTQ individuals could lose coverage for affirming care, leaving already marginalized communities with fewer safe, accessible options.
** Those who need care the most will be impacted the hardest.
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New federal Medicaid limits will leave millions uninsured and force states to raise revenue or cut services, often starting with home- and community-based care. These cuts will spare no one and will lead to hospital closures, layoffs, and less access to care. Medicaid, covering nearly half of all births and supporting many with chronic and mental health needs, faces a manufactured crisis risking over 16 million people.
State Lawmakers Have the Power to Act
By defending Medicaid and advancing policies that keep people covered, that strengthen provider networks, and ensure access to care, states can protect vulnerable populations and safeguard the future of healthcare. Protecting Medicaid is about more than budgets and numbers—it's about building a future where everyone can thrive.
** Medicaid Resources
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** Medicaid Program Names in the States
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As Medicaid is administered at the state level, many states designate their programs using alternative titles. Find the state-by-state “alternative names” for Medicaid here ([link removed]) , or a ready-to-share reel here. ([link removed])
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Check out our Medicaid Defense Toolkit, ([link removed]) designed to provide legislators, advocates, and organizations with the resources needed to act swiftly and protect health coverage in 2025 special sessions and into the 2026 legislative sessions.
** Medicaid Funding & State Budgets
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* How OBBBA Punishes Medicaid Expansion States ([link removed])
* Medicaid Provider Taxes: A Critical Source of Medicaid Funding for States ([link removed])
* How Medicaid State-Directed Payments Support Critical Health Care Providers - Commonwealth Fund ([link removed])
* Senate-Passed H.R. 1: Updated Estimates on Impact to State Medicaid Coverage and Expenditures, Hospital Expenditures, Including Impacts by Congressional District ([link removed])
** Medicaid Cuts & Access to Care
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* Who is Harmed by Medicaid Work Requirements? ([link removed])
* Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF ([link removed])
* Republicans in Congress Considering Harsh Medicaid Cuts That Would Shift Costs to States, Leave People Uninsured ([link removed])
* Medicaid Is Essential for Addressing the Homelessness Crisis. The Reconciliation Bill Would Make It Worse. - Urban Institute ([link removed])
* Recent Policy Proposals Could Weaken the Reproductive Health Safety Net as More People Become Uninsured ([link removed])
** Broader Health Equity & Impact
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* How the Budget Reconciliation Bill Will Make Marketplace Coverage Less Affordable and Undermine Abortion Access for Many - Commonwealth Fund ([link removed])
* The Anti-Immigrant Policies in Trump’s Final “Big Beautiful Bill,” Explained ([link removed])
* Advancing Health Equity for Black Communities Through Insurance Reform ([link removed])
** Join the RFLC!
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Join SiX’s Reproductive Freedom Leadership Council ([link removed]) , our national initiative that supports legislators across the country in their commitment to ensuring healthcare remains accessible and equitable.
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We want to hear from you! What questions do you have about the budget reconciliation bill? What strategies or ideas are you working on with colleagues and partners in your state that we should share with the SiX network?
Let us know here! ([link removed])
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