Listen to the article
The Trump administration has implemented significant changes to Medicaid through the recently passed One Big Beautiful Bill Act, introducing work requirements that align with recommendations from the conservative Project 2025 blueprint but go considerably further in implementation.
Project 2025, a conservative policy roadmap, characterized Medicaid as a “cumbersome, complicated, and unaffordable burden on nearly every state” and “a prime target for waste, fraud, and abuse.” The document specifically criticized Medicaid’s funding structure, claiming it “rewards expansions,” with particular objections to the Affordable Care Act’s Medicaid expansion provisions.
Under the ACA, states were permitted to expand Medicaid eligibility to adults under 65 earning up to 138% of the federal poverty level, with the federal government covering 90% of costs permanently. This expansion has been adopted by 40 states plus Washington, D.C., adding approximately 21.3 million people to Medicaid rolls as of last year, according to health policy research organization KFF.
Project 2025 contended that this expansion led to Medicaid having “improper payments higher than those of any other federal program,” though health policy experts note these often stem from administrative issues like missing paperwork rather than fraud.
During Trump’s first term, his administration encouraged states to implement work requirements for “able-bodied” Medicaid recipients through Section 1115 waivers. Arkansas was the only state to fully implement such requirements with consequences for non-compliance, resulting in 18,000 residents losing coverage before courts struck down many waiver approvals. The Biden administration subsequently rescinded remaining waivers.
The newly enacted One Big Beautiful Bill Act goes beyond both Trump’s first-term policies and Project 2025’s recommendations by mandating nationwide work requirements for ACA Medicaid expansion enrollees. The law requires “able-bodied adults aged 19-64 to work (or perform other qualifying activities) for at least 80 hours a month,” according to the Association of State and Territorial Health Officials.
Certain groups are exempted from these requirements, including pregnant women, those with serious medical conditions, tribal members, and parents or caregivers of dependent children under 13 or children with disabilities. States must implement these work requirements no later than December 31, 2026.
The Congressional Budget Office estimates that these work and reporting requirements alone will reduce federal Medicaid spending by $386 billion over the next decade, representing the largest single source of Medicaid savings in the legislation. Overall, the law cuts Medicaid spending by $911 billion over ten years, according to KFF analysis.
The human impact is expected to be substantial, with CBO projecting an increase of 10 million uninsured Americans, 7.5 million of whom will lose coverage due specifically to Medicaid changes.
The financial impact will vary significantly by state, according to Florida-based lobbying and law firm Holland & Knight. To address funding shortfalls, states may be forced to cut Medicaid services, implement stricter eligibility requirements, intensify redetermination processes, or reduce payments to healthcare providers.
The law also restricts provider taxes that many states have used to help finance their Medicaid programs, further complicating state healthcare budgets. These changes represent the most significant restructuring of Medicaid since the ACA’s passage, with potential long-term implications for healthcare access among low-income Americans.
Verify This Yourself
Use these professional tools to fact-check and investigate claims independently
Reverse Image Search
Check if this image has been used elsewhere or in different contexts
Ask Our AI About This Claim
Get instant answers with web-powered AI analysis
Related Fact-Checks
See what other fact-checkers have said about similar claims
Want More Verification Tools?
Access our full suite of professional disinformation monitoring and investigation tools
8 Comments
This is a significant shift in social welfare policy that warrants close scrutiny. I hope the reporting continues to explore the nuances and potential impacts, both intended and unintended, of these Medicaid changes.
I’m skeptical of the claim that Medicaid expansion led to higher improper payments. That seems like a politically-motivated argument rather than an objective assessment. More data and analysis would be needed to substantiate that assertion.
Agreed. The ‘improper payments’ claim seems questionable without deeper investigation. Policy decisions should be grounded in empirical evidence, not ideological rhetoric.
This is a complex issue with valid concerns on both sides. I appreciate the balanced reporting here, highlighting the policy rationale while also noting the potential impact on Medicaid enrollees. It’s an important debate to follow as these changes unfold.
The Project 2025 blueprint seems to take a very critical view of Medicaid, characterizing it as wasteful and inefficient. I wonder how that aligns with the goal of supporting a social safety net. More analysis on the tradeoffs would be helpful.
Interesting look at the Trump administration’s approach to Medicaid. Sounds like a major policy shift away from the ACA’s Medicaid expansion. I’ll have to read more to understand the full implications for healthcare access and costs.
The work requirements for Medicaid are a controversial element of this policy shift. I can understand the desire to reduce improper payments, but access to healthcare is crucial, especially for lower-income populations. Curious to see how this plays out in practice.
You raise a good point. The work requirements could create barriers to coverage for vulnerable populations who need Medicaid the most. Careful implementation and monitoring will be key.