Summary
Medicaid is a top policy area in which we could see changes during the incoming Administration and Congress. Linked here, please find a set of tables outlining potential threats to Medicaid, a handful of opportunities, and the policy processes through which Congress or the Administration could pursue such changes.
As an overview, Medicaid currently provides health coverage to more than 72 million Americans. Medicaid policy changes proposed by the GOP platform, recommended in Project 2025, discussed during the Trump-Vance campaign, and/or endorsed by incoming Congressional leaders include the addition of work requirements and changes to Medicaid financing either by altering the percentage of Medicaid expenditures paid for by federal funds and/or by altering supplemental payments. Actions could also be taken to alter Medicaid benefits, eligibility levels, or quality metrics to ensure access to care. Congress can alter Medicaid through legislation, either utilizing the normal process which includes a 60-vote threshold to overcome the filibuster in the Senate, or through budget reconciliation, which requires a simple majority (51 votes or 50 votes plus the support of the Vice President) and is feasible given Republican control of the Senate, House of Representatives, and White House. Our recent primer on budget reconciliation includes additional details regarding the budget reconciliation process and how it could impact Medicaid.
The threats and opportunities included in these tables are not exhaustive but are quite thorough. We are happy to dive deeper into any that might be helpful to you. Please reach out with any questions you might have.