Medicaid has long been a cornerstone of the U.S. healthcare system, providing coverage to over 80 million Americans—including children, seniors, people with disabilities, and low-income working adults. But in 2025, sweeping policy proposals at both federal and state levels threaten to fundamentally alter how Medicaid operates. These changes include federal budget cuts, restructuring of funding mechanisms, and new eligibility hurdles like work requirements and co-payments.
While these shifts aim to reduce government spending, they also pose significant risks to the people Medicaid was designed to protect. This article explores the populations most at risk under these proposed reforms and outlines the broader implications for healthcare access and equity in the U.S.
Overview of the 2025 Medicaid Overhauls
At the federal level, the proposed budget backed by House Republicans and supported by former President Trump seeks to cut $880 billion in federal healthcare spending over the next decade. Medicaid is expected to bear the brunt of these reductions. Key changes include:
- Block Grants or Per-Capita Caps: Instead of open-ended federal funding, states would receive a fixed amount, limiting flexibility during economic downturns or public health crises.
- Rollbacks to ACA Expansion: States may lose federal support for covering low-income adults without children.
- Work Requirements: Adults could be required to report employment or job-seeking activity to maintain coverage.
- Elimination of Mandatory Benefits: States could opt out of covering services like long-term care or early childhood screenings.
States like New Hampshire are also proposing their own reforms:
- Introducing premiums and co-pays for low-income enrollees.
- Ending continuous eligibility policies, increasing churn and gaps in care.
Together, these federal and state-level overhauls could shrink enrollment, reduce coverage, and shift healthcare costs back onto patients.
Group 1: Low-Income Working Adults Without Children
This group benefitted most from the Affordable Care Act’s Medicaid expansion, which extended eligibility to adults earning up to 138% of the federal poverty line. However, these same individuals are now at risk if:
- Expansion funding is rolled back, making them ineligible.
- Work requirements are enforced, requiring frequent reporting or face loss of coverage.
Many in this group are employed in retail, food service, caregiving, or gig work—jobs with variable hours and limited benefits. Even small paperwork errors or missed deadlines could result in losing access to essential healthcare.
Group 1: Low-Income Working Adults Without Children
This group benefitted most from the Affordable Care Act’s Medicaid expansion, which extended eligibility to adults earning up to 138% of the federal poverty line. However, these same individuals are now at risk if:
- Expansion funding is rolled back, making them ineligible.
- Work requirements are enforced, requiring frequent reporting or face loss of coverage.
Many in this group are employed in retail, food service, caregiving, or gig work—jobs with variable hours and limited benefits. Even small paperwork errors or missed deadlines could result in losing access to essential healthcare.
Group 3: Children in Low-Income Households
Medicaid and the Children’s Health Insurance Program (CHIP) cover about 40% of all U.S. children. While children often remain eligible under mandatory categories, they still face indirect threats:
- Parents losing coverage can destabilize family healthcare.
- Optional benefits like dental care, vision screenings, or mental health services may be dropped by cost-conscious states.
- Removal of continuous eligibility increases the risk of children being dropped due to clerical errors or short-term income changes.
These disruptions can have lasting effects on child development, school readiness, and chronic disease management.
Group 4: Rural Communities
Rural hospitals are deeply dependent on Medicaid reimbursements. In some regions, Medicaid covers up to 25% of hospital revenue. The proposed cuts risk:
- Closures of rural clinics or hospitals, creating healthcare deserts.
- Long travel distances for emergency care or specialty services.
- Provider shortages, as reduced payments deter doctors and nurses from practicing in rural areas.
Patients in these areas may go without care or delay treatment until conditions worsen, increasing long-term costs and mortality risk.
Group 5: Racial and Ethnic Minority Populations
Black, Latino, and Native American populations are disproportionately represented in Medicaid due to structural inequities in income, housing, and employment. These groups:
- Are more likely to rely on Medicaid for chronic condition management (e.g., diabetes, asthma, hypertension).
- Face language barriers and administrative obstacles during eligibility redeterminations.
- Live in areas with underfunded public health systems and fewer private provider options.
Cutting Medicaid risks widening already severe health disparities and undermining decades of work toward health equity.
Additional At-Risk Groups
Postpartum Women
- Extended postpartum Medicaid coverage (up to 12 months after childbirth) is now optional for states. Some may shorten it to 60 days.
- This threatens maternal health in a country already facing rising maternal mortality rates.
Young Adults Aging Out of Coverage
- Turning 19 or 26 (depending on the program) may trigger loss of coverage.
- Without job-based insurance or a robust individual market, young adults could fall into coverage gaps.
Mixed-Status Families and Immigrant Households
- Fear of deportation or changes in residency rules could prevent eligible family members from seeking or maintaining coverage.
- Increased documentation requirements may further deter enrollment.
Broader Implications of Coverage Loss
- Healthcare Providers: Will face higher uncompensated care burdens.
- State Economies: Could lose jobs in healthcare, especially in hospitals and long-term care facilities.
- Public Health Outcomes: Reduced access to vaccinations, screenings, and chronic care will increase emergency visits and preventable deaths.
- Educational Outcomes: Children with unmanaged health issues are more likely to miss school and fall behind.
According to one analysis, combined Medicaid and SNAP cuts could lead to over 1 million job losses and a $113 billion reduction in GDP by 2026.
Conclusion
While Medicaid reforms in 2025 are framed as efforts to increase efficiency and reduce spending, they pose serious risks to the people most dependent on this essential safety net. Low-income workers, seniors, children, people with disabilities, and communities of color all stand to lose not just coverage, but critical pathways to health, independence, and stability.
The debate over Medicaid is more than a budget line—it is a reflection of the nation’s values. As the conversation continues, it is vital to consider not only the dollars saved but the lives affected.
