As the new administration seeks ways to reduce government spending through the Department of Government Efficiency, Medicaid has been listed as a program under review. Proposals to reduce spending in Medicaid include enacting mandatory federal work requirements, starting in 2026, and reversing Biden-era policies that expanded eligibility, enrollment, and affordability. Both proposals would see an increase in uninsured adults eligible for Medicaid, affecting people with the lowest incomes the most.
Urban’s Health Policy Division has released several reports and analyses reviewing the proposed policies and the widespread effects if either were to be finalized.
About 5 million Affordable Care Act expansion adults ages 19 to 55 could lose Medicaid under implementation of work requirements nationally, though most already work or should be exempt.
Georgia’s Pathways to Coverage program will continue to reach only a small share of eligible adults if the waiver maintains the requirement that applicants document their work activities instead of having the state automatically verify compliance.
HHS proposes to restrict Marketplace eligibility, enrollment, and affordability in first major rule under Trump administration (parts 1 and 2)
Urban researchers review the Health and Human Services (HHS) proposal in two parts.
Part 1: Limits on enrollment opportunities; requiring premiums for auto-reenrolled people; limits on essential health benefits; and additional standards for agents, brokers, and web brokers
Part 2: The rules’ policies on failure to reconcile, income verification, and premium payment thresholds
The proposed rule would restrict Marketplace eligibility, enrollment, and affordability and subject state-based Marketplaces to considerable operational costs and challenging operational timelines.
People with Affordable Care Act Marketplace coverage often face high deductibles and out-of-pocket maximums. Shifting the benchmark plan from silver to gold coverage and expanding cost-sharing subsidies could ease cost burdens for many.
About 1.1 million uninsured young adults will be eligible for Medicaid, while 0.6 million will be eligible for Marketplace premium tax credits (PTCs) after Medicaid unwinding is complete but before expiration of the enhanced PTCs.
