5/14/25 Update
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On Monday, May 12, 2025, we got our first real look at Congressional Republicans’ approach to spending cuts in Medicaid. Cuts are estimated at $715 billion over the next 10 years. There’s quite a lot of detail to digest, but here are some of the features of the reductions:
- Approximately 14 million Americans will lose health insurance through Medicaid.
- There are community engagement requirements. To maintain eligibility, Medicaid beneficiaries who are “able-bodied” (this is not defined anywhere) must work or be legitimately and demonstrably involved in “not less than 80 hours of community service” per month.*
- Hospital/provider taxes, ordinarily applied by states and then certified by states to generate federal Medicaid match, are frozen (i.e., can’t be increased).
- Eligibility re-determination every six months (currently every year).
- Cost-sharing requirements that mandate beneficiaries pay certain co-pays, deductibles and the like not to exceed “5 percent of the family income of the family involved.”
*Language the reconciliation draft includes: ‘‘(V) who is medically frail or otherwise has special medical needs (as defined by the Secretary), including an individual—(dd) with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living.”
Absent from the reconciliation language are two of the most egregious changes that would have devastated Americans with intellectual and/or developmental disabilities (IDD), namely block granting of Medicaid and per capita caps. We’re glad these have not (yet) found their way into proposed changes.
But make no mistake, these changes and the reductions they create are massive. While they don’t target people with IDD, we and our partners locally and nationally are very concerned.
We are asking you, once again, to contact your senators and representatives. Hearing from constituents like you is the only way they know what matters to the people they represent. It is critical to use your voice to speak against these cuts and changes to Medicaid. Click here to submit an email to your legislators. Personalize it. Share your story. You and your loved ones matter.
To read the complete update, click here.
4/3/2025 Update
The Senate may take a vote as early as this week! As we know, the US House has already passed their version of a budget resolution that included $880 billion in cuts that would likely target Medicaid. A cut of this magnitude would be absolutely devastating.
We must continue reaching out to our elected officials to have our voices heard. You can use this link to send a message to your senators. Personalize it and share your story.
The Issue (as of 3/3/2025)
In February, the United States Senate and House of Representatives passed critical federal budget resolutions that target federal spending cuts well into the trillions of dollars.
The House Resolution targets deep spending cuts of $880M in federal fiscal year 2026. Medicaid is among the programs facing deep cuts and restructuring.
Additionally, the Trump Administration has proposed the following fundamental changes to Medicaid:
Why does this matter to Makom?
The Affordable Care Act allowed for states to essentially expand Medicaid to cover people who weren’t otherwise covered by private or other health insurance. The federal government offered certain incentives to entice states to do so, including a higher federal matching rate. The overall average federal match rate for Medicaid is around 62%.
For the services and supports that Makom provides, the match rate is 50%, or $1:$1—for every dollar put in by MD and VA, the states receive a matching dollar from the federal government.
By way of targeting the match rates, the Congressional Budget Office has estimated savings of $1.9 trillion. However, the cost of withdrawing that level of federal financial commitment is the loss of Medicaid as health insurance to hundreds of thousands Americans, including our friends, colleagues, family members, and neighbors with IDD.
The Ask
Visit the American Network of Community Options and Resources (ANCOR) Medicaid Resource Center. It is full of great tools and ways for you to make your voice heard. The Arc of the US also has an easy way for you to advocate with members of Congress. The President of Makom’s Board of Directors, Heather Sachs, is deeply engaged in this fight on Makom’s behalf and for National Down Syndrome Congress. Please join Heather and all of us at Makom to #SaveMedicaid.
CBO Projections for 2025–2034
The non-partisan CBO outlines an analysis of mandatory federal spending that are under the jurisdiction of the House Committee on Energy and Commerce. Over the next 10 years, there is a call for $880B in cuts. It is not explicitly stated that cuts will be made to Medicaid and Medicare.
The problem is in the math. If there’s a 10% cut to only the non-Medicaid programs in their jurisdiction, it tallies to about $381M…leaving cuts to Medicaid at $500B—a half trillion dollars—over the next ten years.
