Medicaid, a health insurance program that covers over 70 million low-income Americans, is facing significant changes through President Donald Trump’s “One, Big, Beautiful Bill” currently being considered by the Senate. This bill aims to cut funding for Medicaid, with both the House and Senate versions proposing reductions totaling hundreds of billions of dollars, according to the Congressional Budget Office (CBO). The CBO estimates that nearly 12 million adults could lose health insurance over the next decade if these cuts are implemented, primarily through new administrative requirements for enrollees.
The White House disputes the CBO’s findings, asserting that the cuts will target fraud and waste while protecting and preserving Medicaid. The bill includes provisions to remove illegal immigrants from the program, introduce work requirements, and enhance eligibility verification to combat fraud. The House has already passed the bill, and efforts are underway to secure its approval by a July 4 deadline set by Trump, despite division among Republicans over the proposed Medicaid cuts.
Medicaid was established in 1965 alongside Medicare to provide health insurance for low-income individuals. Financed jointly by state and federal governments, Medicaid constitutes a significant portion of U.S. healthcare spending and enjoys widespread popularity among Americans. The Affordable Care Act allowed states to expand Medicaid eligibility, with 40 states and Washington, D.C., adopting the expansion. During the COVID-19 pandemic, additional Medicaid funds were allocated to ensure continuous coverage for recipients, with this provision ending in March 2023.
Various states have different names for their Medicaid programs, such as DenaliCare in Alaska, KanCare in Kansas, and SoonerCare in Oklahoma. Medicaid enrollment has remained around 20% of the total U.S. population in recent years.
In March 2025, the Centers for Medicare & Medicaid Services (CMS) reported that over 71.3 million low-income individuals in the U.S. were enrolled in Medicaid, with a majority being adults. This number was higher in previous years, with approximately 100 million individuals enrolled at some point in 2023, according to a report by The Medicaid and CHIP Payment and Access Commission. Following the end of continuous enrollment, enrollment numbers have decreased as states have begun disenrolling individuals from the program.
Medicaid enrollment varies significantly among states, with more than 30% of residents in Louisiana and New Mexico covered by the program compared to just 12% in Wyoming and North Dakota, as reported by KFF.
Eligibility for Medicaid is determined by the federal government, requiring states to provide coverage to certain groups falling below specific income thresholds, including pregnant women, families with children, disabled individuals, and most children in foster care. However, qualifications can differ from state to state, with some states like New Jersey and New York extending coverage to certain immigrants.
While most states do not mandate work requirements for Medicaid recipients, Georgia requires applicants to demonstrate at least 80 hours of work or volunteer service to qualify for coverage. Work requirements in Arkansas and Kentucky were overturned by federal courts, and several states, including Idaho, Kentucky, and Indiana, have recently enacted or are considering implementing similar requirements.
Under Trump’s “One, Big, Beautiful Bill,” there could potentially be nationwide work requirements for Medicaid recipients aged 19 to 64, necessitating verification of employment, job training, education, or volunteer work. Medicaid recipients’ work status would be reviewed biannually.
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