Medicaid Cuts and the States: Tracking National Analyses With 50-State Estimates
Elizabeth Lukanen & Emily Zylla, SHADAC
A range of policy proposals to cut federal Medicaid funding under consideration by Congress could profoundly reshape the Medicaid program. Although the specific details of these proposals have not yet been defined, many entities are actively analyzing the possible effects on state Medicaid enrollment and spending.
In December 2024, the Congressional Budget Office (CBO) released the first national estimates of spending reductions related to three proposed policy levers – establishing caps on federal spending for Medicaid, limiting the ability of states to use provider taxes, and reducing the Federal Medical Assistance Percentage (FMAP). Although national estimates are helpful to understand the overall scope of policy changes, the effects of Medicaid cuts will vary widely by state, reflecting differences in program structures, enrollment levels, state funding mechanisms, and reliance on federal funding. For these reasons, state-level estimates of the impacts of Medicaid cuts are an important tool for policymakers, advocates, and stakeholders to anticipate and respond to the unique challenges each state may face. SHVS is tracking state agencies that have produced their own estimates on the impacts of proposed changes.
To-date, a variety of national analyses that produce parallel estimates for all 50 states have also been released (Table 1). These national 50-state analyses all differ in terms of policies examined, assumptions used, and data sources cited, however most were based on the CBO June 2024 baseline projection of Medicaid spending for 2024 to 2034. In January 2025, CBO produced revised estimates, raising its 10-year baseline projection for Medicaid spending by more than 10%. Specifically, CBO revised projected enrollment in 2025 from 79 million to 84 million and noted that the 2024 cost per enrollees was higher because of a decline in enrollee health status after the end of the Medicaid continuous coverage policy. This resulted in an increase in projected 2025 spending for Medicaid by $57 billion (10%) and an increase in the 10-year baseline (2025 to 2034) projection by $817 billion (12%).
The most recent 50-state analysis, developed by Manatt Health, with support and input from SHVS, uses CBO’s revised January 2025 baseline in its modeling. As a result, the projected impacts of proposed Medicaid cuts are based on the most recent federal assumptions and are much greater in magnitude. Manatt’s tool is designed to support states in informing and validating their own fiscal and program impact estimates of federal policy changes – it provides national and state-by-state estimates of key cuts under consideration in Congress and advises states on how they might consider the various range of results to inform independent modeling efforts. For a summary of the toolkit, see the SHVS expert perspective Analyzing the Impact of Potential Medicaid Cuts: Overview of a Toolkit for States.
As organizations release additional national analyses that include 50-state estimates of impacts, SHADAC will continue to update the table below.
Table 1. National Analyses of the Impacts of Medicaid Cuts With 50-State Results
|
Author |
Publication Date |
Federal Policy Examined |
State-Level Impacts Estimated |
|
4/14/2025 |
Reduce the enhanced federal match rate from 90% to 50% for the expansion population; eliminate the FMAP floor; per capita caps on federal spending for the expansion population; and work requirements (forthcoming). |
State-level changes to Medicaid spending, and where applicable, enrollment. |
|
|
4/14/2025 |
Work requirements. |
State-level coverage loss for Medicaid expansion adults. |
|
|
3/25/2025 |
Distribution of $880 billion in Medicaid cuts*; and $230 billion SNAP cuts across all 50 states (no specific policy defined). |
Reductions in federal funding, state gross domestic products, tax revenues, and job losses. |
|
|
3/7/2025 |
Distribution of $880 billion in Medicaid cuts* across 50 states (no specific policy defined). |
State-level Medicaid coverage loss for the following groups: rural residents, children and seniors who would lose nursing home care. |
|
|
2/27/2025 |
Reduce the enhanced federal match rate from 90% to 50% for the expansion population. |
State-level changes to federal and state Medicaid spending, Medicaid coverage loss and changes to uninsurance rates under two scenarios over a 10-year period: 1) If all states keep their Medicaid expansion in place; 2) if all states drop Medicaid expansion. |
|
|
2/27/2025 |
Per capita caps on federal spending; and reduce the enhanced federal match rate from 90% to 50% for the expansion population. |
State-level changes to federal and state Medicaid spending under a per capita cap and subject to reduced FMAP for the expansion population; separately and in combination over a 10-year period. |
|
|
2/26/2025 |
Per capita caps on federal spending. |
State-level changes to federal and state Medicaid spending and Medicaid coverage loss over a 10-year period. |
|
|
2/24/2025 |
Distribution of $880 billion in Medicaid cuts* across congressional districts in all 50 states (no specific policy defined). |
Reductions in federal funding and Medicaid/Children’s Health Insurance Program coverage loss, by congressional district. |
|
|
2/13/2025 |
Reduce the enhanced federal match rate from 90% to 50% for the expansion population. |
State-level changes to federal and state Medicaid spending and Medicaid coverage loss under two scenarios over a 10-year period: 1) If all states keep their Medicaid expansion in place; 2) if all states drop Medicaid expansion. |
|
|
2/5/2025 |
Work requirements. |
State-level Medicaid coverage loss for expansion and other adults. |
* In February, 2025 the U.S. House of Representatives passed a budget resolution directing the House Energy & Commerce Committee to reduce the federal deficit by at least $880 billion over 10 years. Although the resolution does not specifically mention Medicaid, a subsequent March 5, 2025 CBO letter confirmed that the committee could not reach its target without cutting Medicaid and the Children’s Health Insurance Plan.