Medicaid Cuts and the States: Tracking State-Specific Estimates of the Impacts of Proposed Changes

Elizabeth Lukanen and Emily Zylla, SHADAC

The budget reconciliation bill (H.R.1), signed into law on July 4, 2025, includes major overhauls to the Medicaid program. Preliminary estimates from the Congressional Budget Office projected that the Senate version of the bill (later passed by House) would reduce federal spending on Medicaid by more than $1 trillion over the next ten years and increase the number of uninsured by 11.8 million.

As the federal budget bills were being considered, various federal and state agencies, advocates, and research organizations all sought to estimate the potential impacts on Medicaid programs. Expenditure and enrollment estimates across all 50 states offered valuable insights into the implications of these proposals. These estimates were helpful tools for state staff as they considered how federal policy changes might impact their unique Medicaid programs.

Many individual state agencies also publicly released their own estimates seeking to quantify the potential impacts of federal policy changes on their respective state Medicaid programs (see below).

Many states provided information on cost impacts as well as enrollment. However, they varied significantly in terms of the timeframes examined, the amount of detail provided about assumptions used to generate estimates, and the documentation of data sources used. New York published a visualization with enhanced details such as projections of fiscal, coverage and hospital impacts by congressional district. Pennsylvania provided estimates of coverage losses by county. In addition to its quantitative estimates of financial and enrollment impacts, Wisconsin included qualitative reflections on the potential impacts of proposed cuts.

The estimates compiled here reflect an important snapshot in time, highlighting how states sought to understand the potential impact of sweeping federal Medicaid reforms. We do not anticipate making additional updates to this resource going forward. If new analyses emerge related to implementation or specific policy issues, we will revisit this topic as appropriate.