Key committees in the US House of Representatives are scheduled to convene the week of May 12 to advance plans to identify at least $1.5 trillion in spending cuts to safety-net programs, as required by the budget resolution that passed the House (largely along party lines) on April 10. Alarmingly, experts, including the Congressional Budget Office, agree that the only way to make such cuts possible would be through dramatic cuts or changes to Medicaid—a program essential to the well-being of women and the economy.
Medicaid is a joint state-federal program that provides medical and health-related services and coverage. While there are federal rules that each state’s Medicaid program must follow, states run their own programs with varying eligibility rules and benefits.
Effective in 2014, the Affordable Care Act (ACA) expanded Medicaid to permit states to increase coverage to adults with annual incomes up to 138 percent of the federal poverty level (FPL), which in 2025 is approximately $21,600 for a single-person household and $44,500 for a family of four. Critically, the ACA also provided states with a federal match rate of 90 percent to expand Medicaid eligibility and, therefore, health care coverage for people with incomes above 138 percent of FPL. To date, a total of 40 states and Washington, DC, have expanded their Medicaid programs.
Research from the American Hospital Association shows that one in five Americans relies on Medicaid for health care, and that women comprise most adults covered. Due to the wage gap, occupational segregation, unpaid care work, and economic inequity, women comprise the majority of people who live below the poverty line. Medicaid covers 44 percent of women with disabilities and more than 40 percent of births in the United States. In addition, women of color are overrepresented in Medicaid coverage, particularly those of reproductive age. Making things worse, ongoing reproductive rights restrictions have exacerbated the already devastating maternal mortality crisis that continues to ravage Black and Indigenous communities. As the largest provider of maternal and reproductive health care coverage, Medicaid is essential to the survival of women of reproductive age.
Unfortunately, Congress, with the support of the White House, is considering Medicaid change proposals that would threaten the health and well-being of women. These include reducing or capping the federal share of Medicaid expansion, implementing work requirements for Medicaid eligibility, and imposing provider exclusions that would disqualify health providers that offer abortion care, such as Planned Parenthood, from participating in Medicaid. Such changes could have devastating impacts on the sustainability of state’s Medicaid programs, beneficiary enrollment, and patients’ access to health care providers.
According to KFF estimates, should the 90 percent federal match be eliminated, it would cost states nearly $626 billion to maintain the current level of Medicaid expansion. The same analysis estimated that if states drop the ACA Medicaid expansion entirely, 20 million people—nearly a quarter of Medicaid enrollees—would lose coverage over a ten-year period.
In addition, the Medicaid work requirements being promoted by some congressional leaders could put 44 percent of Medicaid recipients—36 million people—at risk of losing coverage. Research shows that 92 percent of adults receiving Medicaid (those under age 65 not receiving benefits from Social Security programs) work full- or part-time. Those who do not work report that they are unable to do so due to caregiving responsibilities, illness or disability, school attendance, and/or retirement. Work requirement provisions, a holdover of racist and sexist stereotypes surrounding those who rely on social benefit programs, would create additional barriers for beneficiaries to remain enrolled in Medicaid and would prevent people from accessing the benefits they need to survive. Taking benefits away from people who don’t meet work requirements would only increase hardship, particularly for women, people with disabilities, and children.
Further, the proposal to target health care providers committed to supporting abortion care could have chilling effects on millions of women’s access to health care services, particularly for family planning services. In 2021, 11 percent of female Medicaid beneficiaries of reproductive age who received family planning services went to a Planned Parenthood health center. Should Planned Parenthood be excluded from Medicaid, millions of women—particularly women of color—would be at risk of losing access to essential health services.
Any changes to Medicaid that shift the burden of eligibility expansion to states or are inherently rooted in making Medicaid coverage and care harder to obtain would have particularly harrowing consequences for women. Restricting and reducing access to Medicaid would devastate the lives of millions of women of all ages, leading to potentially fatal consequences through increased maternal mortality rates, food insecurity, medical debt, and job loss. Rather than moving forward with policy changes to restrict or reduce access to Medicaid, policymakers should be exploring ways to further expand the program to better support women’s health and economic well-being.
