With President Donald Trump back in the White House and a GOP-controlled Congress determined to cut spending on the public health insurance program for low-income individuals, Republican lawmakers in a number of states are targeting Medicaid expansion.
Some states are already taking steps to terminate or reduce their expanded Medicaid programs as the federal government considers Medicaid cuts.
Republicans in Montana are contemplating letting their enlarged program expire, while lawmakers in Idaho have submitted a bill that would reverse the expansion that was approved by voters. If federal money diminishes, some South Dakota lawmakers want to urge voters to allow the state to stop expanding.In the event that Congress reduces federal funding, nine additional states already have trigger laws that will terminate their expansion programs.
Legislators in non-expansion states like Alabama are waiting to see what the Trump administration will do, which has caused talks to stagnate.
Many conservatives contend that states now face significant financial burdens as a result of Medicaid expansion and that it is dangerous to rely so heavily on federal assistance. They contend that expansion transfers funds to low-income people who may be able to find employment, rather than more vulnerable populations like children and the disabled.
GOP state senator Casey Crabtree wants to use a trigger measure to put Medicaid expansion back before voters in South Dakota, where voters approved it in 2022 through a constitutional amendment. “My proposed amendment to the state constitution empowers voters to maintain financial accountability,” he texted Stateline, adding that the legislature can responsibly assess the state’s financial capacity and the impact on taxpayers while still honoring the will of the people in the event that federal funding falls short of the agreed-upon 90%.
Even some Republicans, however, are concerned about the implications of removing expansion for their voters.
Many states may implement Medicaid work requirements under Trump.
To be honest, constituents have sent me hundreds of emails pleading with me to refrain from repealing. Rep. Lori McCann, a Republican from Idaho who represents a swing seat in the state’s north, stated, “I have received zero asking me to repeal, which I think is very telling.”
McCann stated that while she is hesitant to completely cancel the expansion, she is interested in reducing Medicaid expenses.According to the most recent data from the Idaho Department of Health and Welfare, if the state repeals its expansion, over 89,000 people in the state may no longer be covered. Only a small percentage of people would be eligible to get insurance at a reduced rate on the state exchange, McCann said she discovered this month.
What will happen to the rest of them? They will return to the ER, and we will be faced with the same issues that existed before Medicaid expansion.
Traditional Medicaid insurance was primarily provided to pregnant women, persons with disabilities, and children and their caretakers prior to President Barack Obama signing the Affordable Care Act into law in 2010. The federal government will pay 90% of the costs for those newly eligible registrants, while states can offer coverage to anyone earning up to 138% of the federal poverty threshold, or approximately $21,000 annually for a single person, under the ACA’s Medicaid expansion program. The remainder is kicked in by the states.
The agreement has been accepted by all but ten states, the majority of which are under Republican control. The expansion of Medicaid eligibility has allowed over 21 million low-income individuals nationwide to obtain health insurance.
However, as they search for methods to finance the extension of tax cuts implemented during Trump’s first term in office, the Trump administration and a Republican-controlled Congress are giving ideas for Medicaid reduction careful thought.In addition to approving additional barriers like requiring participants to work in order to qualify for coverage, proposals include lowering the federal 90% funding match, which may push a larger portion of Medicaid expenditure onto states.
Republican state lawmakers, who have long opposed the program despite its popularity, are stepping up their efforts as a result of the federal level uncertainty.
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Republican Governor Sarah Huckabee Sanders of Arkansas said last month in a public speech that the state would request authorization from the federal government to impose job requirements on individuals in order to be eligible for coverage.
Working-age, able-bodied adults must work, attend school, volunteer, or stay at home to care for their children if they wish to receive free health care funded by their fellow taxpayers, she said.
Sanders maintained that coverage devoid of these conditions deters people from working and being independent.
However, proponents and specialists cite a substantial amount of evidence that connects Medicaid expansion to improved health care outcomes, reduced percentages of uninsured people, and financial gains for states, hospitals, and other providers.
They claim that without expansion, a large number of working poor people without employer-sponsored insurance would be left in a coverage gap because they make too much money to be eligible for regular Medicaid but not enough to buy private insurance. That gap is filled by expansion.
Additionally, proponents contend that denying health insurance to tens of thousands of residents in a state would have a significant impact on hospitals, families, and state budgets.
Idaho Democratic state representative Ilana Rubel, the House minority leader and member of the committee examining legislation that might repeal the state’s Medicaid expansion, stated that it would be “completely disastrous for everybody at all levels of the state.”
People would once again be unable to seek preventative care until it was too late, which would result in fatalities, health problems, and financial ruin.
According to Joan Alker, executive director of Georgetown University’s Center for Children and Families, national conservative-backed organizations are behind many of the efforts to revoke Medicaid expansion in states like Idaho and Montana.
Alker, who is also a research professor at Georgetown’s McCourt School of Public Policy, where she focuses on Medicaid and the Children’s Health Insurance Program, said it’s critical to recognize that this is a part of a well-planned and funded attempt to undermine Medicaid in general, particularly for adults.
The Foundation for Government Accountability and the Paragon Health Institute, two conservative-backed think tanks, have opposed Medicaid expansion in testimony before state legislatures and have attempted to defeat state ballot measures.
Representatives from the institute and the foundation pushed state lawmakers to abandon Medicaid expansion in Montana, where it is scheduled to expire this year unless the governor and legislature decide to extend it. In a foundation-produced film, Montana Republican state representative Jane Gillette, a dentist, argued for the state to let its expansion run its course.
Requests for interviews were not answered by either group.
Last year in Idaho, Republican state representative Jordan Redman gave up much of his time to a Foundation for Government Accountability official when he introduced his Medicaid measure. Following strong public opposition, that bill eventually failed to pass out of committee.
Redman brought his Medicaid measure back to life this month. If the federal government fails to maintain the 90% match and the state does not obtain federal approval to implement work requirements and a number of other new restrictions, such as a cap on Medicaid expansion enrollment of 50,000, which is slightly more than half of its current enrollment, and a three-year limit on benefit receipts, it would repeal Medicaid expansion the following year.
Earlier this month, Redman informed the Idaho House Health & Welfare Committee that this safeguard method would maintain flexibility while strengthening Idaho’s Medicaid program. This law guarantees that Medicaid funds will be reallocated to the most vulnerable in the event that the federal government or state agencies do not meet the program’s safeguards. Stateline requested an interview with Redman, but he did not reply.
Redman’s bill was referred to as Medicaid repeal in sheep’s clothing by Democratic leader Rubel.
According to her, it’s a kind of trigger law with extremely improbable requirements. In essence, they are stating that Medicaid expansion will be revoked until a unicorn can be flown to the moon and back.
In 2018, over 61% of Idaho voters supported Medicaid expansion through a ballot issue. In 2020, the law became operative.
Since then, conservative lawmakers in Idaho have made unsuccessful attempts to revoke Medicaid expansion, including last month’s introduction of a new repeal bill. However, this year might be a conservative one. The Republican House Speaker of Idaho increased the committee’s size from 13 to 15 seats prior to the session. Some state Democrats claim that this action was an attempt to force the removal of Medicaid expansion. The platform of the Idaho Republican Party, which advocates for the repeal of Medicaid expansion, has received the backing of at least eight committee members.
Medicaid is well-liked both in states that have expanded and those that have not. A health tracking survey conducted in January 2025 by the health research group KFF found that three-fourths of Americans have a positive opinion of Medicaid. It s a preference that crosses political boundaries: 63% of Republicans, 81% of independents and 87% of Democrats view it favorably.
According to a 2023 poll conducted in Idaho, 75% of voters, including 69% of Republicans, had a positive opinion of Medicaid.
Citizens should not have to work this hard to get something passed that they want and need so desperately, and then keep imploring legislators not to take it away again, said Rubel.
Congress may instantly deny health coverage to nearly 3 million adults if it lowers the 90% federal match rate for Medicaid expansion.
That s because nine states have so-calledtrigger lawsthat would automatically end Medicaid expansion if federal funding is cut: Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia. Three additional states Iowa, Idaho and New Mexico would require the government to take cost-saving steps to ease the financial impact of federal cuts.
Congress is unlikely to adopt such legislation before the end of the majority of state legislative sessions this spring, according to Alker. However, if budget cuts are implemented, the effects might become apparent in 2026.
Regardless of possible cuts at the federal level, states including Arkansas and Idaho are looking at ways to reduce the number of Medicaid-eligible people by instituting work requirements or benefit caps.
States need federal approval to impose such additional conditions on Medicaid eligibility.
The first Trump administration approved work requirementsin 13 states, but the courts later struck those down and the Biden administration rejected such requests. States, including Arkansas, are trying again, hoping they re more likely to get what they want under the new Trump administration.
Redman told Idaho legislators that he expects the Trump administration to grant the waivers that would be needed under his proposed bill.
I actually spoke to several folks at the new federal administration, and they said they re looking for waivers that are unique and creative, that they want to grant, he said.
Meanwhile, Republican lawmakers in non-expansion states have in recent years warmed to the idea of expansion. It was arguably thebiggest issueof last year s legislative session in solidly red Mississippi, and was backed by Republican Lt. Gov. Delbert Hosemann. Expansion is back on the table this year, though lawmakers havesaidthey won t consider a plan unless it includes work requirements.
But in Alabama last month, House Speaker Nathaniel Ledbetter, a Republican, said expansion would no longer be a priority this session because Medicaid was likely to see changes at the federal level.
I think we are better off seeing what they are going to do, he told reporters.
Regardless of possible cuts at the federal level, states including Arkansas and Idaho are looking at ways to reduce the number of Medicaid-eligible people by instituting work requirements or benefit caps.
States need federal approval to impose such additional conditions on Medicaid eligibility.
The first Trump administration approved work requirementsin 13 states, but the courts later struck those down and the Biden administration rejected such requests. States, including Arkansas, are trying again, hoping they re more likely to get what they want under the new Trump administration.
Redman told Idaho legislators that he expects the Trump administration to grant the waivers that would be needed under his proposed bill.
I actually spoke to several folks at the new federal administration, and they said they re looking for waivers that are unique and creative, that they want to grant, he said.
Meanwhile, Republican lawmakers in non-expansion states have in recent years warmed to the idea of expansion. It was arguably thebiggest issueof last year s legislative session in solidly red Mississippi, and was backed by Republican Lt. Gov. Delbert Hosemann. Expansion is back on the table this year, though lawmakers havesaidthey won t consider a plan unless it includes work requirements.
But in Alabama last month, House Speaker Nathaniel Ledbetter, a Republican, said expansion would no longer be a priority this session because Medicaid was likely to see changes at the federal level.
I think we are better off seeing what they are going to do, he told reporters.
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Eliot Pierce is a dedicated writer for ChiefsFocus.com, covering local crime and finance news. With a keen eye for detail and a passion for storytelling, Eliot aims to provide his readers with clear and insightful analysis, helping them navigate the complexities of their financial lives while staying informed about important local events. His commitment to delivering accurate and engaging content makes him a valuable resource for the community.