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ACP opposes Medicaid work requirements, changing Medicaid financing or eliminating the enhanced federal rate match for Medicaid expansion populations

March 7, 2025 (ACP) -- The �������ý is urging members to contact their congressional representatives about the possibility of significant cuts to Medicaid, which provides health coverage for more than 72 million people in the United States.

“Congress is considering major cuts to federal spending to fund an extension of the 2017 tax cuts, border security and other programs,” said Ryan Crowley, ACP manager for health policy. “While Medicaid is an effective program, it's also costly. Congress is considering changes that would cut spending or reduce enrollment.”

In a joint statement, ACP joined the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and American Psychiatric Association in demanding that Medicaid be protected.

“For decades, the Medicaid program has provided health care coverage for millions of people, including children and parents, low-income adults, older adults, pregnant patients, individuals with mental health and substance use disorders and individuals with disabilities, in communities large and small, urban and rural,” the organizations write. “The impact of cuts to Medicaid funding is significant and wide-reaching, and it must be reconsidered. Medicaid is a lifeline for our nation's most vulnerable -- from visits with a primary care physician, to maternal health care and pediatrics, to labor and delivery services, to behavioral health and to preventive care that saves lives. To that end, it is of the utmost importance that Congress protect this vital program.”

The ultimate fate of Medicaid funding is unclear. “President Trump has sent mixed messages about the future of Medicaid,” Crowley said. “During the presidential campaign, he said Medicare and Social Security would be spared from cuts but didn't mention anything about Medicaid. More recently, he said Medicaid would not be targeted.”

However, Crowley noted, “the House budget resolution directs the Energy and Commerce Committee to reduce spending by $880 billion. That's a lot of money, and it's hard to believe at least some of it won't come out of Medicaid.”

House Republicans argue they can find savings by reducing waste, fraud and abuse. from the U.S. Government Accountability Office before the Subcommittee on Oversight and Investigation of the House Energy and Commerce Committee identifies $100 billion in improper payments in Medicare and Medicaid programs in 2023 and states that as of March 2024, more than 15 recommendations to the Centers for Medicare & Medicaid Services had not been implemented, including 15 related to improper payments. While this demonstrates waste and fraud, Crowley said, “it's probably not $880 billion worth. It's likely that other major changes will be considered, like work requirements, per-capita cap financing and cutting the federal Medicaid match for the Medicaid expansion population.”

ACP is opposed to major cuts to Medicaid funding or coverage. “The College is against Medicaid work requirements, changing Medicaid financing to a block grant or per-capita cap structure or eliminating the enhanced federal rate match for the Medicaid expansion population,” Crowley said. “Any of those changes would probably result in millions of people losing their Medicaid coverage.”

A positive sign is that Medicaid, which is funded jointly by the federal government and states, is popular among the public, according to health tracking poll from KFF. “It'll be politically difficult to make major changes to a program that so many people rely on,” Crowley said.

ACP members can tell their representatives to oppose Medicaid cuts through the . “We also suggest members contact or schedule a meeting with their congressional representative in their home districts to explain why Medicaid is important to their patients,” Crowley said.

Back to the March 7, 2025 issue of ACP Advocate