9 states, including Virginia, poised to end coverage for millions if Trump cuts Medicaid funding

With Donald Trump's return to the White House and Republicans taking full control of Congress in 2025, the Affordable Care Act's Medicaid expansion is back on the chopping block.

More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that's enabled states to widen eligibility, according to KFF, a health information nonprofit that includes KFF Health News, and the Georgetown University Center for Children and Families. That's because the states have trigger laws that would swiftly end their Medicaid expansions if federal funding falls.

The states are Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia.

Virginia became the 33rd state to expand Medicaid in the summer of 2018, which allowed more people to be eligible. Following months of legislative debate that year, it passed with bipartisan support.

Medicaid is a state and federal program that provides insurance coverage to low-income people or people with disabilities. Prior to the expansion taking effect in 2019, childless adults were not eligible in Virginia and parents were only eligible for up to 38% of the federal poverty level. According to a 2022 National Library of Medicine study, Virginia had one of the highest uninsured rates of non-elderly adults below 138% of the federal poverty level. The study also found that people were less likely to delay medical care since the expansions.

It's the benefits to Virginians that Sen. Jennifer Boysko, D-Fairfax, said she is focused on amid possible changes in the federal landscape.

She said that the Senate's finance committee discussed the matter at a recent retreat and she hopes lawmakers with higher concentrations of people who have benefitted from Medicaid in their districts will think about protecting the expansion. Boysko finds it "disturbing" that Medicaid funding could be on the federal "chopping block" and is concerned what a federal GOP trifecta might mean for the Affordable Care Act overall.

However, Boysko noted that Virginia's state health insurance exchange — also made possible by the ACA — could be a way to "absorb" some patients if need be and said that lawmakers may also need to "get creative" with some of its surplus.

In the meantime, Virginia and the nation are also experiencing a Medicaid "unwinding," as eligibility checks are underway to determine who still meets criteria to remain covered and who does not. In recent months, over 500,000 people have been disenrolled while about 2 million have been redetermined, according to data from the Department of Medical Assistance Services. "We will address whatever we have to in the General Assembly to do the best we can to help protect our residents," Boysko said. "But we've still got to see how this all pans out."

Medicaid has been in the crosshairs of Republicans in Washington before. Republican congressional leaders in 2017 proposed legislation to cut federal expansion funding, a move that would have shifted billions in costs to states. That plan, part of a strategy to repeal Obamacare, ultimately failed.