Medicaid, What's At Stake

Medicaid is a massive federal and state-funded program that provides health and long term care coverage to low-income people. It covers one in five people nationwide.

Democratic members of Congress are sounding the alarm about the impact of Medicaid cuts on Virginia and the nation. Republicans are saying there is no need for alarm. Both parties are clashing verbally after the U.S. The House agreed to H.Con.Res.14, on Feb. 25, establishing the congressional budget for the United States Government for fiscal year 2025 and setting forth the appropriate budgetary levels for fiscal years 2026 through 2034.

Mary Lee Ruby of Fairfax is very concerned about the possible cuts or program changes to Medicaid. It "would be devastating," Ruby said. Ruby is a Medicaid-funded home care provider for her 24-year-old grandson, Austin, who is severely and permanently disabled after a brain bleed occurred during birth.

The House budget, which included $4.5 trillion in tax cuts, would reduce federal spending by at least $1.5 trillion.

U.S. Rep. Gerry E. Connolly (VA-11), a Democrat, at his telephone town hall in March.

The Senate passed its budget resolution the previous week, on Feb. 21. The House and Senate budgets are at odds, and legislation needs to agree on and approve the same budget framework.

The ranking member of the U.S. House Budget Committee, U.S. Rep. Brendan F. Boyle (PA-02), a Democrat, says that the "GOP [House] budget would force the largest Medicaid cuts in American history." Medicaid is a safety-net health care program for low-income adults and families, people with disabilities, older adults, and pregnant women. It provides free or low-cost health insurance to 150,000 people in Fairfax County, over 2 million in Virginia, and 72 million nationwide, including 2 million veterans.

U.S. Rep. Gerry E. Connolly (VA-11), a Democrat, serves the constituents in parts of Fairfax County and the City of Fairfax in Northern Virginia. Defunding Medicaid is unacceptable to Connolly, said in an email. "President Trump said during the campaign that he would not touch Medicaid, Medicare, or Social Security. That was simply not true. The Republican budget will cut Medicaid by $881 billion to pay for tax cuts for billionaires," said Connolly.

Boyle wrote in his March 18 fact sheet that the House's adoption of the Republicans' budget (H.Con.Res.14) "requires deep, damaging cuts to Medicaid." The Republicans' budget "instructs the Energy and Commerce Committee to cut $880 billion [over ten years]. … Medicare and Medicaid make up more than 97 percent of the total spending overseen by the committee, so … the math doesn't work without deep cuts to Medicaid," Boyle said.

The federal and state governments fund the program together. Federal and state Medicaid spending totaled $880 billion in the 2023 fiscal year. The Republican House majority's aim to cut $880 billion from healthcare and energy over the next decade would be detrimental to low-income Virginians.

The federal government's share of Medicaid spending varies by state, ranging from a minimum of 50 percent to 77 percent. Lower per capita income states receive a higher federal medical assistance percentage, meaning the government covers a more significant share of their Medicaid costs.

What the Public Thinks about Medicaid

According to the latest KFF Health Tracking Poll, March 7, 2025, fewer than one in five adults (17 percent) want to see Medicaid funding decrease, and most think funding should either increase (42 percent) or be kept about the same (40 percent). KFF is an independent health policy research, polling, and news source.

Ruby's grandson, Austin, attends a Medicaid-funded daycare center, and she provides him with Medicaid-funded care outside of his daycare hours "to give his mother a break." Ruby said her son, Austin's dad, is a fire marshal in Fairfax County but "doesn't make a whole lot of money."

Ruby explained Austin weighs about 65 pounds, is blind, and sits in his chair all day. He can do nothing for himself, not even move his hands. "When you walk him through a door, you have to move his hands in because otherwise he'll get stuck in the doorway. He really requires total and complete care."

What Austin can do, though, is hear and he can smile. "He has a beautiful smile," Ruby said.

In the debate over federal Medicaid cuts, the KFF focus groups report that Medicaid enrollees emphasize the program's importance to people and their families. Although not part of the KFF focus groups and unaware of them, Ruby said, "It would be terrible if Medicaid were cut... devastating for him (Austin) to have to be without the care Medicaid covers."

What About Medicaid in Virginia?

Medicaid is a complicated health insurer. One reason is that each state, Virginia included, sets its standards for eligibility, how it addresses population health needs, and how it funds its share of the joint federal and state program.

Virginia Gov. Glenn Youngkin, a Republican, unveiled his 2025 Session Budget Amendments, HB1600 (Governor's Recommendations), to the House of Delegates on March 24. Youngkin said he had taken action to fund Medicaid. "Once adopted, the changes to our current biennial budget will ensure that all our obligations, including Medicaid, are fully funded." https://budget.lis.virginia.gov/amendment/2025/1/HB1600/Enrolled/GR/

"This budget provides an additional $824.5 million for Health and Human Resources over the biennium. It meets and clears a significant hurdle by fully funding the Medicaid and SCHIP forecast increase with $720.5 million in general fund, bringing us to a total of $16 billion in general fund and $53 billion in general and nongeneral fund support to those Virginians most in need," Youngkin said.

Given what Youngkin said, Ruby's stress about Virginia funding Medicaid may have lessened somewhat. Still, federal cuts and program changes, called by some "backdoor cuts," have not been expressed clearly. Nothing is set about the actual dollar amounts committed by the federal government to Medicaid.

What About Virginia's Trigger Law?

Connolly said that almost 90,000 of his constituents are "at direct risk of losing their health coverage. … But that is just the tip of the iceberg. Medicaid is increasingly the tool that seniors use to access nursing home care, memory care, and assisted living facilities. Forty percent of all births in America are covered by Medicaid."

The repercussions of cutting Medicaid, especially in the Commonwealth of Virginia, are immense, given Virginia is one of nine states with "trigger laws." Virginia law requires significant cuts to enrollment or benefits if the federal government reduces its contribution to the Virginia program due to its trigger law. Now, the state pays 10 percent, and the federal government pays 90 percent.

"The consequences of cutting Medicaid would be catastrophic, particularly in Virginia, where state law mandates drastic cuts to enrollment or benefits if the federal government reduces its contribution to the program. I fought hard against the Republican budget in the House, and I will continue to do everything in my power to prevent these unimaginably cruel cuts from ever taking effect," Connolly said.

Nine states are poised to eliminate the Medicaid Expansion component of the Affordable Care Act, as they have some provision, a "trigger law" to eliminate Medicaid Expansion if federal funding is reduced, according to the Virginia Network of Private Providers, Inc. "That would end coverage for the expansion population, resulting in some 3 million people losing their health care." Most of the nine states' triggers activate if federal funding falls below the 90 percent threshold currently funded by the federal government, as does Virginia's. If funding falls below 80 percent, Arizona's trigger will eliminate its expansion.

David Broder, SEIU Virginia state council executive director, said on March 27 that SEIU is holding town halls so constituents can be heard even if their Congressional members are absent. The union plans to continue mobilizing constituents to demand meetings and town halls from their elected officials, even if they refuse.

"We've held round tables with three members of Congress in Virginia. We co-hosted a town hall that over 400 people came to in Congresswoman Jennifer Kiggan's district, even though she didn't …. We know she heard us yesterday; care workers and people with disabilities were on Capitol Hill lobbying. So we will keep doing that. We are going to keep holding actions, rallies, and lobby days," Broder said.

Ruby addressed her commitment to caring for Austin if Medicaid is not funded: "He's my grandson. I would take care of him whenever they needed it, but it would be devastating."