Medicaid coverage declines amid federal budget cuts and new work rules

New federal budget changes and work requirements are significantly impacting Medicaid enrollment across the United States. Under H.R. 1, a budget package projected to cut $1 trillion from Medicaid over the next decade, new rules require enrollees aged 19 to 64 to demonstrate participation in work, school, or volunteer programs for at least 80 hours per month to maintain coverage.

In New York, the State Department of Health estimates that at least 475,000 residents could lose coverage due to these requirements, potentially increasing the state's uninsured population by 45%. The rules also include stricter exemptions for cancer patients, who must now officially prove an inability to work rather than relying solely on a diagnosis.

In California, data from the policy group Children Now indicates a sharp decline in Medi-Cal enrollment among children. Between January and June 2025, approximately 460,000 fewer children were enrolled in the program. Experts attribute this decline to both federal funding shifts and fears within immigrant communities regarding documentation and potential deportation, which prevents eligible families from accessing healthcare services.