So, here we are in 2026, and the dust is finally settling on the "One Big Beautiful Bill Act," or H.R. 1 as the policy nerds call it. If you’ve been following the news even a little bit, you’ve probably seen the headlines. Some say the administration is saving the program from "waste and fraud," while others are basically sounding the alarm that the safety net is being shredded.
Does Trump want to cut Medicaid? Honestly, it depends on who you ask and how you define a "cut."
If you ask the White House, they’ll tell you they’re "protecting" it. During the 2024 campaign and into early 2025, the President repeatedly said he wouldn’t touch Social Security or Medicare, and he’s lumped Medicaid into that "cherish and love" category lately. But the math on the ground tells a different story. Between the OBBB Act signed last July and the new "Great Healthcare Plan" framework rolled out this month, Medicaid is undergoing its biggest transformation since the 1960s.
It’s a lot. Let's break it down.
The $1 Trillion Question: Is it a Cut or "Efficiency"?
Last year, the OBBB Act fundamentally shifted how the federal government sends money to the states. We're talking about a $1 trillion reduction in federal Medicaid spending projected over the next decade.
For the average person, that sounds like a massive cut. To the administration, it's about "incentivizing" states to be more efficient. One of the biggest shifts was sunsetting the 90% federal matching rate for ACA expansion. For years, the feds picked up almost the entire tab for low-income adults who qualified under the expansion. Now, that matching rate is dropping, which puts a massive squeeze on state budgets.
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States like North Carolina are already sweating. Just this week, state lawmakers were complaining that they don't have the time or the cash to keep up with the new federal rules. When the federal government provides less money, states have to make a choice:
- Hike taxes to fill the gap.
- Cut provider pay (meaning fewer doctors will take Medicaid).
- Kick people off the rolls.
Most experts, including the CBO, think option three is the most likely outcome for millions.
Work Requirements: The New 80-Hour Rule
This is the part that’s going to hit people’s mailboxes very soon. Starting in late 2026 and rolling into 2027, most "able-bodied" adults on Medicaid will have to prove they are working, volunteering, or in school for at least 80 hours a month.
The logic here is "community engagement." The idea is that if you're getting government help, you should be working toward self-sufficiency. Sounds simple, right? Well, the implementation is kinda messy.
Critics point to what happened in Arkansas years ago, where thousands lost coverage not because they weren't working, but because the website to report their hours was a nightmare to use. Under the new law, you’ve basically got a three-month "look-back" period. If you can’t document your hours, you’re out.
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There are exemptions, of course. If you’re "medically frail," a disabled veteran, or a parent of a kid under 13, you might be okay. But even getting those exemptions requires a mountain of paperwork. For someone working two part-time jobs with shifting schedules and no reliable internet, logging those 80 hours every single month is a tall order.
HSAs and "The Great Healthcare Plan"
Just a few days ago, on January 15, 2026, the President dropped a new "framework" he wants Congress to pass. He’s calling it "The Great Healthcare Plan."
The core idea? Instead of the government paying insurance companies or states directly, they want to put money into Health Savings Accounts (HSAs) in your name.
"The government is going to pay the money directly to you," he said in the announcement video.
It’s a very different way of looking at healthcare. It treats you like a consumer. You get the money, you shop around for the best deal, and you pay the doctor. The administration argues this will force hospitals to be transparent about their prices. No more $50 aspirins because you’ll be the one checking the receipt.
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But for Medicaid recipients, this is a radical shift. Medicaid has traditionally had very little "cost-sharing" (meaning you don't pay much out of pocket). Moving toward an HSA model with more "skin in the game" could mean that low-income families end up skipping care because they're afraid of draining their accounts.
What This Means for You (The Actionable Part)
If you or someone you know is on Medicaid, the "wait and see" approach isn't a great strategy right now. Things are moving fast.
- Check Your Paperwork: States are starting "eligibility redeterminations" with much stricter rules. Make sure your address and phone number are up to date with your local DHHS office. If they mail you a form and it goes to your old apartment, you could lose coverage automatically.
- Document Your Hours: If you're working or volunteering, start keeping a log now. Don't wait for the December 2026 deadline. Get used to having pay stubs or volunteer logs in one folder.
- Look at "Catastrophic" Plans: Under the 2026 rules, more "Catastrophic" and "Bronze" plans are being linked to HSAs. If you’re worried about losing Medicaid, these might be your fallback, especially with the new hardship exemptions that make them available to more people.
- Talk to Your Doctor: Ask if they plan to keep accepting Medicaid under the new lower reimbursement rates. Some private practices might start capping the number of Medicaid patients they see to stay afloat.
The reality is that "does Trump want to cut Medicaid" is a political question with a mathematical answer. The funding is decreasing, the rules are getting stricter, and the responsibility is shifting from the government to the individual. Whether you call that a "cut" or "reform," the result is that the program you know today won't look anything like the program of 2027.
Stay on top of your state's specific notices. Every state is handling this "One Big Beautiful Bill" differently, and your local rules are the ones that actually matter for your doctor visits.
Next Steps: You should contact your local Medicaid office today to confirm your current eligibility status and ask specifically about when the 80-hour work reporting requirement begins in your county. Keeping a physical folder of your monthly work hours starting now will save you from a paperwork nightmare later this year.