Medicare gets the glossy brochures and the prime-time political ads, but Medicaid is the workhorse of the American healthcare system. It covers about one in five Americans. That's a staggering number of people. If you’re wondering what will be cut from Medicaid, you aren’t just looking at a line item on a spreadsheet; you’re looking at a fundamental shift in how the government handles the "unwinding" process that started after the pandemic-era protections vanished.
It's messy. Honestly, it’s a bit of a bureaucratic nightmare.
During the Public Health Emergency, states weren't allowed to kick anyone off Medicaid. It was a "continuous enrollment" deal. But that ended. Now, we're seeing millions of people lose coverage, and while some are losing it because they actually make too much money now, a huge chunk is losing it for what the experts call "procedural reasons." That's code for "the paperwork got lost in the mail" or "the website crashed."
The Reality of Procedural Disenrollment
When people ask what’s being "cut," they often think of specific benefits like dental or vision. Those are at risk too, sure. But the biggest "cut" isn't a benefit—it's the person.
KFF (formerly the Kaiser Family Foundation) has been tracking this like hawks. Their data shows that in many states, upwards of 70% of people losing their Medicaid are being dropped not because they are ineligible, but because of administrative hurdles. Think about that for a second. You could be perfectly eligible, living under the poverty line, and still lose your doctor because you didn't see a yellow envelope that was sent to an old address.
It's a silent cut.
States like Texas and Florida have seen massive drops in enrollment numbers. In some cases, these states have been criticized by the Centers for Medicare & Medicaid Services (CMS) for processing renewals too quickly or without enough outreach. On the flip side, states with more robust "ex-parte" renewals—where the state uses existing data to automatically renew you—are seeing much lower rates of coverage loss.
Optional Benefits: The First on the Chopping Block
Medicaid has "mandatory" benefits and "optional" benefits. Federal law says states must cover things like inpatient hospital stays, physician services, and X-rays. But then there's the "optional" list. This is where the actual service cuts happen when state budgets get tight.
What’s on that list?
- Dental care for adults (kids are usually protected).
- Physical therapy.
- Vision services and eyeglasses.
- Prescription drug coverage (though every state currently offers it, it's technically optional).
- Hospice care.
- Prosthetic devices.
If a state is facing a massive deficit—which happens when tax revenues dip or when the federal government scales back its matching funds—these are the things that get trimmed. We've seen this movie before. During the 2008 recession, several states slashed adult dental benefits to the bone. It took a decade for some of them to bring those benefits back.
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The weird thing about Medicaid is how much it varies by zip code. You could live in a state where your Medicaid covers a gym membership and acupuncture, or you could live across the border where you can't even get a cavity filled without paying out of pocket.
The "Work Requirement" Resurgence
Politics never sleeps.
There is a renewed push in several state legislatures to implement work requirements for Medicaid. The idea sounds simple to some: if you’re an "able-bodied" adult, you should have a job to get government health insurance. But the implementation is where it usually falls apart.
Back in 2018, Arkansas tried this. It was a disaster. Thousands of people lost coverage, not because they weren't working, but because the reporting system was so convoluted that people couldn't figure out how to log their hours. Most of these folks were already working or qualified for an exemption, but the red tape acted as a functional cut to the program.
Currently, the Biden-Harris administration has been pulling back these waivers, but with shifting political tides in 2026, many states are prepping new proposals. If these requirements pass, the "cut" won't be a specific pill or a surgery—it will be a barrier to entry that effectively reduces the number of people the program serves.
Long-Term Care and the "Home-Based" Struggle
This is the one that keeps families up at night. Medicaid is the primary payer for long-term care in the U.S. Most people think Medicare pays for nursing homes. It doesn't—at least not for long.
There is a massive waiting list for "Home and Community-Based Services" (HCBS). These programs allow seniors or people with disabilities to stay in their homes instead of being moved to a facility. When we talk about what will be cut from Medicaid, we have to talk about the funding for these waivers.
If a state doesn't increase its HCBS funding to keep up with the aging "Silver Tsunami," it's a de facto cut. The waiting lists just grow longer. In some states, people wait years—literally years—to get help with basic tasks like bathing or meal prep. It’s a brutal reality for caregivers who are burnt out and broke.
The Impact of Federal Funding Shifts
The federal government pays a percentage of every Medicaid dollar spent. This is called the FMAP (Federal Medical Assistance Percentage). During the pandemic, the feds gave states a 6.2 percentage point bump. That extra cash is gone now.
Without that "free" money from D.C., states are looking at their budgets and sweating.
When the FMAP drops, states have three choices:
- Raise taxes (unlikely).
- Take money from schools or roads (painful).
- Cut Medicaid.
Usually, they go for number three by lowering the rates they pay to doctors. If Medicaid pays a doctor $25 for a visit that costs $100 to provide, the doctor just stops seeing Medicaid patients. This is a "cut" in access. You still have the card in your wallet, but no one will take it. It's essentially "ghost insurance."
Prescription Drugs and the "Preferred" List
Keep an eye on the "Preferred Drug List" (PDL). States are getting more aggressive about which medications they will cover without a "prior authorization."
If you’re on a brand-name drug for a chronic condition, your state might suddenly decide they’ll only pay for the generic version or a different class of drug entirely. It's a cost-saving measure that feels like a massive cut to the person who suddenly has to switch medications that were working just fine.
What You Can Actually Do
Don't just wait for a letter in the mail.
First, make sure the Medicaid office has your current phone number and address. It sounds stupidly simple, but it’s the number one reason people are losing coverage right now. Check your state's "Member Portal" online. Most of them have one now, even if they're a bit clunky.
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Second, if you get a renewal packet, send it back immediately. Even if nothing has changed. Even if you think you make too much money. Sending it back preserves your right to appeal if they make a mistake.
Third, if you are disenrolled, look into the "Bridge" programs or the Healthcare.gov marketplace. Because of the way the law is structured, losing Medicaid counts as a "Qualifying Life Event," meaning you can sign up for a private plan even if it’s not the open enrollment period. In many cases, if your income is just above the Medicaid limit, you can get a Silver plan on the exchange for a very low monthly premium—sometimes $0.
Lastly, if you're a senior or helping one, look into "Dual Eligibility." Some people qualify for both Medicare and Medicaid. This "Dual" status often protects you from the worst of the cuts because it creates a safety net where one program picks up what the other drops.
The landscape of Medicaid is shifting under our feet. It’s not a static program. It’s a reflection of state priorities and federal budget battles. Staying informed isn't just about reading the news; it's about protecting your access to a doctor when you actually need one.
Actionable Next Steps for You:
- Verify Your Contact Info: Log into your state's Medicaid portal today to ensure your mailing address and cell phone number are 100% accurate.
- Check Your "Renewal Date": Find out exactly when your coverage is up for review so you aren't blindsided by a packet in the mail.
- Review Your "Summary of Benefits": Download the current year's handbook for your specific state plan to see if "optional" services like dental or physical therapy have had their limits changed.
- Gather Income Documentation: Keep your last three months of paystubs or your most recent tax return digital and ready to upload; the most common delay in renewals is missing income proof.
- Appeal if Necessary: If you receive a termination notice and believe your income is still within limits, you have a legal right to a "Fair Hearing"—request it immediately to keep your benefits active during the appeal process.