If you’ve been doom-scrolling lately, you’ve probably seen the headlines. Some say Medicaid is Toast. Others claim it's just getting a "tune-up." People are genuinely scared, especially the 70-plus million Americans who rely on it for everything from insulin to nursing home care.
The short answer? No, he isn't "getting rid" of it in the sense of a total deletion. But "getting rid of" is a tricky phrase when you're talking about a trillion-dollar government program. It's not like an app you can just uninstall.
What’s actually happening is a massive, structural overhaul that fundamentally changes who gets it and how much the government pays for it.
Honestly, the "One Big Beautiful Bill" (OBBBA) signed on July 4, 2025, changed the game. It didn't kill Medicaid. It just made the door a lot harder to get through.
The Reality of the One Big Beautiful Bill (OBBBA)
Most people think Medicaid is a permanent safety net. You're poor, you're covered. Simple, right? Not anymore. The 2025 budget reconciliation—the OBBBA—introduced the first-ever federal work requirements.
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Starting January 1, 2027, "able-bodied" adults in the Medicaid expansion group have to prove they’re working, volunteering, or in school for at least 80 hours a month. If you don’t? You’re out. The Congressional Budget Office (CBO) estimates this move alone could shave $326 billion off federal spending over ten years.
That money doesn't just vanish. It comes from millions of people losing their coverage because they couldn't keep up with the paperwork or didn't meet the hour count.
Redetermination is the New Gatekeeper
Wait, it gets more technical. The law now requires states to check if you're still eligible every six months instead of once a year. Think about that. Twice as much mail. Twice as many forms to lose. Twice as many chances for a clerical error to kick a family off their health plan.
Funding Cuts or Just "Efficiency"?
There's a lot of talk about "per capita caps." This is a fancy way of saying the federal government wants to stop writing a blank check to states. Currently, if a state spends more on healthcare, the feds chip in a percentage of whatever that cost is.
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The new goal is a fixed amount. A cap.
If a new, expensive drug comes out—like those popular new weight-loss injections or a breakthrough cancer treatment—the state is on the hook for the extra cost. If the state can't afford it, they usually do one of three things:
- Cut who is eligible.
- Cut what services are covered (bye-bye dental or vision).
- Pay doctors less, which means fewer doctors will take Medicaid.
It’s a squeeze. It’s not "getting rid" of the program, but for a person who suddenly can't find a doctor within 50 miles, it sure feels like it.
The Immigration Factor
One thing nobody is talking about enough is the change to "Emergency Medicaid." The Trump administration has moved to limit federal matching funds for emergency services for people who aren't "lawfully present."
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It’s a huge shift. Hospitals are worried. When an uninsured person shows up at the ER with a life-threatening issue, the hospital has to treat them. If the federal government stops helping pay for that, the hospital eats the cost. Eventually, that cost gets passed to you in the form of higher insurance premiums or hospital fees.
What Happens Next? (Actionable Steps)
So, what should you actually do if you're on Medicaid or have a parent in a nursing home relying on it?
- Update your address TODAY. This is the number one reason people lose coverage. If the state sends a "redetermination" form to an old apartment and you don't answer, you are automatically disenrolled.
- Start a "Paperwork Folder." If you're in an expansion state (like California, New York, or even North Carolina now), you need to be ready for the 80-hour work requirement. Keep pay stubs, volunteer logs, and school enrollment records in one spot.
- Watch the "Medically Frail" status. If you have a chronic illness or disability, you might be exempt from work requirements. Make sure your doctor has clearly documented your condition in your file so you can claim this exemption when the 2027 rules hit.
- Check your state's stance. Some states are pushing back. Others are sprinting to implement these changes early. Visit your state's Department of Health and Human Services (DHHS) website to see their specific timeline for the OBBBA requirements.
The program is staying, but the "safety net" is getting much smaller holes. You have to be proactive to make sure you don't fall through them.