Will the Trump Administration Get Rid of Medicaid?
Learn about the latest Medicaid policy changes under President Trump’s 2025 executive order and learn how they could impact coverage, eligibility, and healthcare access.
Since taking office in January 2025, President Donald Trump has already made significant changes to federal policies. One major change was the cancellation of Executive Order 14009, which aimed to improve Medicaid programs and make affordable healthcare more accessible. This article will track the administration's policy changes over time that impact Medicaid and healthcare.
President Trump has instructed federal agencies to review Medicaid expansion efforts and related policies as part of his 2025 "Initial Rescissions of Harmful Executive Orders and Actions" Executive Order.
No immediate changes to Medicaid eligibility or coverage have been announced, but federal and state-level reviews could lead to adjustments in the future.
Medicaid beneficiaries should stay informed about state-level changes as these will largely determine coverage and access to care moving forward.
Medicaid in context
Medicaid is a program run by the federal and state governments to help low-income people get health insurance. It started in 1965 as part of the Social Security Act and helps pay for things like doctor visits, hospital stays, prescription drugs, and long-term care.
As of 2025, Medicaid covers 1 in 5 people in the United States, making it the country's largest public health insurance program.
Recent history of healthcare policy shifts through executive orders
Over the past decade, executive orders from both the Trump and Biden administrations have been in a tug-of-war over healthcare policy in the U.S.
An executive order is a directive issued by the President of the United States that manages the operations of the federal government. It carries the force of law but does not require approval from Congress.
In January 2025, Trump signed a new order to undo more than 70 of Biden’s policies. This could mean big changes for Medicaid, with a focus on reducing rules and cutting federal programs that focus on equality in healthcare.
President Trump made little mention of Medicaid during his 2024 presidential campaign, but his return to office has suggested he may cut federal funding for Medicaid and reduce the program's size.
Medicaid and Project 2025
Project 2025 is a plan from The Heritage Foundation, a conservative think tank, that makes policy proposals to decisionmakers in government.
Some of their key ideas about Medicaid include:
Transitioning Medicaid to block grants or per-capita caps: Giving states a fixed amount of Medicaid money instead of unlimited funding. This gives states more flexibility to tailor Medicaid programs to their needs (pro) but could lead to funding shortfalls during economic downturns or increased enrollment (con).
Limiting federal spending: Setting strict limits on how much money the federal government can spend on Medicaid. This helps control government costs (pro) but may result in reduced benefits or coverage for Medicaid recipients (con).
Encouraging market-driven healthcare solutions: Letting private insurance companies compete to offer healthcare instead of relying on government programs. This could increase innovation and competition among private insurers (pro) but may prioritize profits over access and affordability for low-income individuals (con).
These policy proposals align with President Trump's recent actions so far. If adopted, these changes could give states more flexibility but may also reduce coverage and benefits for low-income individuals.
What canceling EO 14009 means for Medicaid
Cancelling Executive Order 14009 marks a major shift and could mean the following:
States may be less likely to expand Medicaid eligibility if they lose federal funding for Medicaid expansion. As a result, millions of low-income people in states that do not expand Medicaid will not have coverage options.
Without federal programs to help people sign up for the ACA marketplace, fewer individuals may learn about it or enroll. This is especially true for those in underserved communities who have benefited from outreach efforts under EO 14009.
If there isn’t a strong federal plan to fix healthcare inequalities, ending this policy could make it harder for marginalized groups to access care.
How the Administration plans to implement this executive order
Section 3(a): Ending federal implementation of DEI ideology
What it says: Agencies must immediately stop the federal implementation of policies related to "radical DEI ideology."
What it might mean: Medicaid policies that support health equality may be reduced or removed. This includes outreach efforts to help underserved communities and attempts to lower health disparities.
Section 3(b): Review and replacement of prior actions
What it says: The Domestic Policy Council (DPC) and the National Economic Council (NEC) need to look at past federal actions. They should suggest ways to cancel, change, or improve these actions to help "increase American prosperity."
What it might mean: Policies under Biden's EO 14009 that aim to expand Medicaid and support ACA enrollment may be changed or not prioritized. Efforts to make enrollment easier and improve coverage for low-income families might be replaced with policies that focus more on saving the government money or promoting economic growth.
Section 3(c): National security memoranda review
What it says: The National Security Advisor must review documents from the previous administration to see if they harm "national security, domestic resilience, and American values."
What it might mean: Healthcare policies tied to national security, such as pandemic preparedness or global health initiatives, may be reviewed and potentially revised.
January 20,2025: President Trump’s January 20, 2025, executive order signaled a rollback of Medicaid expansion efforts and other healthcare equity initiatives. Federal agencies, including the Department of Health and Human Services (HHS), are tasked with reviewing prior policies for rescission or amendment.
January 28, 2025: The Trump administration ordered a temporary pause of federal grant and loan programs. The Administration made it clear that any program providing direct benefits to Americans would not be affected, including Social Security, Medicare, Medicaid and SNAP. A federal judge temporarily blocked the order until February 3. This block only affects government funds that have already been approved, not funds that are still being requested.
Upcoming dates
Upcoming dates: President Trump’s upcoming budget proposal will likely provide more insight into potential changes to Medicaid. Historically, the President’s budget proposal is released in early February, so we can expect to see it around then. Once the budget is released, Congress will review it and may suggest changes, but it will serve as a key indicator of the administration’s intentions for Medicaid.
Visit Congress.gov to track other Medicaid-related bills in real time.
What this means for people on Medicaid right now
No immediate changes to Medicaid eligibility have been announced. Federal agencies are currently reviewing policies, and how these changes will affect you depends on your state. States that expanded Medicaid services under the ACA might face federal funding cuts in the future, which could mean stricter rules in the future.
If you or your family rely on Medicaid waivers, like Home and Community-Based Services, there is a risk that changes in federal funding or rules could lead to fewer services, stricter eligibility requirements, or lower limits on these programs.
You can use Givers free program matching tool to find Medicaid programs with a caregiver pay option in your state to take full advantage of the support available today and plan for the future.
State-level variations
Medicaid is run differently in each state under federal rules, meaning coverage, eligibility, and funding decisions vary widely. State choices about benefits, payment rates, and how they respond to federal changes will largely determine how these shifts affect people on Medicaid.
What Medicaid beneficiaries and their families can do
While the future of Medicaid is currently uncertain, here are some things you can do to protect your coverage and access to care:
Stay informed: Follow news from trusted healthcare advocacy organizations like Families USA or Medicaid Matters.
Advocate for Medicaid: Contact your state representatives and senators to express your support for Medicaid and share your personal story.
Know your rights and options: If you receive services through a Medicaid waiver, stay in touch with your care provider or case manager to understand any potential changes and advocate for continued support.
Engage in community efforts: Join or support local organizations that advocate for healthcare equity and Medicaid preservation.
A poll from KFF Health News shows that most Medicaid enrollees and the public prefer to keep Medicaid as it is today. They prefer that the federal government guarantees coverage for low-income people, sets standards for what states should cover, and matches federal funds for state Medicaid spending as the number of people in the program changes.
Medicaid beneficiaries and their families can help shape policies that impact their access to essential healthcare services by staying informed and participating in advocacy.
Disclaimer from Givers
Givers is a non-partisan organization and does not align with any political party or ideology. This article is intended solely for educational purposes, providing information about Medicaid and recent policy developments to help readers stay informed.
