Washington — Republicans plan to slash Medicaid funding to help offset the tax cuts and new spending included in President Trump’s massive domestic policy bill. There are some differences between the approaches taken by Senate and House Republicans, making Medicaid among the most divisive issues lawmakers have had to navigate in recent months.
Staring down a self-imposed July 4 deadline to get the “big, beautiful bill” to Mr. Trump’s desk, Republican lawmakers have yet to settle their differences. The Senate version, which is still under construction in the hours before final passage, is expected to face some resistance in the House, which passed a separate version in May. No Democrats are expected to support the bill.
Medicaid cuts
About 71 million Americans are enrolled in Medicaid, according to the government’s most recent data. According to a Congressional Budget Office report published late Saturday, the changes to Medicaid and the Affordable Care Act in the Senate version would result in an increase of nearly 12 million more uninsured people by 2034.
The House-passed version would leave slightly fewer without health insurance — nearly 11 million — by 2034, mostly due to cuts to Medicaid and the Affordable Care Act, the CBO estimated earlier in June.
The Senate version makes $930 billion in cuts over a decade to Medicaid, Medicare and the Affordable Care Act, according to the CBO. The House-passed bill includes nearly $800 billion in cuts.
Work requirements
Both versions include new work requirements for the popular entitlement program that provides government-sponsored health care for low-income Americans and people with disabilities. They require adults to work, volunteer or study 80 hours a month to qualify for enrollment, unless they have an exception.
The House-passed bill includes work requirements that would apply to childless Medicaid recipients without disabilities between the ages of 19 and 64, beginning no later than 2026. There are exemptions for caregivers for dependent children or for pregnant women, among others.
The Senate version expands the House bill by requiring parents of children over the age of 14 to work.
Reporting requirements
Both the Senate and the House would require Medicaid recipients to prove their eligibility twice a year, instead of annually.
Home equity and Medicaid
Under both chambers, applicants wouldn’t qualify for Medicaid if their home equity is valued at more than $1 million, regardless of inflation. Under current law, state-determined maximum limits on home equity are between $730,000 and $1,097,000 and are indexed to inflation.
Preventing Medicaid payments to dead people
The Senate approved an amendment to move up Medicaid eligibility verification requirements, a measure aimed at preventing payments for people who are deceased. This was originally supposed to go into effect on Jan. 1, 2028, and Republican Sen. John Kennedy’s amendment moved it to Jan. 1, 2027.
Provider taxes
States can boost federal Medicaid contributions to their states through what’s known as a provider tax, often levying taxes on health care providers, which raises the overall cost of a service and therefore increases the portion reimbursed by the state.
The House measure aims to lower federal costs by freezing states’ provider taxes at current rates and prohibiting them from establishing new provider taxes.
But their Senate counterparts want to incrementally lower provider taxes from 6% to 3.5% by 2032 in states that expanded Medicaid under the Affordable Care Act. Forty states have adopted the Medicaid expansion, and under that provision, the federal government pays 90% of the costs for expansion enrollees while the states are responsible for 10%. The federal government’s portion for those covered through traditional Medicaid can range from 50% to 83%.
Senate Republicans also added a $25 billion fund to help rural hospitals after some GOP senators expressed concern about how they could be affected by the change to provider taxes.
Gender transition care
The House bill prohibits federal Medicaid funding from covering gender transition services for children and adults, including surgeries, hormone therapy and puberty blockers.
The Senate version included a similar provision, but the parliamentarian determined that it did not comply with the chamber’s rules guiding the reconciliation process, meaning it either needed to be removed or modified to be included.
Planned Parenthood funding
Conservatives have long tried to stop Planned Parenthood from receiving federal funds. The Hyde Amendment bans the use of any federal funds for abortion, but Planned Parenthood receives Medicaid money for other services.
Both versions seek to strip Planned Parenthood from receiving any Medicaid payments. The Senate version stops the payments for one year, while the House version ends them for 10 years.
Limits on retroactive coverage
Currently, states must cover Medicaid benefits retroactively for three months before an eligible individual signs up for coverage. The Senate and House bills would reduce that to one month.
Co-payments for services
For those whose incomes are over 100% of the federal poverty level, which in 2025 is $15,650 for an individual and $32,150 for a family of four, states would be required to impose co-payments of up to $35 for medical services, with some exclusions, including for primary care. Both the Senate and House bills contain this provision, but the Senate version would make exceptions for certain types of health care providers.
