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.
Major Medicaid cuts have been proposed under President Trump, including up to $800 billion in reductions and stricter eligibility requirements, but no changes have taken effect yet.
Your current coverage is still in place, and support options like caregiver pay programs remain available.
Stay informed and take action now: Use Givers’ program matching tool, talk to your case manager, and follow Medicaid news in your state to stay ahead of potential changes.
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 Office of Management and Budget (OMB) issued memo M-25-13, ordering a temporary pause on federal financial assistance activities, including Medicaid disbursements. Although the Medicaid payment portal shut down briefly, the administration stated the shutdown was unrelated to the funding freeze. A federal judge later blocked the memo, and the OMB withdrew it on January 29.
February 12, 2025: House Republicans released a budget plan to cut government spending by trillions over the next 10 years. This includes an $880 billion cut to Medicaid, the program that helps low-income people get healthcare. The budget is still being debated in Congress, and no final decisions have been made yet.
February 25, 2025: The House passes a broad Trump-endorsed budget proposal. This was a high-level blueprint laying out the administration’s overall fiscal priorities. It included $800 billion in unspecified Medicaid cuts and $4.5 trillion in tax cuts, largely signaling intent rather than triggering changes. It did not include specific implementation plans.
April 10, 2025: The House passes a targeted budget resolution focused on Energy and Commerce programs. This resolution provided specific instructions to cut $880 billion over the next decade from programs overseen by the House Energy and Commerce Committee, which controls a large portion of Medicaid spending. Unlike the February proposal, this was designed to advance budget reconciliation, a legislative process that could lead to real program changes. While still not final law, it marked a more concrete step toward cutting Medicaid and related health programs.
May 12, 2025:House Republicans introduce a Medicaid reform bill with eligibility restrictions. It included work requirements for certain Medicaid recipients, stricter income and eligibility verification, and new cost-sharing measures like modest co-pays. These provisions reflect a push to curb enrollment and reduce spending without fully eliminating coverage, but could still lead to fewer people qualifying for or maintaining Medicaid access.
May 13, 2025: The House advances President Trump’s “big, beautiful bill”, which included $5+ trillion in tax breaks and $800 billion in Medicaid cuts. The new bill aims to significantly cut federal spending on health and welfare. The Congressional Budget Office (CBO) issued a warning that the proposed changes could result in millions of people losing their health coverage. The package is still moving through the legislative process, facing hurdles in the Senate, but this marks a critical moment in advancing major changes to 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 (HCBS), it's important to be aware of ongoing policy proposals that could affect these programs. Since taking office in January 2025, the Trump administration and House Republicans have advanced multiple proposals to significantly reduce federal Medicaid funding. These proposals are still moving through the legislative process and no changes have taken effect yet.
That means:
Your current coverage and services remain in place
There’s still time to prepare and take action
Some of the proposed changes include things like:
Stricter income and eligibility checks
Work requirements for some recipients
Cost-sharing through co-pays or premiums
If passed, these changes could lead to:
Reduced waiver program funding at the state level
Longer waitlists or fewer available services
Stricter criteria to qualify for HCBS or other supports
Because Medicaid is jointly funded by federal and state governments, any reduction in federal contributions could force states to reevaluate how they operate their waiver programs, including who qualifies, how many people can be served, and which services are covered. But the outcome will depend heavily on individual state decisions and public input.
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 about your state’s Medicaid policy and any changes being discussed
Share your story with your case manager, provider, or local elected officials to make sure caregiver voices are heard
While the future of Medicaid is still taking shape, families who use waiver programs still have options and a voice. It's important to understand your benefits, speak up for what matters to you, and connect with reliable resources that can help you navigate what’s ahead.
Best places to stay informed about your state’s Medicaid policy
Your state Medicaid agency website: Each state Medicaid agency typically posts updates, proposed changes, and public notices.
State advocacy organizations: Look for non-profits or coalitions in your state that focus on healthcare access or disability rights (e.g., Families USA, Center for Public Representation, or local AARP chapters).
State legislature websites: These sites list pending bills and budget proposals. You can also sign up for alerts on topics like Medicaid or long-term care.
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.
