Medicaid is the primary program providing comprehensive coverage of health care and long-term services and supports to more than 90 million low-income people in the United States. In 2023, Medicaid programs are facing new challenges and millions of enrollees are at risk of losing coverage as states unwind the continuous enrollment provision that was put in place early in the pandemic to ensure stable coverage.

This analysis examines the potential impacts on states and Medicaid enrollees of eliminating the 90% federal match rate for the Affordable Care Act (ACA) expansion. Eliminating the federal match rate for adults in the Medicaid expansion could reduce Medicaid spending by nearly one-fifth ($1.9 trillion) over a 10-year period and up to nearly a quarter of all Medicaid enrollees (20 million people) could lose coverage.

With the incoming Trump administration and Republican-led Congress looking to ways to reduce federal spending, this Poll finds that the Medicare and Medicaid programs remain broadly popular, and more people favor more spending on those programs than less spending. Among potential actions on health, the public sees price transparency and limiting chemicals in food as top priorities. Few say so about cuts to Medicaid and restrictions on abortion.

This brief discusses the potential implications of increased enforcement actions under the Trump administration for the health and well-being of families and potential broader impacts for communities, the workforce, and the economy, including health care.

Amid renewed interest in Medicaid work requirements as part of a broader legislative package designed to significantly reduce federal Medicaid spending, KFF has updated its analysis of the work status and demographic characteristics of Medicaid enrollees with the latest data. Data show that, in 2023, 92% of Medicaid adults were either working full or part-time (64%), or were not working due to barriers to work such as caregiving responsibilities, illness or disability, or school attendance — reasons that counted as qualifying exemptions from the work requirements under previous policies.

This analysis highlights USAID’s role in global health and shows that the agency provided the vast majority of the nation’s global health assistance for other countries in 2023 (about $6.2 billion or 73% of the total bilateral global health funding that year).