Nine States That Could End Medicaid Expansion if Donald Trump Cuts Funding

Medicaid under Donald Trump: The future of Medicaid expansion is uncertain in nine states due to potential federal funding cuts, which could automatically reduce health coverage. Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia have “trigger laws” that would end their Medicaid expansion programs if federal funding drops below certain levels. This could leave millions of low-income adults without health insurance.

Under the Affordable Care Act (ACA), states were allowed to expand Medicaid to cover adults earning up to 138% of the federal poverty level, which is about $20,783 for a single person in 2024. This expansion provided coverage to many who were previously ineligible.

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However, proposed cuts in federal Medicaid funding, particularly under the Trump administration, could put that coverage at risk.

Medicaid under Donald Trump: How state “Trigger Laws” could affect Medicaid expansion

“Trigger laws” are designed to automatically end Medicaid expansion if federal contributions drop. Each of the nine states has different criteria for ending the program.

For instance, Arizona’s Medicaid expansion would end if federal funding falls below 80%, while Montana would end its expansion if federal support drops below 90%, unless state lawmakers allocate additional funding to maintain it. These protections were put in place to shield state budgets from unexpected increases in Medicaid costs.

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While the ACA initially covered 100% of Medicaid expansion costs, it later reduced the federal match to 90%, meaning states must cover the remaining 10%. If federal contributions fall below the set thresholds, states would have to cut coverage or find new funding sources, which would directly affect enrollees. If Medicaid expansion is rolled back in these nine states, over three million low-income adults could lose their health insurance.

Other states like Iowa, Idaho, and New Mexico have measures that require Medicaid funding reviews but don’t automatically end the program. However, these states would still face pressure to either raise state contributions or reduce coverage.