Medicaid

April 2025

Take Action for Medicaid!

National advocates are mobilizing to raise awareness about the danger of cutting Medicaid funding, and asking Congress to preserve this funding in upcoming budget negotiations. Visit these links to contact your Congressional representatives and add your voice to the call to protect Medicaid.

• Tailored for social workers: Action Center
• Scripts and social media tools: Defend Medicaid Days of Action - Families USA

Monitoring Medicaid

CLM monitors priorities and concerns for children and families, including in light of the next federal Administration's potential funding and policy changes. While impending changes to Medicaid are uncertain, Congressional Republicans have proposed a budget resolution that would include Medicaid cuts as part of the Administration's emphasis on improving program efficiency and program integrity, and eliminating "waste, fraud, and abuse." These cuts could result in:

• eliminating or severely underfunding the Affordable Care Act (ACA) Medicaid expansion coverage for low-income adults;
• weakening long-standing program protections for enrollees;
• making it harder for states to draw down federal support, like effectively eliminating states ability to tax providers; and/or
• restructuring and cutting general federal funding for the program, such as:
  • adding work requirements for adults receiving Medicaid benefits;
  • reducing the federal matching rate; and/or
  • capping federal spending.

In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth members may be able to get doctors visits, prescription drugs, hospital stays, and many other important services. Behavioral health services are more impacted by Medicaid cuts than other children and family services in the Commonwealth.

Learn more about how Massachusetts uses Medicaid funding here.

Medicaid's Significance

Overview
Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. 32.97 million children, and 88.4 million people overall, were enrolled in Medicaid as of Sept. 2023. (HHS Source).

See Medicaid/CHIP enrollment percentages by Congressional district here.

Find a table of MassHealth and ConnectorCare Enrollments by MA Congressional District here.

Benefits
There are many benefits of Medicaid, such as that it:

• provides health insurance coverage to the most vulnerable people and improves access to care.
• supports financial stability among low-income families;
• improves health outcomes;
• reduced evictions; and 
• provides additional long-term improved outcomes for children, because children with Medicaid:
  • experience fewer emergency room visits and hospitalizations,
  • do better in school and miss fewer school days due to illness or injury,
  • are more likely to finish high school, attend college, and graduate from college., and
  • earn more money as adults.

Eligibility
In order to receive federal funding, states must cover certain “mandatory” populations, including:

• children through age 18 in families with income below 138 percent of the federal poverty line ($29,974 for a family of three in 2020);
• people who are pregnant and have income below 138 percent of the poverty line;
• certain parents or caretakers with very low income; and
• most seniors and people with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program.

Covered Services
Covered services include hospital care (both inpatient and outpatient), physicians’ services, nursing home care, home health care, and certain additional services for children. States have the authority to cover other services and populations and have used that authority extensively. Moreover, many states seek and receive waivers of federal statutory limitations that allow them to provide benefits and cover groups that would otherwise be excluded.

Additional Programs
Massachusetts's 1115 waiver includes a list of the state's programs that could utilize the Designated State Health Programs (DSHPs) for funding. The state's 1115 waiver is set to expire in 2027.

On April 15, 2025 the federal Centers for Medicare & Medicaid Services (CMS) announced that it does not intend to approve new or extend existing requests for federal matching funds for state expenditures on these two types of programs — designated state health programs (DSHP) and designated state investment programs (DSIP).

Cost
Medicaid is funded jointly by the federal government and the states with the federal government covering about 65 percent of the total, depending on the year. For 2023, the Federal Government will spend an estimated $607 billion on Medicaid, which is the 65% of the total estimated spending ($934 billion). Benefits for children account for only $70 billion (15.8%).

Comparison to Medicare
Medicaid is sometimes confused with Medicare, the federally administered, federally funded health insurance program for people over 65 and some people with disabilities. There is some overlap with nearly 10 million low-income seniors and people with disabilities, known as “dual eligibles”, enrolled in both Medicare and Medicaid.

Resources

• The Truth about Waste and Abuse in Medicaid (Georgetown University McCourt School of Public Policy, 2025)
• The Massachusetts Medicaid Policy Institute (Blue Cross Blue Shield Foundation of Massachusetts)
• How Medicaid Supports parents in Crisis, Children in or Youth Aging Out of Foster Care, Relative Caregivers, and Adoptive Families (Georgetown University McCourt School of Public Policy, Center for Children & Families, 2025)
• Webinar: How Medicaid Works & What’s at Stake in 2025 (Georgetown University McCourt School of Public Policy, Center for Children & Families, 2024)
• Medicaid Threats in the Upcoming Congress (Center on Policy and Budget, 2024)
• No Medicaid Cuts: The Republican Plan for Medicaid Will Harm Kids (U.S. Senate Committee on Finance)
• Democrats Have a Winning Hand on Healthcare (presentation of voter survey data on Medicaid (Protect Our Care Coalition, 2025)