Fact check: How do the current administration's Medicaid policies differ from those of the previous administration?

1. A Budget Law That Reshapes Medicaid Access and Rules

The One Big Beautiful Bill Act of 2025 contains provisions that alter eligibility and administrative requirements for Medicaid, explicitly incorporating mechanisms that resemble federal work-reporting or work-requirement policies and new paperwork or verification rules that advocates warn will raise churn and disenrollment ^{[1] [4]}. Congressional and independent summaries of the 2025 reconciliation package describe both immediate statutory changes and authorization for new programmatic conditions that states can use to restrict or condition eligibility; analysts link these changes to higher administrative burdens and widened eligibility scrutiny. The law’s language also includes line items that reduce federal outlays to Medicaid over the next decade, which federal budget scorers translate into lower federal matching dollars for states and tighter state budgets, creating incentives for states to tighten enrollment practices and benefits ^{[2] [4]}.

2. Quantifying the Coverage Loss: Independent Models and Projections

Multiple modeling efforts in 2025 estimate substantial coverage losses if the new administrative and work-reporting provisions are implemented at scale, with some projections estimating roughly 11.8 million people could lose Medicaid and others modeling several million of expansion enrollees affected by a federal work requirement ^{[2] [3]}. Urban Institute–style projections cited in contemporaneous analyses show the population most at risk includes adults ages 19–55 in expansion populations, as well as children and people with disabilities indirectly affected through parental or caregiver noncompliance. These modeling studies use different assumptions about state take-up and administrative error; as a result, the range of estimated coverage losses varies widely, but all credible models point to material and nontrivial enrollment reductions tied to both funding cuts and compliance requirements ^{[3] [2]}.

3. Implementation Uncertainty and the Role of States

Although the federal law sets new parameters, the practical impact depends heavily on state-level policy choices, administrative capacity, and judicial challenges, creating significant uncertainty about final outcomes ^{[5] [4]}. Under the previous administration, Medicaid policy emphasized expansion through the Affordable Care Act and negotiated waiver flexibilities with different priorities; under the current law, states will have more incentive to adopt restrictive approaches but will face political, legal, and operational constraints. Advocacy groups warn that states with limited staffing or technology will see higher erroneous terminations, while supporters argue state discretion lets governors tailor policies to local labor markets. Courts and ongoing litigation could pause or reshape implementation timelines, meaning actual coverage impacts may be staggered and geographically uneven ^{[4] [5]}.

4. Who Bears the Burden: Vulnerable Populations Highlighted

Analysts highlight that children, people with disabilities, low-income adults, and caregivers are disproportionately at risk from the combined effects of reduced federal funding and administrative conditionality, with modeling indicating potential collateral losses when parents lose coverage or face reporting barriers ^{[2] [6]}. Research into prior work-requirement experiments and rollbacks found that even modest reporting systems create significant administrative churn, leading to coverage gaps for people who remain eligible but fail to comply or receive notices. Policy summaries emphasize that these groups have higher healthcare needs, meaning coverage losses translate directly into access and health-outcome harms unless states adopt strong safeguards, exemptions, and outreach-funded systems—measures that the funding cuts may undermine ^{[6] [2]}.

5. Contrasting With the Previous Administration: Priorities and Policy Tools

The previous administration emphasized expansion, waivers focused on access and social determinants, and limited new federal eligibility conditions, prioritizing broader enrollment and state-led innovation with less emphasis on federal work mandates; KFF and waiver-comparison reports document these differing waiver priorities ^[5]. By contrast, the current package moves toward fiscal retrenchment and conditionality, coupling reduced federal matching with statutory permission for stricter eligibility gates. This marks a substantive shift in federal Medicaid philosophy — from promoting coverage expansion and state flexibility to emphasizing budget reductions and behavioral conditions — though the pace and scale of change will be mediated by state choices, legal challenges, and administrative capacity ^{[5] [4]}.