How States Can Prepare if Medicaid Funding Is Cut

Swift policy shifts have placed Medicaid funding under scrutiny since President Donald J. Trump's return to the White House, raising concerns about potential cuts that would threaten coverage for nearly 80 million Americans enrolled in Medicaid. With states like North Carolina recently expanding Medicaid, the impact of such changes extends beyond eligibility—affecting funding for social determinants of health, provider participation, and overall access to care, according to Molly Dean, MSW, policy advisor at Siftwell.

In this interview with The American Journal of Care®, Dean discusses how states can navigate these uncertainties, emphasizing the need for data-driven decision-making to safeguard both beneficiaries and health care providers from the potential ripple effects of policy shifts.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Swift policy changes accompanied President Trump's return, with talk of Medicaid cuts at the forefront. How can state policymakers prepare as key decisions hover?

I think the most important thing for states is to understand who this impacts. It's easy to talk about really high-level things, but take a state like North Carolina, for example. We have 2 Siftwell partners in North Carolina; understanding the geography of a state, understanding the rurality of a state like North Carolina—recent Medicaid expansion—we can literally see, because they are tracking it, who is benefiting in which county across the state from Medicaid expansion. Only speaking in facts here, there's a lot of conversation about adjusting federal match dollars that states are reliant on for this Medicaid expansion population.

If there is a threat to that, it's going to do 1 thing. First off, it's going to really paralyze state government—and we've seen this. We've been here before. Eight years ago we were in this exact same place, a new administration holding the majority in both seats of Congress; we've literally been here before. It creates paralysis. And so I think what you are going to see and what is going to be important for states, and particularly states who run Medicaid through managed care programs, is to understand who is impacted.

Literally understanding when you begin to take away—not only eligibility, but also we're hearing things about those who remain eligible—the investments and social determinants of health, the investments and things that we long know impact health positively or negatively whether you have it in place or not. States are going to have to figure out, 1, what matters, and 2, have a real, finite understanding of who is impacted by virtue of any potential changes with shift in Medicaid coverage. I think you've got that portion of the literal members that they have to be able to understand so that they can make informed decisions to ensure that the program is optimal for who it is working for.

On the other side of that is providers; a significant portion of the provider base that cares for Medicaid members, but they're in big hospital systems. And your traditional providers and communities, if they take Medicaid, they are reliant on the Medicaid portion of their business to stay afloat. If that is in jeopardy, we are going to see providers pull out of business, close down, or no longer accept the Medicaid population because it's too volatile to their ability to literally pay their bills. When you don't have providers willing and or able to see Medicaid members, there are vast impacts.

There are vast impacts, not only to the people, but to the community. You think about population health, you think about access in general. States are really going to need to understand the data behind who they are providing care for and the benefits that they are currently reaping under flexibilities, that many states have exercised, to provide social determinant of health–type things: housing, food. Think about the impact of that on the current membership, and taking that away will negatively impact overall health, in addition to the access issue.