Medicaid Cuts Have Far-Reaching Consequences in Women's Health: Alina Salganicoff, PhD

The budget bill crafted by Republican lawmakers and dubbed the One Big Beautiful Bill Act contained many changes in funding for health care services, including reductions in funding for Medicaid and the elimination of funding for Planned Parenthood, which could have sizeable effects in rural and women's health. Alina Salganicoff, PhD, senior vice president and director for women's health policy at KFF, spoke with The American Journal of Managed Care® about what these changes in the budget bill can mean for health care across the country.

Alina Salganicoff | Image credit: KFF

The budget bill passed on July 3 has added provisions to cut off Medicaid funds from Planned Parenthood. Although this has since been blocked by a federal judge, what does this mean for the future of funding of Planned Parenthood federally?

The future of many Planned Parenthood clinics is in jeopardy. Planned Parenthood, Maine Family Planning, and the attorneys general from several states are challenging the constitutionality of a provision within the 2025 Reconciliation Budget Bill. This provision blocks federal funds from going to Planned Parenthood and certain other providers for all health care services, not just abortion, for 1 year. Medicaid pays clinics for the family planning services they provide to patients but does not pay for abortion care because of the Hyde Amendment’s ban on the use of federal funds for abortions (except in the cases of rape, incest, or life endangerment). Under the new law, patients may no longer be able to use their Medicaid coverage to get care such as contraception, cancer screenings, and sexually transmitted disease testing at Planned Parenthood sites. Although a federal court ruling has temporarily blocked the law's implementation, the Trump Administration is expected to appeal the decision.

Several Planned Parenthood clinics across various states have already announced closures, and Planned Parenthood estimates that as many as 200 clinics nationwide are at risk of shutting down. If fully implemented the impact of the law will vary considerably from state to state, with some Planned Parenthood clinics serving as a significant provider of family planning services to people on Medicaid. Many of these clinics are already operating with extremely tight budgets because Medicaid reimburses providers at lower rates than private insurance and Medicare. This makes it difficult for them to withstand the 1-year duration of this funding prohibition. Moreover, there's concern that similar language could be included in future Republican reconciliation bills, prolonging the funding uncertainty.

On June 26, the Supreme Court sided with Medina in the Medina v Planned Parenthood case that allowed for South Carolina, and any other state, to withhold Medicaid funds from Planned Parenthood and other abortion clinics. What are the repercussions of this decision, especially as it pertains to Planned Parenthood’s future operation in South Carolina and other states?

The Supreme Court's ruling in Medina v Planned Parenthood South Atlantic has significantly broadened the ability of any state to exclude Planned Parenthood from participating in its Medicaid program. KFF estimates that in addition to South Carolina, at least 13 other states have attempted similar exclusions. Over the past decade, numerous efforts have sought to restrict access to and funding for Planned Parenthood clinics. Many of these clinics heavily rely on reimbursements from the Medicaid program as a primary revenue source.

During the webinar hosted by KFF on July 9, 2025, you mentioned that it is unclear what would happen if Planned Parenthoods in medically underserved and rural areas were to close due to the budget bill. Even though the effects to this are unclear, do you have an idea of the potential impacts of these budget cuts?

The closure of or cutbacks in Planned Parenthood clinics will likely have significant impacts on the communities they serve. Planned Parenthood functions as a high-volume specialty provider, offering a focused range of services to a large number of people. In many communities, Planned Parenthood is the only clinic offering reproductive health care, including contraception, sexually transmitted infection testing and treatment, abortion services, pregnancy testing, cancer screenings like Pap smears and breast exams, and other preventive services. One cannot assume that federally qualified health centers, rural health clinics, or state health departments can adequately fill the void created by a Planned Parenthood closure. Many such facilities do not offer the full spectrum of contraceptive options, operate with limited hours, or lack staff trained to provide these specialized services.

This situation is compounded by other factors. Funding for Title X, the federal family planning program, has already been temporarily withheld from numerous sites, including some Planned Parenthood grantees, and the program's long-term existence is uncertain. The president's proposed budget would eliminate funding for Title X. In addition, the implementation of Medicaid work requirements, coupled with the potential expiration of supplemental tax credits that have made Affordable Care Act coverage more affordable for millions, will likely lead to safety-net providers serving a larger proportion of uninsured patients who lack a reliable payment source. This will place further strain on the informal network of reproductive health care safety net providers.

Another aspect of the Medicaid cuts that could affect women’s health is the increased use of Medicaid in rural areas for childbirth. With the cuts to Medicaid in the budget bill, how might this coverage be affected and how can this gap be patched should these cuts to Medicaid be made permanent?

Medicaid has become a major source of coverage for millions of women and is the leading payor of maternity services in the US. When it comes to promoting healthy maternal and infant outcomes, access to health care before pregnancy is crucial. It allows individuals to optimize their overall health and address any concerns that could be exacerbated by pregnancy. KFF research has found that people start prenatal care earlier in Medicaid expansion states.

The new law will also affect rural hospitals, which are expected to experience significant financial shortfalls as a result. The Medicaid program finances almost half (47%) of all births in rural areas. The rural hospital funds allocated in the law are unlikely to sufficiently offset the anticipated financial strain many rural hospitals will face due to these changes. This could lead to closures of hospitals or maternity services and impact those in rural communities most directly.

What can state government and advocates do to address the long-term Medicaid cuts that are set to affect the country?

The impact of this complex law on low-income people, providers, health systems, and state budgets is complex and far reaching. Most people know someone who has been served by the Medicaid program, which covers 20% of people living in the United States. Moreover, the program is a major part of the economy, accounting for one-fifth of health care spending, more than half of spending for long-term care, and a large share of state budgets. Knowing what is happening in your community and communicating your experiences and concerns in real time to local, state, and federal policy makers and officials will be critical as the law is implemented.Policy is not purely data driven; it is shaped by the compelling stories and experiences of those people and organizations that are most impacted. It is important that this communication be open and fluid as health systems prepare for and implement the law.