How Will the Big Beautiful Bill’s Changes in Medicaid Impact You?

How Will the Big Beautiful Bill’s Changes in Medicaid Impact You? 

The complex debate regarding healthcare in the United States appears to have no simple resolution in sight. Just 15 years ago, President Barak Obama signed the Affordable Care Act into law, also known as Obamacare, a consequential revamp of the US healthcare system. But the policy was mired in controversy largely because of the individual mandate requiring everyone to have healthcare insurance. This was part of broader disagreements over the federal government’s role in America’s healthcare. 

Now we’re facing uncertainty with the “Big, Beautiful Bill,” a comprehensive bill that narrowly passed through Congress in early July 2025. This is part of President Donald Trump’s efforts to enact new laws and policies primarily focused on tax cuts, including provisions for Medicaid. Those who oppose this vast bill worry about the potential impacts it will have on healthcare access, especially for the disability community.  

Medicaid and the Disability Community 

The disability community already encounters greater inequities and disparities with accessible healthcare. As an under-recognized population, our unique conditions require us to advocate for ourselves more than average citizens to ensure our needs are met. We often encounter negative misperceptions coupled with inadequate or discriminatory practices. Intentional or not, these frustrating situations can lead to difficult, lifelong struggles.  

Discourse about healthcare rights is plagued by decades of deeply contentious political and economic arguments. Disability rights advocates have spent years on the frontlines fighting to eliminate barriers that the disability community still faces today. Unfortunately, ordinary people get sidelined in these debates, with the disability community as one of the most vulnerable. Working citizens fortunate enough to obtain employer healthcare may fare somewhat better than others. But a primary source of healthcare for many is Medicaid. This joint federal and state government health insurance program helps cover medical costs for persons with disabilities, children, the elderly, and lower-income citizens, enrolling more than 70 million people.  KFF estimates approximately 15 million people with disabilities currently rely on Medicaid. If you do not have Medicaid but are thinking about applying for Medicaid, you should be able to do so and may receive Medicaid for the foreseeable future. However, there could be other options, which are provided at the end of this article. 

America’s Healthcare and the Benefits of Medicaid 

President Lyndon B. Johnson established Medicaid in 1965 to improve American lives through healthcare insurance access. Earlier efforts began with President Harry S. Truman, who requested a national health insurance plan from Congress in 1945, following President Franklin D. Roosevelt’s New Deal endeavors. In 1993, President Bill Clinton enacted reforms, giving states more control over Medicaid and welfare programs. But President Obama’s Affordable Care Act (ACA) in 2010 extended Medicaid coverage to previously excluded demographics and is considered the significant overhaul of America’s healthcare system forty-five years after President Johnson.  

For 60 years, Medicaid has been amended to continue helping Americans with limited financial means or physical and cognitive disabilities obtain equitable healthcare. Though Medicaid is administered at the federal level, it allows individual states some flexibility and control over what services it provides. Mandatory services include:  

• Inpatient and outpatient services  

• Home health services 

• Nursing facilities 

• Transportation to medical care offices 

Optional services may include coverage for:  

• Prescription drugs 

• Physical therapy  

• Speech or hearing services 

• Psychiatric services  

• Health homes for individuals with chronic conditions  

What is the Big Beautiful Bill? 

Since re-election, the Trump Administration has urged Washington lawmakers and implemented efforts to drastically reduce federal government spending. Through the big, beautiful bill, which is effectively one large spending and domestic policy bill, they aim to reduce federal government spending with approximately $4 trillion in tax cuts. Part of the GOP’s efforts is to reverse many healthcare policies that were achieved by previous administrations and reduce federal government’s support for Medicaid and the Affordable Care Act.  

Key Concerns About the Big Beautiful Bill 

The Congressional Budget Office estimates a reduction of at least $1 trillion in spending on Medicaid, putting many Americans in limbo with the potential loss of healthcare. 

Although, the Trump administration asserts that people with disabilities will not be affected by these cuts, not everyone agrees. The tax cuts will affect individuals and could affect healthcare organizations too, like rural hospitals and community health centers, from which many in the disability community rely on for healthcare services. 

Required to Work? 

One concern is a requirement to prove you are working, volunteering, or attending school for at least 80 hours a month until age 65. Though exceptions can be made for parents with children under age 14 and persons with disabilities. This change applies to states which already expanded Medicaid under the Affordable Care Act. Presently, 40 states and the District of Columbia expanded their Medicaid, covering all citizens falling below a certain household income and/or have disabilities among other eligibilities. The following 10 states opted out of Medicaid expansion: 

• Alabama 

• Florida 

• Georgia 

• Kansas 

• Mississippi  

• South Carolina  

• Tennessee 

• Texas 

• Wisconsin 

• Wyoming   

Additionally, there is a cap on taxes that states can impose on Medicaid providers. These taxes help fund rural hospitals, so a reduction or loss of tax revenue could put them at risk for closure. Lower-income citizens living in rural areas are already susceptible to inadequate healthcare access, particularly persons with disabilities, and may be jeopardized without functioning rural hospitals.  

What Can You Do? 

Much of what our elected lawmakers decide is out of our control. However, that doesn’t mean you can’t make a difference.  

• Be informed — get to know your political candidates and help elect those who care about their citizens’ well-being  

• Educate yourself — learn about federal, state, and local laws and requirements as best as possible 

• Find resources — search for organizations that can help advocate for you and others in the disability community  

Understanding your state’s Medicaid program is crucial for your own advocacy. For example, in my home state of North Carolina, basic eligibility for NC Medicaid requires: 

• Being a US citizen 

• Living in North Carolina  

• A valid Social Security number 

Next steps 

Pay attention to any important information you may receive regarding Medicaid and healthcare in the coming months. If you lose Medicaid for any reason, do not panic. You can always reapply for Medicaid and also seek alternative healthcare options, such as temporary health insurance plans, that may be available in your state.  

Remember, you are never alone in this and there is always help.  

Resources for Help 

• Federal Government Medicaid — official website of the United States government with important links and information  

• HealthCare.gov — provides a searchable database for local help where you can connect with someone by phone, email, or in-person 

• Social Security: Continued Medicaid Eligibility — criteria regarding the Social Security Act and protection and eligibility for continuing Medicaid coverage 

• State Medicaid Contact Information —- searchable database of contacts for Medicaid health services by state 

Healthcare changes like these show why advocacy matters. Support Ability Central in protecting access and amplifying disability voices by donating today.