“Don’t F*%$ Around with Medicaid!”

May 30, 2025 | Vol. 29 No. 5 | Archives

Don’t F*%$ Around with Medicaid!”
Action Needed! Sign Our Letter to Urge the Senate to Protect Medicaid
Status of Statewide Medicaid Benefits for Medical Respite / Recuperative Care
Don't Forget to Register!
What (Else) Is Happening
What (Else) We’re Reading

Last Thursday, the House of Representatives passed a budget bill that includes massive cuts to Medicaid (as well as many other harmful provisions for low-income and vulnerable people). After repeatedly promising “not to touch Medicaid” and President Trump telling Republicans “don’t f*%$ around with Medicaid,” this bill includes at least $715 billion in cuts, the largest in Medicaid’s history, and would strip health coverage from 13.7 million people—with people experiencing homelessness at even higher risk for coverage loss.

Join National Health Care for the Homeless Council in sending a letter to the Senate urging them to oppose the House reconciliation bill which includes massive cuts to Medicaid and provisions that will make it harder for people experiencing homelessness to maintain coverage. View the full letter here.

Last week we released a statement on how this will disproportionately harm people experiencing homelessness. Below are eight policies that would most impact the HCH community.

Work Reporting Requirements: Starting in December 2026, all states will be required to establish “community engagement requirements” for adults aged 19-64. Participants will have to prove they engaged in at least 80 hours per month of work, community service, or education. While there are exemptions to this requirement for specific populations (disabled; medically frail; those incarcerated, pregnant, in drug treatment, or with behavioral health disorders), there will still be a need to regularly PROVE the exemption in order to remain eligible for coverage.
Address Verification: States will be required to “regularly obtain” Medicaid enrollees’ addresses and report it into a larger system--supposedly to prevent simultaneous enrollment in multiple states. Address information must come from a “reliable data source” including returned USPS mail with a forwarding address, the national change of address database, or a managed care entity or prepaid inpatient or ambulatory health plan.
Citizenship Verification Requires states to verify an individual’s citizenship status before requesting federal Medicaid funds.
Frequent Eligibility Checks: Starting December 2026, Medicaid expansion beneficiaries will have to re-verify their eligibility every 6 months as opposed to the current 12 months.
Penalties to States for Noncitizen Coverage: Mandates a 10% cut to a state’s ACA expansion reimbursement in the 34 states that cover lawfully residing children or pregnant immigrants or that use their own taxpayer dollars to offer health insurance coverage, or any form of comprehensive health benefits, to state residents regardless of their immigration status.
Out of Pocket Cost Sharing: Medicaid expansion enrollees earning over 100% of the federal poverty level will be subject to co-pays up to $35 per service or 5% of their income (although this does not apply to primary care, mental health care, or substance use disorder services).
Gender Affirming Care: Prohibits federal Medicaid funding for “gender transition procedures” for all people—both adults and minors. This includes puberty blockers, testosterone, estrogen or other androgens, medications, and any surgeries.
Retroactive Coverage Slashed: Retroactive Medicaid coverage would be cut from 90 to 30 days, leaving people (and providers) vulnerable to massive medical bills.

Impact on People Experiencing Homelessness: These policies create serious barriers to retaining coverage, putting many people experiencing homelessness at risk of losing their health insurance. Without stable housing, individuals lack consistent access to mail, phones, and the internet, making it extremely difficult to comply with work reporting, address verification, and eligibility redetermination requirements. The documentation needed to prove citizenship or continuously recertify eligibility (birth certificate, social security card, etc.) are often missing or lost and are difficult to replace (note: encampment sweeps exacerbate loss of paperwork).

More frequent eligibility checks kick people off Medicaid due to administrative issues, not eligibility factors--just as we saw during the post-COVID-19 Medicaid unwinding where 25 million people lost coverage. Given the slew of administrative paperwork being introduced to Medicaid, unhoused people will have great difficulty meeting these requirements, resulting in a massive loss of Medicaid coverage for otherwise eligible individuals.

Impact on HCH Providers: Providers will also face increased administrative burdens and should anticipate a rise in uninsured patients as more patients cycle on and off Medicaid. The administrative burden of proving work hours, exemptions, or citizenship status will fall on providers who will have to spend clinic time trying to navigate benefits rather than provide care. Cuts to retroactive coverage and challenges re-verifying patient eligibility will result in higher rates of uncompensated care and billing uncertainty. Likewise, the cost-shifting and penalties to states for non-citizen coverage will likely mean states reduce Medicaid-covered benefits, roll back covered populations, cut reimbursement rates to providers, and scale back the program in order to cover budgetary shortfalls.

Below are additional resources for a deeper dive on how these cuts impact other populations:

NEW NHCHC RESOURCE: Frequently Asked Questions: Homelessness and Medicaid: What’s the Connection?

What's the connection between homelessness and Medicaid?
How does Medicaid promote stability for people experiencing homelessness?
Why is Medicaid important for the health care safety net?
How would work requirements impact unhoused people and their providers?
What happens if Medicaid is taken away from people experiencing homelessness?

What happens next? The bill now heads to the Senate where Senators can make changes, but they won’t act unless they hear from us. Now is the time to raise our collective voice and demand what we know is best for our community: NO CUTS TO MEDICAID!

Call your Senators today and urge your friends and colleagues to do the same. Let’s flood their phones and inboxes to let them know they need to protect Medicaid.

Related Reading:

NEW NHCHC RESOURCE: Access a shareable version of this information in our new fact sheet: One Big Beautiful Bill Act: Impact on the HCH Community.

Wondering what’s going on at the state-level regarding medical respite care? We have an updated, newly interactive map showing how 20 states are pursuing statewide medical respite/recuperative care benefits!

Get started here.

Join us on Tuesday, June 11, 2025 for a conversation with Tyler Sadwith, State Medicaid Director for the California Dept. of Health Care Services along with our Senior Director of Policy, Barbara DiPietro, for a conversation about the state of Medicaid, the CalAIM Initiative, and the future of this crucial funding source for so many service providers in California. Attendees will have the option to submit questions for Mr. Sadwith to answer live.

Date: June 11, 2025
Time: 1 p.m. Pacific Time / 3 p.m. Central Time

Immigration: A federal judge blocked Trump’s Executive Order requiring proof of citizenship to vote and another ruled that the use of the Alien Enemies Act for deportations is unlawful. The Administration is working to expand the immigration detention system by building facilities on US military bases and turning mass deportations “into an efficient business like Amazon” which will make businesses richer and harm millions of immigrant families.

Housing: Housing funds have remained in limbo as DOGE chaos and administration policies are challenged in court - most recently, by King County in Washington state who is challenging the new conditions applied to previously awarded CoC grants.

“Don’t F*%$ Around with Medicaid!”

📢📢ACTION NEEDED📢📢
Sign Our Letter to Urge the Senate to Protect Medicaid

📢 Take Action on Medicaid 📢

NEW NHCHC RESOURCE: Status of Statewide Medicaid Benefits for Medical Respite / Recuperative Care

ALSO: Don’t forget to register for our conversation with California's Medicaid Director!

What (Else) Is Happening

What (Else) We're Reading

“Don’t F*%$ Around with Medicaid!”

📢📢ACTION NEEDED📢📢 Sign Our Letter to Urge the Senate to Protect Medicaid

📢 Take Action on Medicaid 📢

NEW NHCHC RESOURCE: Status of Statewide Medicaid Benefits for Medical Respite / Recuperative Care

ALSO: Don’t forget to register for our conversation with California's Medicaid Director!

What (Else) Is Happening

What (Else) We're Reading

📢📢ACTION NEEDED📢📢
Sign Our Letter to Urge the Senate to Protect Medicaid