How federal Medicaid cuts threaten women’s healthcare

Last updated: April 2026

The 2025 One Big Beautiful Big Act (H.R.1) introduced sweeping changes to the Medicaid program—stricter eligibility and verification rules, increased administrative burdens, and significantly reduced federal funds to the tune of almost $911 billion over 10 years. These changes, with some taking effect in 2026, put millions of low-income women, caregivers, long-term care residents, and women living in rural areas at increased risk of facing serious interruptions in care.

For context, nearly 1 in 5 women (25 million) in the US rely on Medicaid. It is the single largest public source of funding for family planning services, and finances care for 60% of nursing home residents.

Here's a quick summary of the changes most likely to impact women:

• Work requirements: The bill requires adults to prove they’re working, volunteering, or in school to keep Medicaid. This is optional currently. In the future, anyone who can’t prove compliance could lose coverage immediately.
• More paperwork: States will have to track and verify participants’ work hours every month, requiring more staff and/or other resources.
• Funding cuts: The stated goal is to reduce federal funding to states by $911 billion over 10 years.
• Cuts to long-term care: It reduces support for home and community care programs that older women and women with disabilities rely on, forcing some into nursing homes or leaving them without needed help.

Note: As of April 2026, changes to Medicaid are underway, including decreased funding, work requirements, and provider payment caps, among other things. A Rand study released in February captured the following changes as a result:

• 7.6 million people, including roughly 4 million women (52%), are estimated to lose Medicaid coverage by 2034.
• States that expanded Medicaid benefits previously stand to lose the most funding: from $63-$112 billion over 10 years. This includes Arizona, Iowa, Nevada, California, and New York.
• Non-expansion states, like Florida, North Dakota, and Nebraska, will experience minimal declines, primarily due to offsets from a rural health care component of the OBBBA.
• States with small relative populations (Wyoming and South Dakota) may see increases in funding due to the rural health care offsets.

Why It Matters

For the 25 million women who rely on Medicaid, these cuts will be incredibly harmful. Their options for care will dramatically decrease, forcing them to travel further, pay out of pocket, or give up some services completely - whether it's health screenings, pregnancy wellness exams, contraception or nursing home services. But there will also be collateral damage to women not on Medicaid, especially in rural areas where clinics, hospitals, and assisted living facilities are already limited. In fact, the looming cuts are already causing maternity wards to close in rural hospitals (100 since 2020) and raising alarms for states that are battling increasing infant and maternal mortality rates.

Background

Medicaid plays a central role in women’s health care in the US: it finances a large share of births (up to 40%), supports postpartum visits, covers contraception and STI care, and enables preventive screening for cancer. When Medicaid funding is interrupted or lost entirely, the ripple effects may include loss of access to essential services, delayed care, and increased health risks.

In 2018, when Arkansas briefly implemented a Medicaid work requirement, over 18,000 people lost coverage in just a few months. Studies later showed that most of them were working or should have been exempt, but they lost coverage because of confusing rules and reporting systems. The same would likely happen under a national mandate, but on a much larger scale.

The following facts might help to put the cuts and impact into a better perspective:

• Medicaid has been jointly funded by states and the federal government since 1965. Its purpose is to help low-income families and individuals access healthcare.
• From 2014-2024, Medicaid has remained relatively steady as a percent of total state spending (~16%) and federal spending that is earmarked for states (52-56%). Note the priority on Medicaid at the federal level (more than half of all state funding).
• Medicaid is the largest single payer for pregnancy-related care in the U.S..
• Over half of Medicaid spending goes to services for seniors and people with disabilities. People in rural areas are more likely to be on Medicaid than those in urban areas due to lack of other coverage options.
• Medicaid has been broadly popular with 41 out of 50 states choosing to expand access through the Affordable Care Act.
• Most non-US citizens are already ineligible for federally-funded Medicaid coverage. However, many of the qualified non-US citizens will lose coverage in 2026.

Resources

There are so many good resources out there on the history of Medicaid, spending statistics, and enrollee data, etc. The main ones are:

Pew Research Center - What the data says about Medicaid
Center on Budget and Policy Priorities - Introduction to Medicaid
KFF - Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States: Enacted Reconciliation Package
Commonwealth Fund - Medicaid Cuts Could Increase Maternal Mortality and Jeopardize Women’s Health
Center For Children and Families - Worth Repeating: Pregnant Women, Infants, Young Children are NOT Protected in Proposed Medicaid Cuts
Center on Budget and Policy Priorities - 2025 Budget Stakes: Proposals Would Harm Women
Georgetown University - The Truth About Medicaid Coverage for Immigrants – and the Looming Threats
Guttmacher Institute - The right is waging a quiet war on contraception (opinion)