Leadership in Congress has tasked their committees with coming up with details to slash trillions of dollars in federal funding for various programs – including Medicaid. While leadership didn’t define exactly which programs to cut – they gave the various committees the task of ‘finding the money’ to cut among the executive branch agencies that they oversee.
Among the likely early proposals will be one to cut way back on the federal contributions for Medicaid coverage for what’s known as the ‘expansion population’ (in our state that’s ‘childless adults & people between 100 and 138% of poverty).
The current plan to ‘come up’ with the cuts is to reduce the federal contribution for Arizona’s expansion population from 90% to 65%, triggering automatic coverage losses under state law. The result? Approximately 550,000 Arizonans, including low-income adults and individuals earning between 100% & 138% of the federal poverty level would be left uninsured.
Interestingly, the parts of the state that voted for Mr. Trump by the widest margins are in the very areas that stand to lose the most if these cuts happen. Thirty-six percent of working-age Arizona adults who live in rural Arizona are covered by Medicaid versus 17% who live in urban areas, data from Georgetown University’s Center for Children and Families shows.
Medicaid funding cuts could put thousands of Arizonans in peril
Arizona’s existing “trigger law” means any reduction in federal funding automatically cuts coverage for these populations unless the state steps in to fill the financial gap.
And that’s where the problem lies. Arizona’s Hospital Assessment—designed to fund the state’s share of Medicaid expansion—is already at its legal limit of 6% of net patient revenue. To keep coverage, the state would need to find nearly $1 billion annually to replace the lost federal funds.
Given the Republican majority in the Arizona Legislature, which has historically opposed increasing state Medicaid funding, there’s little chance that lawmakers will allocate the necessary resources.
Without a new funding mechanism, Arizona’s Medicaid expansion will collapse, disproportionately affecting rural residents who rely on it for primary and emergency care.
Beyond the direct human cost, these cuts will place strain on Arizona’s healthcare system. Hospitals in rural areas would have a sharp rise in uncompensated care costs as uninsured patients crowd emergency rooms—often their only choice for medical treatment (care that the hospitals won’t get paid for).
This financial pressure could force some hospitals to scale back services or even shut down, further worsening the healthcare crisis in underserved communities.
Politically, the cuts are part of a broader effort to dismantle key ACA provisions, rolling back Medicaid expansion in multiple states. While some states might be able to cushion the blow by reallocating funds, Arizona’s trigger law ensures an immediate impact.
For now, advocacy groups are focusing on convincing Representative Ciscomani to be wary of going along with a change in the federal contribution to support enrollment of the expansion population. Other representatives in a few other ‘trigger’ states like ours are also being targeted for ‘education’.
We’ll see later this year if it makes any difference.
Rep. Juan Ciscomani signals doubt about Republican Medicaid cuts
