12 States That Will Be Hit the Hardest by Medicaid Cuts

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One of the most significant pieces of legislation of President Donald Trump’s second administration is the passing of the One Big Beautiful Bill Act (OBBBA) earlier this year. It is a massive budget reconciliation bill basically designed to prolong many of the major facets of Trump’s Tax Cuts and Jobs Act from 2017, from his first term.

Moving into 2026, many states are facing Medicaid cuts due to their large populations, reliance on the Affordable Care Act (ACA) expansion, lower incomes or recent adoption of expansion. This could be devastating for residents, as now more localized governments are facing massive funding reductions, increased uninsured rates and potential strain on hospitals, nursing homes and assisted living facilities.

Here are a dozen states that are poised to suffer the most from the Medicaid cuts. 

States Being Hit the Hardest by Medicaid Cuts

The financial burden of matching funds for noncitizens’ medical care is shifting from the federal level to state governments and hospitals. That’s particularly concerning for states with high percentages of foreign-born residents who heavily rely on Medicaid.

Currently, 12 states in America are likely most vulnerable to Medicaid cuts as featured in the OBBBA. Those states have what are known as “trigger laws” — policies in place in which Medicaid expansion would either be scaled back, end entirely if federal funding for Medicaid is cut or cause reviews that could result in cut benefits or the elimination of expansions, per HealthInsurance.org. Those states are:

• Arizona
• Arkansas
• Idaho
• Illinois
• Indiana
• Iowa
• Montana
• New Hampshire
• New Mexico
• North Carolina
• Utah
• Virginia

OBBBA vs. Medicaid

There are many provisions of the OBBBA designed to implement stricter Medicaid eligibility requirements. Here are a few key takeaways:

• OBBBA slashes $1 trillion in Medicaid funding over a decade, impacting states’ ability to maintain current coverage levels.
• There will be new verification requirements to receive Medicaid, which will be limiting to many current users. 
• It is now mandating more frequent redeterminations, which increases the number of eligibility checks, making it harder for some to maintain coverage, particularly those experiencing short-term job loss.
• There is a prohibition of Medicaid for gender-affirming care.
• It allows for narrower eligibility criteria for non-citizens, excluding certain categories like refugees and asylees. 
• Medicaid will not fund any nonprofits that assist in abortion procedures or care.
• Medicaid recipients who live above the poverty line are now forced to pay more for their coverage.

Final Take To GO

The OBBBA is aiming to truly gut Medicaid and its coverage for millions of Americans. It significantly impacts Medicaid through cuts to funding, stricter eligibility requirements and increased cost-sharing for recipients. These changes are projected to reduce Medicaid spending by $1 trillion over ten years, and this healthcare bill raises the question of what and who the Trump administration is really saving.

T. Woods contributed to the reporting for this article.

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