Cuts, Changes To Medicaid Proposed In New Bill: What To Know In CA

CALIFORNIA — House Republicans have unveiled the cost-saving centerpiece of President Donald Trump’s “big, beautiful bill” that could have a big effect on California's more than 14 million Medi-Cal enrollees.

The GOP proposal unveiled Sunday is touching off the biggest political fight over health care since Republicans tried but failed to repeal and replace the Affordable Care Act during Trump's first term in 2017.

The latest legislation calls for at least $880 billion in cuts — largely to Medicaid — to help cover the cost of trillions of dollars in tax breaks that are part of the 2017 Tax Cuts and Jobs Act. The tax breaks are set to expire at the end of 2025, but if extended they would cost an estimated $4.5 trillion over a 10-year period.

In California, Medicaid is administered through the state's Medi-Cal program. Medi-Cal pays for a variety of medical services for children and adults in California who have limited income and resources. California seniors on Medicare who cannot afford to pay their premiums are also among Medi-Cal recipients, as are many people with disabilities.

As of November 2024, California had enrolled 14,815,950 people in Medi-Cal, according to the state's Department of Health Care Services.

Over 8 million people in California could lose their health coverage under the GOP proposal, according to the California Budget and Policy Center, a progressive think tank that advocates for programs that benefit low-income individuals, people of color, and vulnerable communities.

Nationwide, 78,532,341 people were enrolled in Medicaid and the Children's Health Insurance Program in the 50 states and the District of Columbia, according to December 2024 data from the federal government. Like Medicaid, the CHIP program provides free or low-cost health insurance to children whose families fall in certain income brackets.

Republicans insist new work and eligibility requirements are needed to root out “waste, fraud and abuse” in the Medicaid program, but Democrats warn millions of Americans will lose their health care coverage. The nonpartisan Congressional Budget Office said in a preliminary estimate that 8.6 million people would lose their health care coverage over a decade under the GOP proposal.

Republicans are planning around-the-clock hearings this week on various sections to meet House Speaker Mike Johnson’s Memorial Day deadline to pass the bill.

Senator Alex Padilla (D-Calif.) has been vocal in his opposition to potential Medicaid cuts, fearing they will harm vulnerable populations in the state. He argues that Republicans are prioritizing tax breaks for the wealthy at the expense of essential health services.

He is among the chorus of Democrats who view the potential cuts as "shameful."

“In no uncertain terms, millions of Americans will lose their health care coverage,” said Rep. Frank Pallone of New Jersey, the top Democrat on the panel. “Hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes.”

More than a dozen House Republicans have told Johnson and GOP leaders they will not support cuts to the health care safety net programs that residents back home depend on.

But they are not the GOP majority. Loyalists to President Donald Trump appear to be sticking to their guns on Medicaid cuts.

“Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans’ promise to hardworking middle-class families,” said Rep. Brett Guthrie of Kentucky, the GOP chairman of the Energy and Commerce Committee, which handles health care spending.

According to data from KFF Health News, Medicaid and CHIP recipients nationwide are a mix of people:

• 82 percent are children living below the poverty level;
• 62 percent are people living in nursing homes;
• 41 percent are pregnant women giving birth;
• 39 percent are children;
• 31 percent are non-elderly adults with disabilities;
• 19 percent are Medicare recipients.

Medicaid is a valued safety net program, according to a recent KFF poll that showed 77 percent of Americans and 84 percent of Medicaid recipients view it favorably. Nearly half (46 percent) and two-thirds of Medicaid enrollees believe the federal government isn’t spending enough on the program, according to the poll.

The road ahead is uncertain. Under the GOP proposal, to be eligible for Medicaid, there would be new "community engagement requirements" of at least 80 hours per month of work, education or service for able-bodied adults without dependents.

Most adults covered by the state's Medi-Cal program — about 3 in 5 — already work full-time or part-time, and those who don’t are mainly caring for family, ill or disabled, or going to school, according to the California Budget and Policy Center.

Under the GOP proposal, people would also have to verify their eligibility to be in the program twice a year, rather than just once.

This is likely to lead to more churn in the program and present hurdles for people to stay covered, especially if they have to drive far to a local benefits office to verify their income in person. But Republicans say it'll ensure that the program is administered to those who qualify for it.

Many states have expanded their Medicaid rosters thanks to federal incentives, but the legislation would cut a 5 percent boost that was put in place during the COVID-19 pandemic. Federal funding to the states for immigrants who have not shown proof of citizenship would be prohibited.

In recent years, Medi-Cal coverage has expanded to cover all California residents who meet income requirements. The most recent expansion was on January 1, 2024, when Medi-Cal opened to California residents regardless of immigration status.

SEE ALSO: CA’s $10B Deficit 'Precisely' Matches Undocumented Health Care Costs

Up to 1 million undocumented residents statewide may be receiving Medi-Cal, according to estimates from the UC Berkeley Labor Center. If accurate, the figure represents about 7% of all Medi-Cal recipients.

Under the GOP proposal, there would also be a freeze on the so-called provider tax that some states use to help pay for large portions of their Medicaid programs. The extra tax often leads to higher payments from the federal government, which critics say is a loophole that creates abuse in the system.

The Associated Press contributed reporting.