Cuts to Medicaid – and Impact on People with Disabilities

President Trump’s “One Big, Beautiful Bill” could inflict harm on millions of people with disabilities.

The H.R. 1 bill, as it currently stands, would cut Medicaid by at least $600 billion, the largest single cut to the program ever.

About 72 million people – or one-fifth of people living in the United States – are currently insured by Medicaid. That includes more than 15 million people with disabilities.

The new bill, if it becomes law, would establish work requirements in order to qualify for the program for the first time ever. Currently, there is no requirement for people to work or do any kind of volunteering in order to receive Medicaid benefits. But if the new bill passes, people who qualify for the program under the Affordable Care Act would have to report at least 80 hours of work or volunteering each month in order to hold onto their benefits. The new requirements would go into effect at the end of 2026.

There are supposed to be exemptions for seniors, people with disabilities, caregivers for dependent people and pregnant people. But some decisions about how to implement the work requirements are going to be left up to individual states. For example, states could force people to report their work/volunteering monthly or every six months. And research has shown that requiring additional reporting often leads to more people losing their benefits.

“This bill asks poor and disabled Americans to pay more for medical care and imposes burdensome work requirements and bureaucratic paperwork designed to exclude people from the coverage they need,” said Deirdre Schiefeling, ACLU’s chief political and advocacy officer in a statement.

If the “One Big, Beautiful Bill” passes, millions of people would likely lose their Medicaid coverage. The Congressional Budget Office estimates that 10.3 million people would lose their Medicaid coverage by 2034. Separately, the Center for Budget Policy and Priorities estimates that up to 14.4 million people could lose their benefits in the next 10 years.

Medicaid quite literally saves people’s lives. When people lose Medicaid benefits, they are more likely to postpone medical care because of how much it costs. 

Additionally, Medicaid funds 77% of essential services for people with intellectual and developmental disabilities. Without Medicaid, many people could lose their independence and be forced into nursing homes or state-run institutions. 

Supporters of the new bill claim the changes would save money, root out waste and encourage responsibility. But executive director of Georgetown University’s Center for Children and Families, Joan Alker, says work requirements actually don’t result in more people having jobs, but rather just in fewer people having health insurance.

“If you lose your job going forward, good luck to you,” she said. “There is a good chance you’re going to be uninsured because of this bill.”

What’s the current status of the bill?

The H.R. 1 bill passed the House by just one vote on Thursday, May 22, 2025. 

Now the bill heads to the Senate. There, Senators could either approve the bill or make changes to it. If the Senators pass the bill, it would then go to the president who could sign it into law or veto it. If the Senators make any changes, the bill would then go back to the House for another vote.

Democrats, who don’t have a majority in the House or Senate, have heavily criticized the bill.

What else should we know about this bill?

The first important thing to know is that the bill exacerbates inequality. 

The bill would cut more than $290 billion from the Supplemental Nutrition Assistance Program (SNAP), which helps more than 42 million people buy groceries, according to the Agriculture Department.

And while the bill would take away $1.1 trillion worth of health benefits and food stamps from many of the country’s poorest people, it would simultaneously give $1.1 trillion in tax cuts to those who make more than $500,000 a year.

“It is a straight transfer from people who cannot afford food and medical care to people who can afford to fly first class,” Ezra Klein wrote in a New York Times op-ed.

The bill also slashes green energy subsidies, the tax credits that support wind, solar, electric vehicle and nuclear power industries.

It also supercharges spending on the military and border security, increasing risks for immigrants or other people swept up in the administration’s mass deportation efforts.

The bill would give almost $80 billion to internal immigration enforcement. That includes $45 billion for U.S. Immigration and Customs Enforcement (ICE) detention and $14.4 billion for ICE transportation and removal operations. 

“Let’s call this what it is,” Schiefeling stated in the ACLU press release. “Taking Medicaid away from sick people and low-income families in order to fund tax cuts for billionaires and turbocharge deporting immigrants who have lived, worked and raised families here for years.”

“I’ve been a policy journalist for more than 20 years,” Klein wrote in his opinion piece for the New York Times. “I’ve covered more bills than I can count. I cannot remember a more cruel or irresponsible piece of domestic legislation that has been seriously proposed.”