Some families have decided the price is too great of a financial burden and canceled their coverage.

SUGAR GROVE, N.C. — Year after year, Ross and Rebecca Tobiassen saw their healthcare costs rise, having relied on the Affordable Care Act for federally subsidized health insurance since its start in 2014. Year after year, the couple in western North Carolina kept their coverage, believing the peace of mind was worth the cost.

But in December, that changed. The Tobiassens decided to cancel their insurance when Rebecca saw the cost of their monthly premiums would jump from $130 to more than $550.

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The 2025 reconciliation law reduced federal Medicaid spending by an estimated $911 billion from 2025 through 2034, some of which stems from new restrictions on Medicaid state directed payments (SDPs) for hospital and other health care services. While states are generally prohibited from directing how managed care organizations (MCOs) pay for care, states can implement SDPs that require MCOs to increase rates or set minimum rates for specified Medicaid services. In authorizing SDPs, the Centers for Medicare and Medicaid Services (CMS) aimed to help states improve access to care and provider participation. Many states that contract with MCOs use SDPs to make uniform rate increases that function like supplemental payments in fee-for-service (FFS) Medicaid. This issue brief analyzes Medicaid spending by state on SDPs that require prior CMS approval to better understand the use of SDPs before new limits in the reconciliation law take effect. A companion issue brief provides more details about the forthcoming changes.

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The 2025 reconciliation law reduced federal Medicaid spending by an estimated $911 billion from 2025 through 2034, some of which stems from new restrictions on Medicaid state directed payments (SDPs) for hospital and other health care services. While states are generally prohibited from directing how managed care organizations (MCOs) pay for care, states can implement SDPs that require MCOs to increase rates or set minimum rates for specified Medicaid services. In authorizing SDPs, the Centers for Medicare and Medicaid Services (CMS) aimed to help states improve access to care and provider participation. Many states that contract with MCOs use SDPs to make uniform rate increases that function like supplemental payments in fee-for-service (FFS) Medicaid.

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The Trump administration has issued final rules on how states should ensure that millions of Medicaid enrollees prove they’re working or completing other activities, such as job training, volunteering, or being enrolled in an educational program.

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When Congress failed to extend the covid-era enhanced subsidies for the Affordable Care Act, many experts predicted millions of people would lose coverage because they would be unable to make payments toward the higher premiums. It has taken a few months, but that prediction seems to be coming true.

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SALT LAKE CITY — Ben Dowse hadn’t expected to treat measles when he became a doctor, but there he was, examining a newborn exposed to the virus in the womb. The infected mother had given birth just hours earlier. The hospital had alerted Dowse to the case before delivery, and he’d braced himself for the worst.

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The looming impact of federal Medicaid cuts has reignited a long-simmering, costly battle between California’s medical industry and one of its largest health worker unions.

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Nearly every Tuesday for a decade, Steve Siple attended a bar trivia night with friends in Birmingham, Alabama. After moving to North Carolina, he developed a new ritual — joining other Charlotte locals on Saturdays to pick up trash along the city’s light rail.

These are more than fun outings to Siple. They help keep him alive.

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The Trump Administration continues its focus on rooting out fraud, waste, and abuse in federal programs, including Medicaid. In March 2026, President Trump issued an Executive Order establishing the Task Force to Eliminate Fraud, chaired by Vice President J.D. Vance. In May 2026, the Centers for Medicare and Medicaid Services (CMS) announced a six-month nationwide moratoria (or pause) on the enrollment of new Medicare hospice and home health agency providers. The Department of Health and Human Services (HHS) has also taken nationwide and state-specific action in the Medicaid program, including:

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More than 1 million children have lost insurance since President Donald Trump took office in 2025. Another million could lose it amid the Trump administration’s immigration crackdown and new Medicaid eligibility rules. On WAMU’s Health Hub on June 3, KFF Health News chief Washington correspondent Julie Rovner explained how fear and confusion complicate access to health coverage.

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