The Trump administration has signaled a willingness to halt billions of dollars in federal health payments to multiple states, mirroring moves they made against Minnesota.

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Introduction

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The Medicaid program finances about 4 in 10 births in the U.S. Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days postpartum. After that period, some postpartum individuals may qualify for Medicaid through another pathway, but others may lose coverage, particularly in non-expansion states. To help improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act of 2021 gave states a new option to extend Medicaid postpartum coverage to 12 months via a state plan amendment (SPA). 

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Conservative lawmakers in multiple states are pushing legislation drafted by an anti-abortion advocacy group to increase protections for crisis pregnancy centers, organizations that provide some health-related services but also work to dissuade women from having abortions.

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Medicaid is the primary program providing comprehensive coverage of health and long-term care to 83 million low-income people in the United States and accounts for one-fifth of health care spending. Medicaid is jointly financed by states and the federal government but administered by states within federal rules. The recently passed House budget resolution targets cuts to Medicaid of up to $880 billion or more over a decade. While several options appear to be under consideration to significantly reduce Medicaid spending, President Trump publicly said recently about Medicaid, “We are not going to touch it. Now, we are going to look for fraud.” Speaker Johnson has said, “Medicaid is hugely problematic because it has a lot of fraud, waste, and abuse.” 

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Health care affordability is top of mind for many Americans, rising well above other necessities based on recent KFF polling.

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It’s open enrollment season for Medicare Advantage, when people currently enrolled in private managed-care plans can either sign up for a new one or switch to original Medicare through March 31.

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Medicaid is the primary program providing comprehensive health and long-term care to low-income people, including access to prescription drugs to treat acute problems and manage ongoing chronic conditions, covering about one in five people in the United States. In recent years, Medicaid spending on prescription drugs has grown substantially, in part due to the emergence of new, high-cost drugs, including GLP-1s and cell and gene therapies that treat, and sometimes cure, rare diseases.

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After years of rapid increases, Medicare Advantage enrollment growth slowed in 2025, a trend that continued in 2026. The number of Medicare Advantage prescription drug (MA-PD) plans available to the average Medicare beneficiary has declined from a peak of 36 in 2024 to 32 in 2026. Additionally, the trend of rapidly expanding extra benefits, spurred by sharp increases in rebate payments from the federal government, has stalled, with a smaller share of plans offering over-the-counter allowances and meals after hospital stays. Medicare Advantage insurers have warned that recent changes to the Medicare Advantage payment system have already hurt enrollees, leading to plan terminations, reduced benefits, and higher costs, and that these harmful effects will be exacerbated if the Trump Administration’s proposed payment rates for the 2027 plan year are finalized.

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If you judged by the more than 16,400 comments posted on a federal government website, you’d think there was a groundswell of older Americans demanding that federal officials hike payments to their Medicare Advantage health insurance plans. 

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