A mother holds her daughter while she gets a vaccine at a clinic in Texas in March. Children and adults who receive health insurance through Medicaid or the Children’s Health Insurance Program will now be subject to immigration or citizenship status checks, according to a new initiative announced this week by Robert F. Kennedy Jr., who oversees Medicaid as secretary of the U.S. Department of Health and Human Services. (Photo by Jan Sonnenmair/Getty Images)

This week, the Trump administration’s Centers for Medicare & Medicaid Services (CMS) announced an effort to check the immigration status of people who get their health insurance through Medicaid and the Children’s Health Insurance Program.

Medicaid is the public health insurance program for people with low incomes that’s jointly funded by states and the federal government. For families that earn too much to qualify for Medicaid but not enough to afford private insurance, CHIP is a public program that provides low-cost health coverage for their children.

The feds will begin sending states monthly enrollment reports that identify people with Medicaid or CHIP whose immigration or citizenship status can’t be confirmed through federal databases. States are then responsible for verifying the citizenship or immigration status of individuals in those reports. States are expected to take “appropriate actions when necessary, including adjusting coverage or enforcing non-citizen eligibility rules,” according to a CMS press release.

“We are tightening oversight of enrollment to safeguard taxpayer dollars and guarantee that these vital programs serve only those who are truly eligible under the law,” Robert F. Kennedy Jr., who oversees CMS as secretary of the U.S. Department of Health and Human Services, said in a press release announcing the new program.

As of April, roughly 71 million adults and children nationwide have Medicaid coverage, while another 7 million children have insurance through CHIP. Immigrants under age 65 are less likely to be covered by Medicaid than U.S.-born citizens, according to an analysis from health research organization KFF.

Immigrants who are in the country illegally aren’t eligible for federally funded Medicaid and CHIP. Only citizens and certain lawfully present immigrants — green card holders and refugees, for example — can qualify.

But some states have chosen to expand Medicaid coverage for immigrants with their own funds. Twenty-three states offer pregnancy-related care regardless of citizenship or immigration status, according to KFF. Fourteen states provide coverage for children in low-income families regardless of immigration status, while seven states offer coverage to some adults regardless of status.

The tax and spending package President Donald Trump last month cuts federal spending on Medicaid by more than $1 trillion, leaving states to either make up the difference with their own funds or reduce coverage. But the new law also includes restrictions on coverage for certain immigrants, including stripping eligibility from refugees and asylum-seekers.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

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U.S. Rep. Tom Tiffany speaks to voters on Jan. 27 at a listening session on the campus of UW-Eau Claire Barron County. (Henry Redman | Wisconsin Examiner)

U.S. Rep. Tom Tiffany painted a rosy picture of how the budget reconciliation law recently signed by President Donald Trump will affect Wisconsinites and pushed for state and federal policies that encourage the growth of extractive industries in the state during a telephone town hall hosted by the right-wing organization Americans for Prosperity on Tuesday evening. 

Tuesday’s event struck a far different tone from the in-person town hall hosted by U.S. Rep. Bryan Steil last week and the tour of in-person listening sessions Tiffany made across his northern Wisconsin district in the early weeks of the second Trump administration in January. 

At Steil’s event, in the much more politically mixed 1st Congressional District in southern Wisconsin, he faced a hostile crowd. And at one of Tiffany’s events in January, the crowd was made up of a mix of supporters and opponents worried about what the first weeks of Trump’s term meant for the country’s direction. 

But on Tuesday, all six questions Tiffany took came from people who expressed broad support for the Trump administration and the policies in the “One Big Beautiful Bill” passed by congressional Republicans and signed by Trump. 

Tiffany has been flirting with running for governor next year. He recently told the Milwaukee Journal-Sentinel he’d make a decision about entering the Republican primary by the end of September. 

During the phone call, the moderator, Americans for Prosperity-Wisconsin’s Megan Novak, noted that she was “seeing a lot of questions” in the queue about Medicaid but instead of letting a constituent ask the question, Novak asked if Tiffany could “clear up some of the information about what the bill actually does related to Medicaid to help protect it for the most vulnerable members of our society.” 

The Medicaid provisions in the law are among the most controversial. In an effort to cut federal spending and partially fund the cost of expanding the tax cuts passed by Republicans in 2017 during Trump’s first term, the law imposes strict work requirements on people seeking to qualify for Medicaid coverage. The nonpartisan Congressional Budget Office has estimated that the law will cause 10 million people to lose health care coverage. 

Tiffany said he doesn’t believe the estimates and added that only people without legal documentation to be in the U.S. and lazy people will lose coverage. 

“Let’s say there’s a 30-year-old young man sitting on his couch each day collecting $50,000 in benefits from you, the taxpayer,” Tiffany said. “Should you pay for their health care? I say no, and I think most people agree with that, that we should not, as taxpayers, be paying for someone’s health care when they’re able bodied and they can work.” 

There is no evidence that a large subset of 30-year-old Americans who are not working are enrolled in Medicaid. Research has shown that many Medicaid enrolled adults work for low wages at small companies and in industries with low rates of employer-provided insurance coverage. 

In his opening remarks, Tiffany said that the provisions of the Republican reconciliation package that will most benefit Wisconsinites are those that  increase spending on air traffic controllers, codify a number of Trump’s executive orders and increase mineral drilling and logging in Wisconsin and across the country. 

Throughout his career as a state legislator and member of Congress, Tiffany has been a major supporter of extractive industries. Several times during the town hall, he said the country and Wisconsin had to do more to use natural resources while deriding energy from sources such as solar and wind. 

In an answer about passing policies to bring energy costs down, Tiffany said Wisconsin had to stop “sidelining baseload power” from sources such as coal and oil. He said that the country has devoted too much effort trying to move to intermittent power sources like solar and wind and complained that China is selling wind turbines to Americans while continuing to build coal plants. 

China has continued to build coal-burning power plants and remains the world’s largest emitter of greenhouse gases, however it is also the biggest installer of green energy technology. Last month, the country installed 100 solar panels every second, the Guardian reported. 

“I believe you have to be able to utilize your natural resources to be prosperous,” he said. “You know, whether it’s forestry, mining, oil, gas, and, of course, agriculture. And I would say to you, tourism, also … and if we get rid of that red tape, we are going to be able to see more businesses created, especially in these regions where we get to utilize our natural resources.”

With the largely friendly lines of questioning, tight controls that prevented constituents from speaking and the relatively short 40-minute duration, Tiffany was under far less pressure than other Republicans at recent town halls, giving him room to promise that “we’re going to do more stuff around these lines” as the budget reconciliation package and to compare its  provisions to those passed under President Ronald Reagan in the 1980s. 

“I think much like the 1980s when we saw the seminal changes that President Reagan led with the Reagan Revolution, I think you’re going to see the same thing as a result of the ‘One Big, Beautiful bill,'” Tiffany said. “This is going to kick off a decade, a decade of prosperity if we continue to move in the direction of free markets and free people.”

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The Transporting Students with Disabilities and Special Needs (TSD) Conference in Frisco, Texas this fall looks to address the unique challenges and considerations of transporting this at-risk population.

Providing the best care for the students, empowering the transportation staff, and building an operational culture of communication and clear policies will be discussed by industry veterans, transportation consultants, and school district and bus company staff members.

In the driver training category, session topics include how to model behavior interventions in transportation settings, training for empathy of children’s needs, providing training for the service of medically fragile riders, and other proactive training educational discussions.

For upholding legal requirements and federal standards, speakers will plan to address topics such as impact of the updated National School Bus Specifications and Procedures on operations, alternative transportation, Medicaid reimbursement funding, and developing policies for proper and safe usage of student restraint and seclusion practices.

To address collaborating with contractors or other resources to aid student transportation, examples of topics include how to avoid one-size-fits-all solutions, how to create successful partnerships between school districts and contractors, and the OT/PT Transporter Forum on multidisciplinary policy development.

In addition to the hands-on training classes that cover wheelchair securement, school bus evacuations and use of child safety restraint systems on school buses, instructors from the Texas School for the Deaf will provide training for student transporters on using American Sign Language to communicate.

For a full list of 2025 TSD conference topics, visit tsdconference.com.

Save $100 on regular conference registration with Early Bird registration by Oct. 3. The TSD Conference will be held November 6-11 in Frisco, Texas at the Embassy Suites Dallas-Frisco Hotel and Convention Center. Find more information on daily agenda, unique experiences, hotel and registration at tsdconference.com

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Related: TSD Conference Registration is Open for Event in November
Related: TSD Evacuation Class Emphasizes Importance of Training
Related: (STN Podcast E236) TSD 2024 Recap: Supporting Students with Special Needs as Unique People

The post TSD Conference Topics Plan to Cover Unique Aspects of Transporting Students appeared first on School Transportation News.

First District U.S. Rep. Bryan Steil (R-Janesville) holds an in-person listening session at Elkhorn High School in Elkhorn, Wisconsin, Thursday evening July 31, 2025. (Copyright Mark Hertzberg/for Racine County Eye)

ELKHORN — At a raucous listening session in a high school auditorium Thursday evening, U.S. Rep. Bryan Steil (R-Janesville) defended the immigration and tariff policies of  President Donald Trump and the Republican budget reconciliation law that Trump signed on July 4.

From the roars of the crowd, critics of the congressman appeared to account for the majority of the group that filled nearly two-thirds of the 600-seat Elkhorn High School auditorium. But there were also recurring cheers, shouts and applause at key moments from a smaller coterie of supporters in the room.

Steil represents the 1st District in Congress, which covers Southeastern Wisconsin from Janesville and Beloit east to Racine and Kenosha on the shores of Lake Michigan.

Over the last several months, Republican members of Congress have been counseled not to hold in-person events with constituents after publicity about angry crowds turning up at some GOP town halls.

Steil’s constituents have been protesting weekly outside his office in Racine for months, calling on him to hold an in-person meeting rather than telephone ones. 

Taking the stage shortly after 5 p.m. and lasting for about 80 minutes there, Steil stuck with a cheerful, breezy tone. He treated the loud, impassioned and often angry audience cries as mostly a difference of opinion.

When an audience member asked Steil how he might take a stand against other congressional Republicans “who lie to the American public and malign the dignity of 70 million people on Medicaid by suggesting that they are lazy,” Steil lamented the tone of political discourse and vowed not to denigrate anyone. Then he turned the subject back to the boisterous auditorium.

“I’d say the overall majority of people here want to learn and understand my perspective, want to hear the question,” he said. “And then there’s a small group of people that are challenging.”

It was left to the moderator of the session, Janesville radio host Tim Bremel, to lecture the crowd to refrain from shouting over Steil’s answers during a Q&A period.

During one interruption, the radio host scolded, “Ladies and gentlemen, we will never get questions if we can’t keep the auditorium quiet. And please do the person who asked the question the respect of allowing his question to be answered.”

Pledge of Allegiance

Steil kicked off the session with the Pledge of Allegiance, inviting the audience to join him. They did so, some shouting the final words “and justice for all” with vehemence.

He followed with a short talk offering “just kind of an overview of where we’re at in this country to get ourselves back on track” — words that prompted more angry taunts.

Steil said that the nation’s spending is about “$1.8 trillion more than on the revenue side,” a comment that prompted scattered shouts scoffing at “tax breaks.”

He defended the expansion in the budget reconciliation law of work requirements for SNAP food aid, saying the change followed a model that Wisconsin had already instituted for the program in the 1990s.

When he switched to immigration and a graph that Steil said showed “the dramatic drop, the decrease that we have seen in border apprehensions,” a cry of “We are all immigrants!” came up from several rows of seats.

Nine minutes in, Steil made a pitch for his office’s constituent services, then appealed for restraint from the crowd.

“The more civil we are with each other — there’s people that have different views in here, we heard applause and boos on the border security issue, we’ve heard it a couple of times,” he said. “We have people on all sides, it’s great, that’s what makes us so great.”

Tariffs, ICE and deportation

The questions that followed came from members of the audience who filled out forms at tables in the school lobby.

Bremel told the crowd that the questioners would be chosen at random. Some greeted that claim with loud skeptical scoffs. Over the course of the hour, however, the vast majority of people who were chosen asked questions sharply critical of Steil, Trump, the Republican congressional majority, or all three.

Criticizing Trump’s tariffs, Tom Burke asked Steil “what dire economic circumstances” justified the president’s executive orders to impose them.

“What we need to do is make sure that we’re having other countries treat the United States fairly,” Steil replied, adding that the U.S. should “work collectively with our allies to address the real culprit, which is China.”

Burke wasn’t satisfied with the answer. U.S. allies, “seem to be alienated beyond belief,” he told Steil, adding that until he got a satisfactory answer to his question about their rationale, “I’m going to be totally opposed to these tariffs — period.”

Specifying that her question was about “not politics, but morality,” Jean Henderson of Elkhorn told Steil, “What I see happening to our immigrant population embarrasses me, terrifies me.”

Henderson criticized the deployment of Immigration and Customs Enforcement (ICE) personnel, their faces hidden by masks, against immigrants “who are doing the right thing by going to the immigration office,” only to be taken into custody. “It is a trap,” she said. “Why is this happening and why aren’t you stopping it?”

Steil began in reply, “What I view is the moral hazard created by the Biden administration…,” prompting a roar of disapproval from the crowd, then a shout of “Joe Biden sucks!” from someone perhaps more sympathetic to the congressman.

The rest of Steil’s response was largely drowned out.

When it was her turn at the microphone, Kelly Neuens connected the experiences of her grandparents and great aunt and great uncle, who were held in U.S. internment camps during World War II as U.S. citizens of Japanese descent, to the conditions in the El Salvador prison where the Trump administration has sent some immigrants taken into custody.

“President Trump said, ‘Homegrowns are next’ when he was speaking to the El Salvador president,” Neuens told Steil. “My worry is that we are repeating history here.”

A plea for the climate

In his answer, which was repeatedly interrupted, Steil described the World War II internment as “one of the more darker chapters of American history,” then added, “As we look at the engagement that law enforcement is doing now against immigrants who are in the country illegally, I don’t see the  exact parallel.”

Another questioner asked Steil to explain “why you support Linda McMahon and defunding the Department of Education?”

Congress, Steil said, is still “analyzing what the spending will be for the upcoming fiscal year.” He added that the department “has burdened a lot of our local school districts with unnecessary red tape” in the course of distributing funds to the states. “I think what we will see as we negotiate this going forward is a way to make sure that those funds are there” for local schools, he said.

When it was her turn to ask a question, Sharna Ahern of Fontana thanked Steil and his staff “for answering all the contacts I’ve made with you over the years.”

She enumerated a wide range of concerns she has had — about the Department of Education, about the treatment of immigrants, “about the rule of law and civil rights” — and then turned her focus on the environment.

“Extreme weather conditions are happening more frequently as we experience them,” she told Steil. “The EPA is deregulating the standards that are in place to fight climate change, to protect the citizens. Where do you stand on this issue? And how can you be an advocate for us to initiate legislation to restore our safeguards?”

Steil praised Wisconsin as “one of the most beautiful states in the country” and asserted that “making sure that we’re protecting our air and water and soil is absolutely essential.” He said that on the issue of climate change, “what we need to be doing is focused on addressing that global aspect. But again, make sure other countries are doing their fair share of it.”

The crowd largely jeered at the response. When another audience member asked about Trump’s executive orders rolling back Biden administration measures to address climate change, Steil said that action was necessary to “correct … the overreach in the previous administration.”

It was after 6 p.m. when Bremel called for the final question.

A few minutes earlier, someone had shouted a question about “children starving in Gaza,” and the woman whose turn it was asked Steil to address that topic as well as to defend the SNAP cuts.

“I can do them both,” Steil said. He started with SNAP, reiterating his earlier assertion that Wisconsin would not be affected by the program’s changes to work requirements because of policies the state had in place already.

Turning to Gaza, Steil said, “To me the easy answer to address this crisis is for Hamas to surrender and release the hostages. Release them. Israel was unfairly, unjustly attacked.”

His comments gave rise to another brief demonstration, punctuated by repeated chants of “60,000 people are dead!”

By the time the chanting ended, Steil had left the stage. 

The photos accompanying this report are not available for republishing except by agreement with photographer Mark Hertzberg. 

Earlier this month, Washington Gov. Bob Ferguson said the state would provide $11 million in funding if Planned Parenthood loses its lawsuit and federal support. There are 30 clinics in the state that serve 10,000 patients every year. (Photo by Jake Goldstein-Street/Washington State Standard)

Planned Parenthood affiliates nationwide are once again protected from a “defunding” provision passed by Congress after a federal judge in Massachusetts granted an emergency request for a new preliminary injunction.

The order from U.S. District Judge Indira Talwani, appointed by former Democratic President Barack Obama, comes one week after an initial injunction blocked only certain clinics from receiving Medicaid funds under the new law. One of the affiliates that filed the lawsuit, Planned Parenthood Association of Utah, along with affiliates that did not provide abortion services or that did not bill Medicaid more than $800,000 in fiscal year 2023 were protected, which covered a fraction of the 600 clinics nationwide.

In the weeks since President Donald Trump signed massive budget reconciliation bill H.R. 1 on July 4, the mere threat of cuts has caused clinics to close or restrict services in several states. Two clinics shut their doors in rural areas of Ohio, two closed in the Houston area of Texas, and five closed in California, according to news reports. In California alone, the Medicaid cuts would create a loss of $300 million in funding for the state’s 114 clinics that serve more than 1 million patients per year, according to CalMatters. 

In Washington state, where abortion access is legal and available until fetal viability, Gov. Bob Ferguson announced on July 9 that the state would provide the $11 million in federal funding lost if the lawsuit is unsuccessful. There are 30 Planned Parenthood clinics in Washington that serve 100,000 patients every year, and Medicaid covers about half of them, Washington State Standard reported.

The national group, Planned Parenthood Federation of America, said the initial decision was disappointing and asked the court to reconsider, which Talwani granted Monday.

Attorneys for the Trump administration appealed the initial injunction on July 23, and told the court they opposed the emergency request for a new injunction.

Planned Parenthood Federation of America and affiliates in Massachusetts and Utah sued just a few days after Congress passed the bill that included the provision the organization said directly targeted their services for Medicaid funding cuts  — a longstanding goal of anti-abortion advocates and many Republican elected officials. Federal Medicaid dollars cannot be used for abortion services except in cases of rape, incest, or certain health conditions.

The clinics rely heavily on Medicaid funding to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections, cancer screenings and contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of clinics are in rural areas or places with health care provider shortages.

In the order, Talwani said the law — part of a sweeping package of tax and spending cuts approved by a party-line vote — unfairly targets Planned Parenthood for punishment without a trial, and violates free speech constitutional rights by preventing the organization from advocating for reproductive health care.

Attorneys for the U.S. Department of Justice have argued Congress was free to target those clinics because “larger providers carry out more abortions and receive more government subsidies,” and said the law is meant to “stop federal subsidies for Big Abortion.” Talwani said those arguments were not persuasive, and that it is unlikely they can justify the defunding as part of a goal to reduce abortion.

“… it is unclear how including only entities that are non-profits and provide medical services in underserved communities is in any way related to reducing abortion. Nor is it clear how withholding Medicaid reimbursements from Planned Parenthood Members who do not provide abortion furthers that end,” Talwani wrote.

Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts, called the ruling a “powerful reminder that patients, not politics, should guide health care.”

Lee said in a statement: “In Massachusetts and beyond, we will keep fighting to ensure everyone can turn to the provider they trust, no matter their insurance or zip code.”

Editor’s note: This story was updated July 31, 2025 to correct the number of patients served annually by Planned Parenthood clinics in Washington state.

A Planned Parenthood clinic in Salt Lake City is pictured on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

This report has been updated.

WASHINGTON — A federal judge issued a preliminary injunction Monday, blocking a provision in Republicans’ “big, beautiful” law that would have barred Medicaid funding from going to Planned Parenthood for one year.

District Court Judge Indira Talwani wrote in a 36-page opinion that Planned Parenthood established “a substantial likelihood of success on their equal protection claim” since the new law “burdens” the organization’s First Amendment rights. But she limited the protections to only certain Planned Parenthood clinics.

“A preliminary injunction maintains Planned Parenthood Members’ ability to seek Medicaid reimbursements—and maintain their status quo level of service to patients,” Talwani wrote. “And an injunction requiring Defendants to continue funding Medicaid reimbursements in accordance with the status quo imposes no additional Medicaid costs on Defendants, where there is no dispute that Medicaid funds will still be provided only for reimbursable healthcare services.”

Congress has barred federal taxpayer dollars from going to abortion services with limited exceptions for decades. But GOP lawmakers used their sweeping tax and spending cuts package to eliminate Medicaid funding from going to Planned Parenthood for other types of health care, like annual physicals and cancer screenings.

The original House version of the bill included a 10-year moratorium on Medicaid reimbursements to Planned Parenthood, but that was changed to a one-year prohibition in the Senate.

Planned Parenthood filed a lawsuit challenging the new law just days after President Donald Trump signed it during a ceremony on the Fourth of July.

Talwani, who was nominated to the bench by former President Barack Obama, issued a temporary restraining order the same day the case was filed, blocking that provision’s implementation.

The Trump administration argued against the court issuing a preliminary injunction, writing in a 58-page motion submitted last week that Planned Parenthood’s “constitutional claims are utterly meritless.”

“All three democratically elected components of the Federal Government collaborated to enact that provision consistent with their electoral mandates from the American people as to how they want their hard-earned taxpayer dollars spent,” the brief states. “But Plaintiffs—Planned Parenthood Federation of America (“PPFA”) and its members (together, “Planned Parenthood”)—now want this Court to reject that judgment and supplant duly enacted legislation with their own policy preferences.”

Talwani wrote in her ruling that it would apply to “Planned Parenthood Association of Utah and other Planned Parenthood Federation of America Members who will not provide abortion services as of October 1, 2025, or for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social Security Act for medical assistance furnished in fiscal year 2023 made directly to them did not exceed $800,000.”

Planned Parenthood Federation of America, Planned Parenthood League of Massachusetts and Planned Parenthood Association of Utah — the three organizations that filed the suit — issued a written statement after the ruling that they were “disappointed that not all members were granted the necessary relief today.”

“Patients across the country should be able to go to their trusted Planned Parenthood provider for birth control, cancer screenings, and STI testing and treatment,” they wrote. “This is about patients and their right to get care — no matter their insurance. The court has not yet ruled on whether it will grant preliminary injunctive relief to other members. We remain hopeful that the court will grant this relief. There will be nothing short of a public health crisis if Planned Parenthood members are allowed to be ‘defunded.’”

The Department of Justice declined to comment whether it would appeal the preliminary injunction, though a spokesperson for the Department of Health and Human Services said it doesn’t agree with the ruling.

“We strongly disagree with the court’s decision,” HHS Director of Communications Andrew Nixon wrote in a statement. “States should not be forced to fund organizations that have chosen political advocacy over patient care. This ruling undermines state flexibility and disregards longstanding concerns about accountability.”

The Trump administration filed a notice later Tuesday it intends to appeal the preliminary injunction to the United States Court of Appeals for the 1st Circuit. 

Emma Widmar, shown with her dog Zander, has relied on Medicaid while managing complex health problems that she has had since she was 12. (Photo courtesy of Emma Widmar)

At the age of 26, Emma Widmar has been chronically ill for more than half her lifetime.

Widmar was 12 when her symptoms first showed up — severe allergies to food, hormones and her environment. At the age of 18 she qualified for Social Security disability payments as well as for Medicaid. The combined federal-state health insurance program pays for her ongoing medical care, frequent emergency room visits and necessary home care.

“I equate Medicaid to a lifeline,” Widmar says. “Some people might think that’s an exaggeration, but it isn’t. It ensures all my needs are met.”

With the enactment on July 4 of the mega-bill extending the tax cuts passed during President Donald Trump’s first term along with deep cuts in Medicaid and other safety net programs, Widmar is uncertain how her life might change.

After she graduated from Gateway Technical College, Widmar worked for four years for the Racine County Eye, an online journalism outlet. A case of respiratory syncytial virus — RSV — in January 2024 brought on severe neuropathy and hampered her breathing, forcing her to give up a job she had loved.

“I lost my ability to walk,” Widmar says. “It really wreaked havoc on my body and I couldn’t keep up.”

As complex as her health problems are, they’ve also become deeply familiar to her. 

 “It has been my life, and I simply can’t ignore it,” Widmar says. “It’s just the way that it is.”

While she and her family along with many others hope that science will one day unlock treatments for intractable illnesses such as hers, “these are chronic, lifelong conditions that right now there’s no cure for,” she says. For now, “it’s about finding the best quality of life for myself.”

Widmar lives with her parents in Mount Pleasant. Her mother is a primary caregiver.

Wisconsin’s home- and community-based care Medicaid waiver covers the cost of medications “that allow me to function,” she says.

 It also makes it possible for her to have additional home and personal caregivers. With Medicaid “those caretakers can be compensated,” Widmar says. “It ensures that I always have eyes on me and that I’m getting what I need.”

Her chronic food allergies require a special diet, with food that is more expensive than the typical grocery store purchase. Widmar’s disability has qualified her for benefits under the Supplemental Nutrition Assistance Program — SNAP, known as FoodShare in Wisconsin.

“Health care and food assistance are not just line items in a budget — they are a matter of life and death for American families,” said Sondra Goldschein, executive director of Family Friendly Economy, which campaigned against the mega-bill and shared the stories of people affected by it, including Widmar.

The bill passed despite widespread popular opposition. Widmar says she wants to encourage people “to continue voicing their opinions to policymakers, lawmakers and politicians,” not give up in resignation. “We are the ones that employ the government,” she says. “They work for us and we have to remind them of that.”

Widmar suspects most people wouldn’t consider her a typical Medicaid recipient — younger, coming from a middle-class upbringing and with a family that is able to support her. But that’s really the point: Medicaid, she observes, has helped people from all different backgrounds, regardless of class, race, ethnicity or education.

She also expects the spending cuts will ripple far beyond the Medicaid population.

“We’re altering health care as a whole, which will have an impact on everyone,” Widmar says.

For several years, the Affordable Care Act has helped drive down the number of people without health insurance. The mega-bill’s changes not just to Medicaid but also the ACA have been forecast to reverse that trend, increasing the uninsured population by 17 million over the next decade.

One Medicaid change, scheduled to take effect in 2027, will be the imposition of work requirements for some recipients. Nationally, two-thirds of Medicaid recipients already work full- or part-time, according to KFF, a nonprofit health policy research, polling and news organization, and researchers have found that some people who qualify are excluded due to paperwork problems.

Widmar has already experienced a work requirement as part of her SNAP enrollment. When her illness made work impossible, the requirement was waived.

With the extent of her current disabilities, she hopes that she would qualify for an exemption from the coming Medicaid work requirement.

She might not know for sure until late 2026, however. Wisconsin won’t be able to draw up the details of how it implements the work requirement until the publication of the federal rules, which aren’t due until next June.

In her previous experience with SNAP, Widmar said work requirements didn’t always match the realities for people with disabilities.

“Unfortunately we don’t make it easier for people who are disabled to have a job and contribute,” she says. “It’s not a system that says, ‘We have a work requirement — do what you’re able to do…’”

When she was able to work, “I loved my job,” Widmar says. Her employer was understanding and accommodated her disabilities.

That was no small matter. Because of her condition, Widmar says, she can’t be alone: Her low blood pressure can cause her to faint unpredictably. Her hours also had to be flexible to match her erratic energy levels.

“It’s difficult to work and have a disability and be on these programs,” Widmar says. “It’s like an agility course you have to go through.”

While Widmar is concerned about what lies ahead for her when the changes to Medicaid take effect, her foremost worry is for people whose lives are more difficult.

“I have a support system to help me get through it. But there’s people that don’t know where to turn for help. And it’s really unfortunate for them,” she says.

For people living at or near poverty, she sees life on the verge of becoming more harsh.

“We’re already at bare bones,” Widmar says, “and now we’re taking away more from the most vulnerable populations.”

 

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For over a decade, Wisconsin has heard the same message from Republicans regarding full Medicaid expansion: Accepting 90% federal reimbursement to cover more low-income people will only set Wisconsin up for failure if the federal government abandons its part of the deal. 

At first glance, President Donald Trump’s recently signed big bill appears to validate that argument. The 40 states that have fully expanded are now expected to lose billions of dollars in federal aid while getting tagged with additional administrative costs to create work requirements and eligibility assessments required in the bill. 

But it turns out Wisconsin is still going to be subject to the new federal mandates without the higher federal reimbursement rate that expansion states will continue to receive. In other words, at a time when the Republican-controlled federal government is supposedly pulling out the rug from expansion states, Wisconsin is still left holding the bag.

A look back

Back in 2014, then-Gov. Scott Walker and Wisconsin Republicans made the controversial decision not to accept full Medicaid expansion.

At the time, Walker explained his goal “is to get more people out into the workplace, more people covered when it comes to health care and fewer people dependent on the government, not because we’ve kicked them out, but we’ve empowered them to take control of their own destiny.”

But he also argued that the federal government would eventually pull back on its commitment to fund Medicaid at 90%.

“That commitment is not going to be there and taxpayers all across America will be on the hook,” Walker said. “They are not going to be on the hook in Wisconsin.”

At the time, Wisconsin was one of 25 states not accepting expansion. Now, the state is one of the 10 remaining holdouts, with most of the others in the deep red South. Even reliably red states, like Arkansas and Louisiana, have accepted full expansion. 

Instead of accepting full expansion, Wisconsin chose to cover individuals through BadgerCare, the state’s Medicaid-supported health insurance program for low-income residents set up by former Gov. Tommy Thompson, a Republican. 

Walker and Republicans lowered Medicaid coverage to 100% of the federal poverty line from the previous 200% and eliminated the waiting list for childless adults. Those above the poverty line without employer-sponsored insurance could purchase it through the Affordable Care Act marketplace using federal subsidies, according to the Wisconsin Policy Forum.  

But Wisconsin taxpayers are paying more to cover individuals below the poverty line: 39.3% of costs rather than 10% under full Medicaid expansion. In 2023, Medicaid accounted for 15.7% of state taxpayer spending, according to the policy forum.

Under its approach, Wisconsin doesn’t have an eligibility gap like some states, something Republicans highlight as a reason the state doesn’t need to expand.

But that has come with a loss of federal funds. Over the past decade, Wisconsin’s Department of Health Services estimates, the state has spent about $2.6 billion more to cover the costs of a partial expansion compared with the projected cost under a federal expansion.

Under an expansion, more individuals would be able to access Medicaid. But the Wisconsin Policy Forum found it would have a somewhat modest impact on coverage levels — the percentage change in Medicaid enrollees would be 7.2%, compared with nearly 30% or more in other non-expansion states. 

Work requirements still in effect under Trump bill

With the recent federal bill, Walker and other Republicans still argue Wisconsin was right not to accept federal expansion. The state is going to experience the impacts to a lesser extent than fully expanded states. 

But because Wisconsin receives federal waivers for its Medicaid program, the state is still subject to some provisions under the new law, including the work requirements, eligibility determinations and provider taxes.

Under the new work requirements, individuals covered by Medicaid are required to prove they are working 80 hours per month — parents with dependent children or people who are medically frail are exempted.

As a result, some 230,000 Wisconsin residents could lose coverage while the state incurs administrative costs to account for the new requirements, according to an estimate from U.S. Senate Democrats based on data from the Congressional Budget Office.

The work requirements don’t stop at individuals covered by Medicaid alone; it also extends to coverage through marketplace subsidies, affecting over 200,000 Wisconsin residents. 

Work requirements used to be required for Wisconsin residents to access coverage through federal waivers, but in 2021 then-President Joe Biden removed the work requirement. 

The labor force participation rate has dipped from about 68% in 2017 to a little over 65% as of May 2025 but has remained higher than the national average, which is about 62%. Some reports suggest that decline is due to the aging workforce in the state.

Work requirements have also been found to increase the uninsured rate.  

The Wisconsin Policy Forum reports that one of the main reasons work requirements may lead to higher uninsured rates is that they are confusing and time-consuming. Some people may choose to get rid of coverage altogether to avoid unnecessary paperwork. 

What could happen with the federal bill?

The Kaiser Family Foundation also found that implementing work requirements will be costly for states, costing anywhere from $10 million to over $270 million, depending on the size of the state. DHS estimates the state will pay $6 million annually to implement work requirements, while receiving a lower federal match rate than fully expanded states to reimburse for administrative costs.

With a lower federal match rate, Wisconsin has increased Medicaid funding through hospital taxes, which the new state budget just increased from 1.8% to the federal maximum of 6% for the 2025-27 biennium budget.

Republican lawmakers in the state were quick to approve the hospital tax increase, despite their previous opposition to Medicaid expansion as a means for drawing down additional federal funding. If they hadn’t, the state’s 1.8% tax would have been frozen under Trump’s big bill. The increase will raise some $1 billion more annually in federal matching funds that the state can use to pay hospitals for care they provide Medicaid patients.

States that expanded will not lose the 90% federal match rate, but those like Wisconsin that didn’t will now miss out on an additional incentive to expand created during the Biden administration.

The incentive would have raised the federal match rate to 95% for two years, but was eliminated by Trump’s big bill. Instead Wisconsin will remain at about 60% reimbursement, while still facing the same bureaucratic requirements as expansion states.

Wisconsin still losing out from not expanding Medicaid — even under Trump’s big bill is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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Wisconsin will receive an estimated $1 billion more annually in federal funds for Medicaid because the state budget includes a change that pre-empts a provision in President Donald Trump’s big bill.

Trump’s bill would have prevented Wisconsin from raising its hospital tax.

But days before Trump signed it, the Republican-led Legislature and Democratic Gov. Tony Evers approved a 2025-27 state budget that raises Wisconsin’s hospital tax from 1.8% to 6%.

The increase will raise some $1 billion more annually in federal matching funds that the state can use to pay hospitals for care they provide Medicaid patients.

Wisconsin’s largest Medicaid program is BadgerCare Plus, which provides health insurance to about 1 million low-income people age 64 and under.

Republican U.S. Rep. Derrick Van Orden, who represents western Wisconsin, claimed that Trump’s bill “secured” the $1 billion.

The bill cuts roughly $1 trillion over 10 years from Medicaid, which costs nearly $900 billion annually.

This fact brief is responsive to conversations such as this one.

Sources

• Wisconsin Hospital Association: WI State Budget Bill Includes Historic Medicaid Rate Increase for Hospitals
• Milwaukee Journal Sentinel: Derrick Van Orden claims credit for Wisconsin's extra Medicaid dollars after voting to cut the program
• Milwaukee Journal Sentinel: Ron Johnson laments Wisconsin's reach for Medicaid funds, spurred by the Trump bill he voted for
• Wisconsin Department of Administration: Wisconsin Health Services Department budget
• Wisconsin Legislature: Health Services budget
• Wisconsin Department of Health Services: BadgerCare Plus
• Wisconsin Department of Health Services: BadgerCare Plus
• X: Derrick Van Orden post
• Axios: Trump's spending bill cuts Medicaid: Here's what it's called in your state
• Kiplinger: What to Know About New Medicaid Cuts: Is Your Local Hospital Closing Soon?
• Wisconsin Watch: Have millions of nondisabled, working-age adults been added to Medicaid?

Does Donald Trump’s big bill provide an additional $1 billion annually for Wisconsin’s Medicaid program? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

A Planned Parenthood clinic in Salt Lake City, Utah, is pictured on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

WASHINGTON — The federal government cannot withhold Medicaid funding from Planned Parenthood for at least the next two weeks, after a district court judge issued a temporary restraining order the same day the organization filed a lawsuit.

Republicans included language in their “big, beautiful bill” that would block Medicaid payments from going to Planned Parenthood for the next year, a move that would effectively prevent enrollees in the state-federal health program for lower income people from visiting any of its clinics for routine health care.

The ban began when President Donald Trump signed the bill into law on Friday.

Congress already bars federal funding from going to abortion services with limited exceptions.

Planned Parenthood filed a lawsuit over the change in federal law Monday in U. S. District Court for the District of Massachusetts and quickly requested the temporary restraining order, which was issued later that day.

The suit alleges Planned Parenthood was singled out “in order to punish them for lawful activity, namely advocating for and providing legal abortion access wholly outside the Medicaid program and without using any federal funds.”

The filing also says more than 1 million Medicaid enrollees go to Planned Parenthood in a given year and that the organization received more than one-third of its total aggregate revenue from Medicaid reimbursement during fiscal year 2023. 

District Court Judge Indira Talwani’s brief two-page temporary restraining order called on the Trump administration to file a status update later this week. And she set an in-person hearing later this month to hear from Planned Parenthood and the Trump administration.

Talwani was nominated to the bench by former President Barack Obama.

The Trump administration has yet to file any documents in the case and the Department of Health and Human Services did not immediately respond to a request for comment from States Newsroom about the judge’s temporary restraining order. 

Attorney General Pam Bondi indicated during a Cabinet meeting Tuesday afternoon that the Department of Justice plans to challenge the temporary restraining order.

“Absolutely, yes. We’re on it,” Bondi said.  

Planned Parenthood Federation of America, Planned Parenthood League of Massachusetts and Planned Parenthood Association of Utah — the three groups that filed the lawsuit — wrote in a statement they were “grateful that the court acted swiftly to block this unconstitutional law attacking Planned Parenthood providers and patients.

“Already, in states across the country, providers and health center staff have been forced to turn away patients who use Medicaid to get basic sexual and reproductive health care because President Trump and his backers in Congress passed a law to block them from going to Planned Parenthood. There are no other providers who can fill the gap if the ‘defunding’ of Planned Parenthood is allowed to stand. The fight is just beginning, and we look forward to our day in court.”

Planned Parenthood has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of a provision in the massive budget bill signed by President Donald Trump last week. (Photo by McKenzie Romero/Utah News Dispatch)

Days after President Donald Trump signed a massive budget bill, attorneys for Planned Parenthood Federation of America and its state members in Massachusetts and Utah filed a lawsuit Monday challenging a provision they say will affect more than 1 million patients who use their clinics across the U.S.

Planned Parenthood says if the defund provision stands, those targeted will be patients who use Medicaid as their insurance at its centers for services including birth control and cancer screenings. The organization says it only uses federal Medicaid funding for abortion in the very narrow cases allowed, including rape, incest, and to save a pregnant person’s life.

The complaint, filed in U.S. District Court of Massachusetts against U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Medicaid and Medicare administrator Dr. Mehmet Oz, challenges a provision on page 597 of the reconciliation bill. It prohibits Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $800,000 in federal and state Medicaid funding in fiscal year 2023. That prohibition will last one year from the date the bill was signed.

While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics. The entire organization has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of the change in the law.

“This case is about making sure that patients who use Medicaid as their insurance to get birth control, cancer screenings, and STI testing and treatment can continue to do so at their local Planned Parenthood health center, and we will make that clear in court,” said Planned Parenthood Federation of America president and CEO Alexis McGill Johnson in a public statement.

The organization identified 200 of its clinics in 24 states that are at risk of closure with the cuts, and said nearly all of those clinics — 90% — are in states where abortion is legal. In 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. Because of that, some reproductive health advocates have called it a backdoor nationwide abortion ban.

The nonprofit also warned that eliminating Planned Parenthood centers from the Medicaid program would likely also impact patients who use other forms of insurance, if centers are forced to cut their services or close. 

Planned Parenthood argued this section of the bill is unconstitutional because it specifies and punishes them, saying it violates equal protection laws and qualifies as retaliation against free speech rights. 

“The Defund Provision is a naked attempt to leverage the government’s spending power to attack and penalize Planned Parenthood and impermissibly single it out for unfavorable treatment,” the complaint says. “It does so not only because of Planned Parenthood members’ long history of providing legal abortions to patients across the country, but also because of Planned Parenthood’s unique role in advocating for policies to protect and expand access to sexual and reproductive health care, including abortion.”

The complaint also details numerous instances when Trump said he was committed to defunding Planned Parenthood in 2016 and 2017, during his first presidential term, and it highlighted the provisions of Project 2025 that called for the defunding of Planned Parenthood. Project 2025 is the blueprint document drafted by the conservative Heritage Foundation, and the administration has followed many of its directives so far.

According to the lawsuit, Planned Parenthood members have “structural independence,” meaning no member “has control over the operations or decision-making processes of another.” It’s argued in the complaint that 10 members, including plaintiff Planned Parenthood Association of Utah, don’t meet the definition of prohibited entity under the new law, because they do not provide abortion services or did not receive over $800,000 in Medicaid funds during fiscal year 2023. They say these members are not “affiliates, subsidiaries, successors, or clinics” of any prohibited entity because they are separately incorporated and independently governed.

“But these Non-Qualifying Members can take no comfort in the plain text of the statute,” reads the lawsuit. “Defendants will willfully misinterpret the statute to disqualify them from receiving federal Medicaid funding, based solely on their association with PPFA and other Planned Parenthood Members.”

“As the Trump administration guts our public health care system, we know millions will suffer and struggle to get care. We will not tolerate these attacks,” said Shireen Ghorbani, interim president of Planned Parenthood Association of Utah, in a statement. “For over 55 years, we have proudly cared for generations of Utahns, and we will always find ways to meet the health care needs of our communities. Here in Utah, we are used to politicians trying to strip away our rights for political gain. We haven’t backed down before, and we won’t now.”

Defunding will harm general wellness, not abortion care, Arizona clinic owner says

Planned Parenthood also noted in its complaint that the harms could be especially devastating because “even where alternative providers are theoretically available, those providers, who are already stretched to capacity, often do not offer the same comprehensive sexual and reproductive health service options, have long wait times for patients, and cannot accommodate the huge influx of patients who would need to find a new provider of care.”

Some clinics that operate independently of Planned Parenthood will be affected by the law as well. George Hill, president and CEO of Maine Family Planning, said they receive nearly $2 million from Medicaid funds (MaineCare) on a yearly basis, and about half of their patients are enrolled in some form of Medicaid. Hill said they plan to sue as well, but the timing is uncertain at this point. Abortion care makes up about 15% of their overall services, while the rest is routine gynecological and preventative health care, he said.

In the meantime, Hill plans to solicit as much support as possible from individual donors to keep the doors to their 19 clinics open and serving Medicaid patients.

“Whether or how long we’ll be able to do that is another question,” Hill said.

In Arizona, Dr. DeShawn Taylor operates the independent clinic Desert Star Institute for Family Planning. About 75% of the services at Desert Star are abortion related, and while Medicaid (AHCCCS in Arizona) dollars can’t be used for the procedure, Taylor said they could often at least get the initial consultation appointment covered by Medicaid.

The cuts that are coming, Taylor said, will not stop people from obtaining an abortion somehow. But there will be other downstream effects.

“People are already economically depressed,” she said. “What we’re going to see is people are still going to do what’s necessary to get (abortion) care, but what’s going to fall off is their ability to get their preventative care, their contraception, their wellness exams, those types of things.”

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We’ve learned a bit about American society amid the rhetoric over President Donald Trump’s “big beautiful bill.” For example, unauthorized immigrants don’t get Medicaid, but millions of working-age adults have gone on it. We’ve also knocked down some false claims about the bill along the way.

As of July 3, the nearly 900-page measure, filled with tax breaks and spending cuts, had moved toward passage but was still being debated in Congress.

Wisconsin Watch fact briefs have cleared up misstatements about the bill itself and about programs it would cut, such as Medicaid and food stamps.

Note: Our fact briefs answer a factual question yes or no based on the facts available when the brief is published.

Here’s a look.

Would the ‘big beautiful bill’ provide the largest federal spending cut in US history?

No.

The largest-cut claim was made by Republican U.S. Rep. Scott Fitzgerald, who represents part of southeastern Wisconsin. His office cited a $1.7 trillion claim made by the Trump administration.

Even if the net cut were $1.7 trillion, it would be second to a 2011 law that decreased spending by $2 trillion and would be the third-largest cut as a percentage of gross domestic product, according to the Committee for a Responsible Federal Budget.

But when Fitzgerald made his statement, the bill’s net decreases were $1.2 trillion, after taking its spending increases into account, and $680 billion after additional interest payments on the debt.

Have millions of nondisabled, working-age adults been added to Medicaid?

Yes.

Millions of nondisabled working-age adults have enrolled in Medicaid since the Affordable Care Act expanded eligibility in 2014.

Medicaid is health insurance for low-income people.

The nonpartisan Congressional Budget Office estimated that in 2024, average monthly Medicaid enrollment included 34 million nonelderly, nondisabled adults — 15 million made eligible by Obamacare.

Republican U.S. Rep. Tom Tiffany, who represents most of northern Wisconsin, complained about “able-bodied” adults being added, saying they are “draining” Medicaid.

The nonpartisan health policy organization KFF said 44% of the working-age adults on Medicaid, some of whom are temporarily disabled, worked full time and 20% part time, many for small companies, and aren’t eligible for health insurance.

Are unauthorized immigrants eligible for federal Medicaid coverage?

No.

Unauthorized immigrants are not eligible for traditional, federally funded Medicaid and have never been eligible.

Fourteen states, excluding Wisconsin, use state Medicaid funds to cover unauthorized immigrants. 

Trump’s bill proposed reducing federal Medicaid funds to those states.

Opponents of the bill, including Democratic U.S. Rep. Mark Pocan, who represents the Madison area, said Trump administration officials claimed that unauthorized immigrants receive traditional Medicaid.

Do half the residents in one rural Wisconsin county receive food stamps?

Yes.

In April, 2,004 residents of Menominee County in northeast Wisconsin received benefits from the federal Supplemental Nutrition Assistance Program (SNAP).

That’s about 46% of the county’s 4,300 residents.

SNAP, formerly known as food stamps and called FoodShare in Wisconsin, provides food assistance for low-income people.

Menominee County’s rate was cited by U.S. Sen. Raphael Warnock, D-Ga., at the Wisconsin Democratic Party convention. He commented on the bill’s provision to remove an estimated 3.2 million people from SNAP, according to the nonpartisan Congressional Budget Office.

Is Donald Trump’s megabill projected to add more than $2 trillion to the national debt?

Yes.

Nonpartisan analysts estimate that the “big beautiful bill” would add at least $2 trillion to the national debt over 10 years.

The debt, which is the accumulation of annual spending that exceeds revenues, is $36 trillion.

U.S. Rep. Gwen Moore, D-Milwaukee, and U.S. Sen. Ron Johnson, R-Wis., claimed the bill would add trillions.

Among other things, the bill would make 2017 individual income tax cuts permanent, add work requirements for Medicaid and food assistance, and add funding for defense and more deportations.

After we published this brief, the Senate passed a version of the bill that would increase the debt by $3.3 trillion.

Would ‘the vast majority’ of Americans get a 65% tax increase if the GOP megabill doesn’t become law?

No.

Most Americans would not face a tax increase near 65% if Trump’s 2017 tax cuts are not extended under the bill.

The tax cuts are set to expire Dec. 31. 

The Tax Foundation estimates that if the cuts expire, 62% of taxpayers would see a tax increase in 2026. The average taxpayer’s increase would be 19.4% ($2,955).

GOP U.S. Rep. Derrick Van Orden, who represents western Wisconsin, made the 65% claim. 

Do you have questions about this bill and how it affects Wisconsin? Submit them here, through our Ask Wisconsin Watch project.

Here are 6 claims about Donald Trump’s big bill — and the facts is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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Millions of nondisabled working-age adults have enrolled in Medicaid since the Affordable Care Act expanded eligibility in 2014.

Medicaid is health insurance for low-income people.

The nonpartisan Congressional Budget Office estimated that in 2024, average monthly Medicaid enrollment included 34 million nonelderly, nondisabled adults – 15 million made eligible by Obamacare.

Two smaller estimates used U.S. Census survey data.

The White House Council of Economic Advisers said there were 27 million nondisabled working-age (age 19-64) Medicaid recipients in 2024.

That’s similar to the 26 million for 2023 estimated by the nonpartisan health policy organization KFF. That figure includes people who are disabled.

KFF said 44% worked full time and 20% part time, many for small companies, and aren’t eligible for health insurance.

Medicaid costs nearly $900 billion annually, two-thirds from the federal government, one-third from the states.

Forty states, excluding Wisconsin, adopted the Obamacare Medicaid expansion.
Congress is considering President Donald Trump’s proposal adding work requirements for Medicaid.

This fact brief is responsive to conversations such as this one.

Sources

• KFF: The Affordable Care Act 101
• U.S. Health and Human Services Department: What’s the difference between Medicare and Medicaid?
• Congressional Budget Office: Medicaid June 2024
• White House Council of Economic Advisers: Medicaid Community Engagement Requirements and the Value of Work
• KFF: Understanding the Intersection of Medicaid and Work: An Update
• Medicaid and CHIP Payment and Access Commission: Medicaid Spending by State, Category, and Source of Funds, FY 2023 (millions)
• KFF: 5 Key Facts About Medicaid Expansion

Have millions of nondisabled, working-age adults been added to Medicaid? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

U.S. Senate Majority Leader John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C.  after a meeting with President Donald Trump. (Photo by Anna Moneymaker/Getty Images)

This report has been updated.

WASHINGTON — President Donald Trump on Thursday told his supporters to call members of Congress and lobby them to support the “big, beautiful bill,” a crucial push with just days to go before a self-imposed Fourth of July deadline.

Trump’s plea follows several tumultuous days on Capitol Hill as GOP leaders struggled to find consensus on multiple policy disagreements, especially after the parliamentarian ruled core elements of the package don’t meet the complex rules for moving a budget reconciliation bill.

Trump during an event in the White House’s East Room that was attended by several GOP lawmakers also cautioned Republicans against voting down the tax and spending cut package.

“We don’t want to have grandstanders,” Trump said. “Not good people. They know who I’m talking about. I call them out. But we don’t need grandstanders. We have to get our country back and bring it back strong.”

Some Republican senators remain optimistic they can work through the weekend and that the House votes will come together next week, despite growing opposition from members in that chamber.

Sen. Eric Schmitt said he doesn’t think the parliamentarian’s rulings will delay the votes “outside the weekend window, which has been the goal all the time.”

“We’re probably voting into the weekend, though. That’s probably my guess — Saturday and I suppose even Sunday — but, that’s the goal, I don’t think that materially changes too much,” the Missouri Republican said.

Senate Majority Leader John Thune, R-S.D., however, appeared a bit less definite, telling reporters in the afternoon that he didn’t know when the chamber would take the procedural vote that kicks off floor consideration.

“I’ll get back to you on that,” he said.

Medicaid provisions tossed

Earlier Thursday, Senate Republicans suffered a significant setback when the parliamentarian ruled several changes to Medicaid in the bill don’t comply with the rules, which means billions of dollars in savings are no longer available for the GOP to offset the cost of tax cuts.

Finance Committee Chairman Mike Crapo. R-Idaho, must rework or completely eliminate nine changes the committee proposed to the health care programs, though more of the panel’s proposals are still under review.

Republicans can no longer reduce the amount of federal matching funds for state governments that use their own tax dollars to provide Medicaid coverage for immigrants in the country without proper documentation.

The GOP bill cannot bar gender-affirming care for Medicaid patients.

And Republicans need to change or scrap a proposal to reduce states’ Medicaid provider tax credits, an issue that is relatively in the weeds of health care policy but has sharply divided the GOP and drawn fierce opposition from states.

The changes or eliminations will have a major impact on how much in savings the GOP tax and spending cut bill will generate during the next decade and will likely make the overall package’s deficit impact higher than before. The legislation is intended to extend the 2017 tax cuts and make spending reductions.

The ruling might make it more difficult for Trump and GOP leaders in Congress to get the votes needed to pass the bill at all, let alone before their self-imposed Fourth of July timeline. Senate GOP leaders had said they wanted to begin procedural votes as soon as Friday.

The measure already had been stuck on Wednesday amid growing disputes over how Medicaid changes will impact rural hospitals and far more.

Democrats to continue scrutinizing bill

Senate Budget Committee ranking member Jeff Merkley, D-Ore., who released the parliamentarian’s rulings, wrote in a statement that Democrats will continue to advocate for removing dozens of proposals from the bill that they believe don’t meet reconciliation rules.

“Republicans are scrambling to rewrite parts of this bill to continue advancing their families lose, and billionaires win agenda, but Democrats stand ready to fully scrutinize any changes and ensure the Byrd Rule is enforced,” Merkley wrote.

A staffer, who was granted anonymity to discuss the chairman’s plans, said the Finance Committee will “rework certain provisions to address the Byrd guidance and be compliant with reconciliation.”

The Byrd rule, named for former West Virginia Sen. Robert Byrd, includes several guardrails for reconciliation bills.

Finance Committee ranking member Ron Wyden, D-Ore., wrote in a statement that the parliamentarian’s ruling will lead to “more than $250 billion in health care cuts removed from the Republicans’ big bad bill.

“Democrats fought and won, striking health care cuts from this bill that would hurt Americans’ walking on an economic tightrope. This bill is rotten to its core, and I’ll keep fighting the cuts in this morally bankrupt bill until the end.”

The parliamentarian is still deciding whether several health provisions meet reconciliation rules, including language that would block all Medicaid funding from going to Planned Parenthood, effectively blocking Medicaid patients from visiting the organization for routine health services.

Federal law already bars funding for abortions with exceptions for rape, incest, or the life of the pregnant patient.

The parliamentarian will also decide later whether Republicans’ bill can block the Department of Health and Human Services from implementing a Biden-era rule that would require nursing homes to have a nurse working 24 hours a day, seven days a week.

Higher ed provisions axed

The parliamentarian also struck down several attempts from congressional Republicans to overhaul the higher education system.

GOP lawmakers cannot streamline student loan repayment options for current borrowers to just a standard repayment plan or an income-driven repayment plan, making such restrictions apply to only new borrowers.

Republicans have to nix a proposal that opened up the Pell Grant — a government subsidy that helps low-income students pay for college — to institutions that are for-profit and not accredited.

The parliamentarian scrapped a proposal that would have barred payments made by students enrolled in a medical or dental internship or residency program from counting toward Public Service Loan Forgiveness.

The federal program eliminates remaining debt for borrowers when meeting certain requirements, including working for a qualified employer within the government or nonprofit sector.

The parliamentarian rejected GOP lawmakers’ proposal to end federal student aid eligibility for certain immigrants who are not U.S. citizens.

‘Too many Medicaid cuts’

Missouri Republican Sen. Josh Hawley said the parliamentarian’s ruling on the Medicaid provider tax rate will give lawmakers “a chance to get it right.”

“This is a chance for the Senate to fix a problem that they created and not defund rural hospitals,” Hawley said, later adding he supports the House language that would freeze the rate at 6% instead of decreasing it to 3.5% over several years. 

Hawley said hours before Trump’s event that he expects the president to get more involved in negotiations now that he’s back from a NATO conference in Europe and said Trump was in a “terrific mood” during a recent phone call.

“I think he wants this done. But he wants it done well. And he does not want this to be a Medicaid cuts bill,” Hawley said. “He made that very clear to me. He said this is a tax cut bill, it’s not a Medicaid cuts bill. I think he’s tired of hearing about all these Medicaid cuts, you know. As am I. It’s because there are too many Medicaid cuts.”

Louisiana Republican Sen. Bill Cassidy early Thursday night called on leaders to put the House’s language regarding Medicaid back into the bill, wiping out changes made by the Finance Committee.

“My position is that cuts, and especially drastic cuts, to Medicaid have to be avoided. The Senate bill cuts Medicaid too much,” the influential chairman of the Health, Education, Labor and Pensions Committee wrote in a social media post. “I agree with President Trump, the House version is better.”

SNAP cuts

The Agriculture Committee also is reworking parts of its bill, some being closely watched by states, to meet the rules that govern reconciliation.

Committee Chairman John Boozman, R-Ark., said he expects to hear from the parliamentarian before the end of Thursday about whether a revised state cost share provision for the Supplemental Nutrition Assistance Program that’s based on error rate payments will be in the final bill.

“It was thrown out the first time, so we actually gave her revised text. If she rules the revised text is fine, then we’ll release it,” Boozman said.

The committee released a statement later in the day announcing the parliamentarian had cleared the revised state cost share for SNAP that’s based on a state’s error payment rate.

States that have SNAP error payment rates higher than 6% will have to contribute some of the cost of the program. The updated proposal will give states the option of choosing between fiscal 2025 and fiscal 2026 to determine their match, which will begin during fiscal 2028. After that, a state’s match will be determined by its error payment rate for the last three fiscal years. 

State and local tax, ‘revenge tax’

Senate Republicans also remained stuck on finding a deduction level for state and local tax, or SALT, that passes muster with House Republicans who represent high-tax blue states.

The House version would allow taxpayers making under $500,000 to deduct up to $40,000 in SALT from their federal tax bill. Both the $40,000 cap and the $500,000 income threshold will increase annually at 1% until hitting a ceiling of $44,000 and $552,000. The deduction cap phases down for higher earners.

Senate Republicans and the White House sought to lower the income threshold but were shot down Thursday by House Republicans, according to multiple reports.

Sen. Markwayne Mullin of Oklahoma, the lead negotiator on SALT for Senate Republicans, said he remained optimistic.

“We’re gonna be in a good spot. We’re gonna find a landing spot,” Mullin said.

A Senate Finance Committee spokesperson declined to comment on current negotiations, including any proposed income level changes.

Treasury Secretary Scott Bessent also weighed in on another tax provision: the so-called “revenge tax” on investments from countries whose trade policies the president views as unfair to U.S. businesses.

Bessent asked lawmakers to remove the up to 20% tax from the mega-bill following an agreement made with G7 partners, he wrote on social media.

“This understanding with our G7 partners provides greater certainty and stability for the global economy and will enhance growth and investment in the United States and beyond,” Bessent said.

The retaliation tax would have raised roughly $116 billion over 10 years, according to the Committee for a Responsible Federal Budget.

Timing on votes

Republican lawmakers don’t have much time left to rework all of the ineligible provisions, clear them with the parliamentarian, read through final bill text, slog through a marathon amendment voting session in the Senate and then move the bill through the House before their self-imposed deadline.

White House press secretary Karoline Leavitt said during a briefing before Trump’s event that the president is “adamant” Congress must pass the “big, beautiful bill” within the next week, despite the latest ruling.  

“We expect that bill to be on the president’s desk for signature by July Fourth. I know there was a ruling by the Senate parliamentarian this morning,” Leavitt said. “Look, this is part of the process, this is part of the inner workings of the United States Senate. But the president is adamant about seeing this bill on his desk here at the White House by Independence Day.” 

U.S. Senate Majority Leader John Thune, R-S.D., speaks to reporters at the Capitol as lawmakers work on the "One Big Beautiful Bill Act" on June 25, 2025 in Washington, D.C.  (Photo by Joe Raedle/Getty Images)

WASHINGTON — U.S. Senate Republicans appeared deeply divided Wednesday over how to establish a fund for rural hospitals to offset the budget impacts of Medicaid cuts in the “big, beautiful bill.”

The hospitals, which are generally already hurting financially, rely heavily on Medicaid, a state-federal partnership that provides health insurance for low-income households and for some people with disabilities.

GOP senators haven’t yet reached agreement on how to structure the fund, or on dozens of other unresolved provisions in the sweeping package, even though leaders hope to begin voting as soon as Friday. Still up in the air were agreements on major provisions of the measure involving the U.S. Department of Agriculture’s food aid program for low-income people and a proposed selloff of certain public lands.

Republican leaders continued to project optimism. “We’re well on our way to getting this bill passed this week,” Senate Majority Leader John Thune, R-S.D., said during a floor speech, continuing to press ahead toward a self-imposed Fourth of July deadline. 

Others saw it differently. Wisconsin Republican Sen. Ron Johnson cast doubt on the short timeframe leaders have set to reach final agreement and move the bill through both chambers.

“We’re still discussing some pretty fundamental issues,” Johnson said. “I’m just laying out the reality of the situation. We’ve got a lot of work to do.”

‘The only person up here that’s ever ran a rural hospital’

Dueling plans to establish the rural hospital fund to ease the threat of Medicaid cuts circulated among senators working to finalize the massive tax and spending cut measure, but an agreement had not surfaced by late afternoon.

Unofficial details showed Senate Republicans eyeing the inclusion of a $15 billion fund — $3 billion a year between fiscal 2027 and fiscal 2031 — to help rural hospitals, according to multiple reports.

But Sen. Roger Marshall, who sits on the Senate Committee on Finance, said he wants to increase that fund to $5 billion annually, with “half of that going to rural hospitals, and half of it going to primary care and prescription drugs and throw in physical therapy and occupational therapy, all the others as well.”

The Kansas Republican and physician said “we should probably only do it for four or five years and then regroup and see where we are.”

“I’m the only person up here that’s ever ran a rural hospital — I actually know something about them,” he added.

While Marshall said he loves “90%” of the broader bill, he said not nearly enough is being cut.

“But I can’t get the votes to do that, so it’d still be the largest cut in spending in my lifetime anyway,” he said, noting that “it’s going to be hard for the House to vote against it.”

Fund size criticized

On a midday call with reporters, Traci Gleason with the Missouri Budget Project said the stabilization fund being batted around by lawmakers “would fall well short of addressing these problems.”

“Forty-three percent of Missouri’s rural hospitals are at risk of closing, and 17% are considered to be at immediate risk,” said Gleason, who spoke during a virtual press briefing organized by the left-leaning Center for Budget and Policy Priorities.

“Those figures don’t account for all of the other health care providers in rural communities, like federally qualified health centers and others that operate on these incredibly thin margins. So the massive cuts to Medicaid are what is creating the problem and the only real way to address it is for Congress to not make these massive cuts,” she said.

‘Problematic’ Medicaid cuts

Sen. Susan Collins was advocating for a much bigger rural hospital stabilization fund, at $100 billion.

“I don’t think that solves the entire problem,” the Maine Republican and chair of the Senate Appropriations Committee said.

“The Senate cuts in Medicaid are far deeper than the House cuts, and I think that’s problematic as well.”

Sen. Jim Justice of West Virginia said that the $15 billion “is better than zero.”

“You know, naturally, I’d want it to be as high as it possibly can,” he said, adding that rural hospitals are the “lifeblood” of his state.

Sen. Josh Hawley of Missouri, a loud voice against Medicaid benefit cuts, said a stabilization fund is a “good idea but we’re still going to have to address the longer term effects of this.”

When asked for a dollar figure, Hawley said “it depends on the structure of it.”

Texas Republican Sen. John Cornyn said he keeps hearing the Senate will take a procedural vote on Friday, though that isn’t set in stone. 

“Should be a fun weekend for all of us,” Cornyn said. “Can’t wait.”

Once the Senate votes on what is called a motion to proceed, there’s a maximum of 20 hours of floor debate before the chamber must begin its marathon amendment voting session and eventually a passage vote.

SNAP provisions

Senate Agriculture Chairman John Boozman, an Arkansas Republican, said a revised version of his committee’s bill had not yet been reviewed by the parliamentarian.

The updated text alters a section restructuring the cost-share of the Supplemental Nutrition Assistance Program, or SNAP, a key food assistance program for low-income people.

The provision would require states for the first time to shoulder some of the cost of the program’s benefits. The amount a state owes would be determined by its error payment rate, with greater error rates requiring a higher state share.

Complex rules govern what can and can’t be included in the measure. The Senate parliamentarian ruled the language in the initial proposal did not comply with the chamber’s reconciliation rules.

The updated proposal would allow states more flexibility during the policy’s phase-in in fiscal 2028, allowing them to choose either the error rate in fiscal 2025 or fiscal 2026.

Boozman told reporters that change sought to respond to the parliamentarian’s ruling.

The parliamentarian “asked us to allow them (states) to use a different time frame — essentially gave them more time to understand what their error rate would be and to plan for it,” Boozman said. “And so we adjusted for that and I think we satisfied it.”

Lee and public lands

Senate Energy and Natural Resources Chairman Mike Lee of Utah reportedly narrowed a provision that would mandate the sale of Bureau of Land Management lands. He has not publicly said where it stands with the parliamentarian.

A committee spokesman did not return messages seeking clarification Tuesday and Wednesday, but a version of the changes obtained by news media shows changes consistent with what Lee proposed Monday.

Those changes include limiting the mandated sales to only the BLM — and not U.S. Forest Service lands, as Lee had initially proposed — and lowering the percentage of the agency’s lands that must be sold to between .25% and .5%. The initial proposal required between .5% and .75%.

The updated provision would also only require lands located within 5 miles of a population center to be sold and exempts lands that are currently used for grazing or another “valid existing right that is incompatible with the development of housing,” according to a copy of the changes obtained by hunting and angling publication Outdoor Life.

The provision has sparked opposition from Western lawmakers, including a handful of conservatives.

But it also has its share of supporters. Alaska Republican Dan Sullivan told reporters he had not seen the updated text but remained supportive of the idea.

“I’ve been supportive of what Sen. Lee is trying to do,” he said. “We have a lot of public lands in Alaska that the federal government abuses. But we’re in a good discussion on that, so I need to see the update.”

 

Susan Monarez, President Donald Trump’s nominee to be the director of the Centers for Disease Control and Prevention, testifies during her confirmation hearing before the U.S. Senate Committee on Health, Education, Labor, and Pensions on June 25, 2025. (Photo by Kayla Bartkowski/Getty Images)

WASHINGTON — Members of the U.S. Senate Committee on Health, Education, Labor and Pensions pressed President Donald Trump’s nominee to lead the Centers for Disease Control and Prevention about vaccine recommendations Wednesday after the Health and Human Services secretary fired members of a critical vaccine panel this month.

Trump’s pick, former acting CDC Director Susan Monarez, said that she trusted vaccines while defending HHS Secretary Robert F. Kennedy Jr.’s decision this month — widely seen as part of a vaccine-skeptical agenda — to fire all 17 members of the Advisory Committee on Immunization Practices, or ACIP, and recommend eight new members.

“Part of the secretary’s vision in restoring public trust is making sure that the American people can be confident in the way the evidence and science is driving decision-making,” she told senators.

The panel’s seven members — one dropped out this week — will meet Wednesday and Thursday to review data and vote on new vaccine recommendations. The recommendations carry significant weight as insurance providers and federal health programs like Medicaid use them to determine if shots are covered and schools rely on them for immunization mandates.

Cassidy questions

Louisiana Sen. Bill Cassidy, who chairs the committee, said he was concerned about ACIP, especially as a non-CDC staff member is scheduled to give a presentation to the committee about thimerosal, a mercury-based preservative. The panel is expected to vote on approving flu shots that contain the compound.

Lyn Redwood, the former head of Children’s Health Defense, the anti-vaccine group that Kennedy founded, is giving the presentation arguing that thimerosal causes autism. The CDC’s own research shows that thimerosal does not cause autism. 

Cassidy said that while Monarez had no part in this week’s ACIP meeting, or the agenda, he said that “if the ACIP hearing today is being used to sow distrust, I would ask that going forward, that you would make sure that there really was a balanced perspective.”

“Yes, someone can speak as a critic, but there should be someone who is reviewing the overwhelming evidence of the safety of vaccines,” Cassidy, who is a physician, said.

Monarez, who was the agency’s acting director from January to March, said that she trusted vaccines and that immunization was important to save lives.

If Monarez is confirmed by the Senate, she would be the first director of the CDC without a medical degree in nearly 70 years. She has a Ph.D. in microbiology and immunology.

More concerns about vaccine panel

Cassidy was not the only Republican on the panel concerned about the firing of all the members of ACIP.

Alaska Republican Sen. Lisa Murkowski said she was concerned about the backgrounds of the seven new panelists.

“I would hope that one of the things that you would all be looking into is to make sure that these individuals are going to be looking at the science in front of them, (and) leave their political bias at home,” Murkowski said.

Democratic Sens. Patty Murray of Washington state and Angela Alsobrooks of Maryland also pressed Monarez about Kennedy’s actions to fire everyone on the panel.

Murray asked Monarez if the new members of the panel voted to not recommend vaccines, if she would listen to that recommendation.

Monarez sidestepped the question and said the roles at ACIP were difficult to fill and that members needed to pass an ethics process.

“If they have not gone through an ethics approval process they shouldn’t be participating in the meetings,” she said.

Alsobrooks asked Monarez if she believed the 17 members fired from ACIP lacked qualifications.

Monarez did not answer the question, but said Kennedy’s reasoning for “resetting the ACIP to a new cohort was going to be on the path of restoring public trust.”

Grant funding and layoffs

Senators also raised concerns about grants that had been canceled, even though Congress already approved the funds.

Maine GOP Sen. Susan Collins, who is the chairwoman of the Senate Committee on Appropriations, said that her state is suffering from a high level of Lyme disease and as a result a vaccine was in the works at a research institute in Maine.

“This vaccine is very promising and I want to make sure that it is allowed to continue to its conclusion,” Collins said.

Monarez agreed and said if she is confirmed, she will specifically work to make sure funding for that vaccine continues.

“It’s ironic that our dogs can get a vaccine to protect them against tick-borne illnesses like Lyme disease but we humans can’t and I hope we can remedy that,” Collins said.

Sen. Tim Kaine, Democrat of Virginia, pressed Monarez about the elimination of the Office on Smoking and Health at the CDC. He asked if she was involved in laying off all the staff in April, the month after her brief stint as acting director ended.

“I had no participation in (the layoffs) after I left,” she said.

Fluoride in water

Alsobrooks pressed Monarez about Kennedy’s push to have the CDC stop recommending that low levels of fluoride be placed in public drinking water.

Fluoride is added in drinking water to help prevent cavities, tooth decay and other dental health issues.

Alsobrooks asked Monarez, who is her constituent, if the public water supply that contains fluoride in Potomac, Maryland, where Monarez lives, was safe to drink.

“I believe the water in Potomac, Maryland, is safe,” Monarez said. 

Reading Time: < 1 minute

Unauthorized immigrants are not eligible for traditional, federally funded Medicaid, which helps cover medical costs for low-income people.

They have never been eligible. A 1996 welfare reform law signed by Democratic President Bill Clinton also requires most authorized immigrants to wait five years for eligiblity.

Fourteen states, excluding Wisconsin, use state Medicaid funds to cover unauthorized immigrants. 

President Donald Trump has proposed reducing federal Medicaid funds to those states. That would cause 1.4 million people to lose coverage, the nonpartisan Congressional Budget Office estimated. 

Medicaid costs nearly $900 billion annually, two-thirds from the federal government and one-third from the states.

In Wisconsin, Medicaid serves 1.28 million people, more than a third of them children. Among adults, 45% work full time, 28% part time. The annual cost is $12.1 billion, $4.2 billion of it in state spending.

While unauthorized immigrants can’t get Medicaid in Wisconsin, they can apply to receive emergency care covered by state Medicaid.

This fact brief is responsive to conversations such as this one.

Sources

• Georgetown University: The Truth About Medicaid Coverage for Immigrants – and the Looming Threats
• KFF: 5 Key Facts About Immigrants and Medicaid
• Medicaid.gov: Eligibility Policy
• U.S. Health and Human Services Department: What’s the difference between Medicare and Medicaid?
• Civic Media: Trump & Musk Implode While Republicans Gut Your Healthcare | Rep. Mark Pocan Explains the Truth
• Rolling Stone: Mike Johnson and Russ Vought Continue to Lie About Medicaid Cuts
• Truth Social: Donald Trump post
• KFF: Which States Would Be Affected by a House Proposal to Cut Federal Medicaid Funding for States That Cover Undocumented Immigrants?
• ABC News: What will Trump's 'big, beautiful bill' do to Medicaid and SNAP?
• Georgetown University: Factchecking The White House “Mythbuster” on Medicaid Cuts and Immigrants
• Congressional Budget Office: Letter
• Medicaid and CHIP Payment and Access Commission: Medicaid Spending by State, Category, and Source of Funds, FY 2023
• Congress.gov: H.R.3734 – Personal Responsibility and Work Opportunity Reconciliation Act of 1996
• Wisconsin Department of Health Services: Medicaid: Health Care Coverage for Noncitizens
• Wisconsin Watch: Medicaid covers 1.2 million in Wisconsin. The election will determine its future
• KFF: Medicaid in Wisconsin
• Wisconsin Department of Health Services: Medicaid: Health Care Coverage for Noncitizens Frequently Asked Questions
• Congressional Research Service: Unauthorized Immigrants’ Eligibility for Federal and State Benefits: Overview and Resources
• Congress.gov: H.R.3734 – Personal Responsibility and Work Opportunity Reconciliation Act of 1996
• Wisconsin Department of Health Services: ForwardHealth: BadgerCare Plus and Medicaid Emergency Services
• Wisconsin Department of Health Services: Frequently Asked Questions
• National Health Law Program Q and A: The Legal Immigrant Children’s Health Improvement Act
• National Health Law Program Medicaid Coverage of Emergency Medical Conditions: An Update

Are unauthorized immigrants eligible for federal Medicaid coverage? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

U.S. Senate Minority Leader Chuck Schumer, D-N.Y., speaks during a press conference inside the Capitol building on Wednesday, June 18, 2025. Oregon Democratic Sen. Ron Wyden is at right. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — The next hurdle for Republican leaders in the U.S. Senate and the “big, beautiful bill”: Democrats — and possibly a few of their own members — in a marathon voting session will make last-ditch attempts to change the tax and spending cut measure.

The vote-a-rama, as it’s known, is expected to begin sometime during the last full week of June as Congress heads toward the Fourth of July recess. It will likely begin in the afternoon and  last overnight into the next morning. Senators will debate and vote on dozens of amendments attempting to revise the massive legislation that could have an effect on nearly every American.

Democrats, who have 47 votes in the Senate compared to 53 for Republicans, plan to zero in on Medicaid, taxes, corruption, policies that could raise energy costs and proposals that would increase the deficit, according to Senate Minority Leader Chuck Schumer.

Senate Majority Leader John Thune, R-S.D., and the committee chairs tasked with drafting pieces of the package have spent weeks combing through the House-passed bill to figure out what needs to be altered to avoid divisive floor votes. 

They’ve rewritten numerous policy proposals to comply with the strict rules that go along with the complex reconciliation process and are now trying to work out disagreements among GOP senators that could doom or complicate a final deal.

The goal is to avoid a protracted debate over core GOP provisions in full public view once the vote-a-rama begins, though some senators are already predicting votes on GOP amendments.

‘A potentially messy process’

Missouri Republican Sen. Josh Hawley, who has raised concerns about the bill’s impact on rural hospitals, said he hopes GOP leaders reach a consensus before vote-a-rama but didn’t rule out offering his own amendments if they don’t settle their disputes.

“Amending it on the floor, that’s a potentially messy process,” Hawley said. “I would hope that we could get to a good place before that. But we have to fix the rural hospital issue.”

Alabama Republican Sen. Tommy Tuberville said he will likely propose amendments during floor debate, though he declined to say what specific policies he’d seek to change or eliminate from the package.

“Yeah, we’ll have some,” Tuberville said. “And we’ve got them all, we just haven’t turned them in yet.”

Thune said he and other negotiators are making “headway” toward consensus on the more significant provisions in the package, which in many respects is far from its final form.

“The meetings right now are on the major provisions in tax and health. We have sort of pre-litigated a lot of that,” Thune said. “But there are a lot of the other provisions in the bill, chapters in the bill that are still subject to going through the Byrd bath, and we’re in the process of doing that. But hopefully that’ll be done by early next week.”

Republicans are using the reconciliation process to pass their sweeping tax and spending cuts package through the Senate with just a simple majority vote, requiring them to comply with the Byrd rules.

That includes the Byrd bath — going before the Senate parliamentarian to explain how each provision has an impact on federal revenue or spending that is not “merely incidental.” Democrats then usually debate before the parliamentarian the various changes that don’t meet that threshold. The process is named after the late Sen. Robert Byrd, a West Virginia Democrat.

Once the parliamentarian rules what elements comply and which need to be removed, the bill can go to the floor and senators can trudge through vote-a-rama. Eventually, all 100 lawmakers will vote to approve or disapprove of the legislation.

GOP senators passing their version of the package would send it back to the House, which passed its version on a slim 215-214 vote earlier this year — and could make yet more changes in the Senate bill.

Democrats develop strategy

Democrats are hoping to highlight policy divisions among Republicans during the vote-a-rama. And even if they don’t succeed in getting any of their amendments adopted, several votes could serve as fodder for campaign ads during next year’s midterm elections.

Schumer said Wednesday during a press conference it would be “difficult” for Democrats to peel off at least four GOP senators from the rest of the party in order to get an amendment adopted, but said he’s hopeful Republicans will “vote with us on some things they’ve all said they’ve agreed with.”

Democratic senators, he said, have created a task force to reach out to Republicans on major issues in the package, including how it would impact rural hospitals.

“Many of these hospital administrators and employees are Republican,” Schumer, a New York Democrat, said. “In many of the rural hospitals, they are the largest employer in the county, and in most they’re the only supplier of health care. It infuriates the rural counties, and they tend to be Republican.”

‘It’s just a show, it’s a charade’

West Virginia Republican Sen. Shelley Moore Capito said she’s not concerned about having to vote on dozens of amendments. 

“We’re here to vote,” Capito said. “As a creature of the House, we voted all the time on everything, so this doesn’t bother me. And, you know, just let the body work its will. If some changes are made, those will have to be dealt with. But I’m not worried about that.”

Arkansas Republican Sen. John Boozman said he expects the vote-a-rama will be “a very late night” and that he’s not planning to offer any of his own amendments.

As chairman of the Agriculture, Nutrition and Forestry Committee, Boozman expects to spend a considerable amount of time during vote-a-rama arguing against amendments seeking to change those provisions — including controversial cuts in the Supplemental Nutrition Assistance Program, which provides food aid for lower-income families.

Wisconsin Republican Sen. Ron Johnson said he plans to spend much of the vote-a-rama “going back and forth from my hideaway,” the ceremonial office that every senator holds in the Capitol building.

But Johnson cast doubt on actually being able to amend the package during that process, saying changes to the various bills that Senate committees have released need to be agreed to before then.

“You’ve got to get this before it ever goes to the floor. I mean, you’re not going to change things substantially or significantly with amendments. I know people have some idealized version that happens. It doesn’t,” Johnson said. “You’ve got to get these things in the base bill. Amendments; it’s just a show, it’s a charade.”

Vote-a-rama after vote-a-rama

The Senate has held two vote-a-ramas so far this year, and both demonstrated how difficult it is to change a piece of legislation.

The first all-nighter in February went along with Senate debate on its budget resolution and included votes on 25 amendments, with lawmakers adopting just two — one from Alaska Republican Sen. Dan Sullivan and one from Utah Republican Sen. Mike Lee.

The second vote-a-rama took place in April just before the Senate voted to approve the budget resolution that ultimately cleared the way for Congress to use the budget reconciliation process to advance the “big, beautiful bill.” Senators debated 28 amendments, voting to adopt one change from Sullivan.

Oregon Democratic Sen. Ron Wyden, ranking member on the Finance Committee, said he and staff on the panel will continue to parse through details of the panel’s bill, which Republicans just released Monday.

Wyden said he plans to hold several town hall meetings in GOP areas of his state over the weekend to gauge how residents there view the policy revisions Republican senators have put forward.

“We’ve had this bill for basically 36 hours. The first time I had it, I stayed up all night, so last night I got a little sleep,” Wyden said on Wednesday. “But on the plane, I’ll be working through it. And I expect to be working through it all through the next few days, except when I’m having these town hall meetings where I’ll have a number of questions.”

Tami Jackson of the Wisconsin Board for People with Developmental Disabilities describes how unpaid family caregivers could be affected by proposed Medicaid cuts in the Republican budget reconciliation package in Washington, D.C. Janet Zander of the Greater Wisconsin Agency on Aging Resources, seated at right, also spoke. (Photo by Erik Gunn/Wisconsin Examiner)

Among the many people whose health care could be in jeopardy from possible Medicaid cuts, one group may be even less visible than the rest.

For elderly residents as well as children and adults with disabilities whose health care is covered by Medicaid, family members who help with their care will also be affected by the proposals coming from Republican members of Congress.

“Medicaid is the primary thing that supports family caregivers,” said Tami Jackson, policy analyst for the Wisconsin Board for People with Development Disabilities (BPDD), in a presentation to social workers Thursday in Dodgeville. 

The person under the caregiver’s care could be living at home, but will probably still require long-term support of some kind — support covered by Medicaid, Jackson said. Medicare provides coverage only for a limited time, such as when a person has come home after being hospitalized.

Private long-term care insurance plans “are unaffordable and they have not been workable for many years,” she added. “So Medicaid is it — and we happen to have a lot of people who need long-term care.”

Jackson and Janet Zander of the Greater Wisconsin Agency on Aging Resources met with Iowa County social workers in Dodgeville Thursday to explain the likely effect of Medicaid cuts that are part of the budget reconciliation bill that has passed the U.S. House and is now in the Senate.

The GOP majorities of both houses want to pass the legislation so they can extend tax cuts enacted in 2017, when President Donald Trump was in his first term. Those tax cuts have been found to heavily benefit wealthy Americans. Without action they will expire at the end of 2025.

Cutting Medicaid, hiking other costs

Medicaid is the single largest source of federal funds in the state budget — about $9 billion a year.

Under the U.S. House version of the budget reconciliation bill, the Wisconsin Department of Health Services (DHS) has projected between 71,000 and 111,000 Wisconsinites would lose Medicaid coverage, including more than 3,800 people with disabilities and 2,400 older adults. The state’s federal Medicaid revenues would be cut by $501 million to $663 million.

The Medicaid cuts on the scale of those in current iterations of the bill “are too large to not cause states to have to cut many things in their state budget,” Jackson said.

The bill’s Medicaid cuts as well as changes it would make to the Affordable Care Act’s health insurance marketplace — including ending subsidies that have made marketplace plans more affordable for lower-income people — would increase the number of uninsured Americans by 16 million in the next decade, according to the Congressional Budget Office.

“Whether you’re a caregiver, whether you’re on Medicaid, whether you’re working for somebody who’s on Medicaid,” everyone will be affected by 16 million more uninsured people, Zander said.

With more uncompensated care for hospitals and providers, she predicted that the cost for other payers will increase.

“We’re going to see premiums for any kind of [health] insurance skyrocket — the employer’s portion, the employee’s portion,” Zander said.

Reduced Medicaid care, more unpaid care

Family caregivers feel Medicaid’s impact in several ways. For many people who are elderly or have disabilities it enables them to get paid, professional care at home. If that care is cut back, that means more work for the unpaid family member.

“Those paid caregivers — they’re paid for by Medicaid dollars and there aren’t enough of them. There haven’t been enough of them for years,” Jackson said.

 If Medicaid cutbacks reduce the pay for those caregivers, the workforce that is already underpaid is likely to be even harder to find — making access to paid care even more difficult, she added, to the point where “it’s either the unpaid caregiver or nothing.”

Family caregivers who take on more unpaid care responsibilities may have to cut back on their own paid jobs.

“The amount of people who are reducing, limiting [work hours or] leaving the workforce because there isn’t a stable, paid caregiving workforce to provide what they need is huge,” Jackson said.

A BPDD survey found that for unpaid family caregivers in Wisconsin providing or coordinating care or filling in for missing care workers took 80% of their time. Two-thirds said caregiving had a negative impact on their family finances and 50% said they left jobs or reduced hours to provide care because there were no care workers to hire.

Unpaid caregivers who leave the workforce not only lose income but reduce the earnings that contribute to their Social Security retirement, Jackson said.

Kristin Voss, a Madison public school teacher for 24 years, had to retire to help manage and care for her 23-year-old daughter. Her daughter has epilepsy, autism and an intellectual disability and “functions at about anywhere from 6 to 12 years old,” Voss said in a panel discussion that was part of Thursday’s presentation.

Until her daughter was 21, she was entitled to public education, where she got “tons of support” including in her transition period that started when she was 18, Voss said. At 21, those supports were no longer available, however.

Her daughter enrolled in the state’s self-directed long-term care program called IRIS. The program includes a caseworker, but Voss also has responsibility as her daughter’s family caregiver, helping to manage day-to-day changes in her daughter’s placement and activities.

“I don’t mind doing these things, but there’s things that I don’t always know about and I’m not always prepared for,” Voss said. “And so, no, I couldn’t do this and be a public school teacher.”

Instead, she has put together a collection of part-time positions that give her flexibility that she needs — although none of them have health insurance, Voss said.

Unpaid caregivers ‘untangling the mess’

Some unpaid caregivers who leave the workforce may also turn to Medicaid for their health coverage because they can’t afford health insurance or work at a job that doesn’t provide insurance.

“About 4 million people nationally are unpaid caregivers who are in Medicaid themselves,” Jackson said.

Among the changes proposed for Medicaid is a requirement for participants in the program to prove every six months that they are still eligible for the program, instead of once a year, the current standard. Another change proposed is to add a work requirement for certain Medicaid participants.

Both of those changes will mean more paperwork. “Unpaid caregivers are the folks that are keeping people who are in Medicaid programs already,” Jackson said — by filling out the forms that are required to prove the person is still eligible.  

“Often these processes are so complex,” Jackson said. And when something goes wrong, because of an error in an eligibility form or a billing mistake, family caregivers “are the people who are untangling the mess.”

The current version of the bill in the Senate gives caregivers an exemption from the work requirement — but Jackson said the definition has raised concerns.

The current proposal limits the exemption to people who are caring for a person under the age of 14. National advocates have said that “really narrows that caregiver exemption and doesn’t quite fit with the reality that most unpaid caregivers are providing care for people with disabilities and older adults,” Jackson said.

Including exemptions in the proposed work requirement provisions also doesn’t necessarily reduce the paperwork.

“You either have to prove you’re meeting the work requirements, or you have to prove that you’re exempt for those requirements,” Jackson said. “And if you’re a caregiver who’s in Medicaid, you have to do that for yourself and probably the person you’re supporting.”

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