As Congress continues to threaten deep cuts to the Medicaid program, a new KFF report shows how some of the proposed changes could end coverage for an estimated 20 million people nationwide, more than 800,000 in Illinois. One idea targets the Medicaid expansion federal match rate. The federal government currently pays 90% of the costs for people covered under what's known as the Medicaid expansion, that extended coverage to nearly all low-income adults.

Liz Williams, senior policy analyst with KFF, explained that if the federal match rate drops, Illinois would have two options: come up with more than $40 billion to cover expansion costs or drop it altogether.

"Illinois has a law where the state is required to automatically end expansion coverage if the match rate drops, so in those trigger law states, there's 12 of them, enrollees are at greater risk of losing coverage," she explained.

Nearly 30% of Medicaid enrollees in Illinois have health-care coverage because of the Medicaid expansion and would be at risk of losing it should these changes go through.

The Medicaid expansion under the Affordable Care Act was enacted to reduce the number of uninsured people nationwide. It provided states with an increased federal match rate to help pay for their health-care costs. Williams added that if states can't afford to pick up the added costs from decreased federal support, the number of uninsured people will dramatically increase, and any gains in financial security and health outcomes associated with the expansion would be reversed.

"Medicaid is jointly funded by states and the federal government, so any restrictions in federal Medicaid spending really leaves states with tough choices about how to offset reductions," she continued.

She said states have a few options, including increasing state tax revenues, decreasing spending on non-Medicaid services such as education, or decreasing coverage for other groups. Governor J.B. Pritzker has already proposed eliminating Medicaid coverage for non-citizen adults aged 42 to 65 as a way to make up for the state's $1.7 billion-budget gap.


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The budget reconciliation bill being considered by the U.S. Senate proposes $863 billion in Medicaid reductions over a decade, with 10.9 million Americans projected to lose coverage by 2034, according to a June 4 Congressional Budget Office report.

In Florida, where 760,000 Medicaid enrollees rely on community health centers, advocates say the cuts would destabilize preventive care and overwhelm hospitals.

Austin Helton, CEO of Brevard Health Alliance, said the cuts would dismantle primary-care access, rupturing what he called Florida's "health-care ecosystem."

"If you cut spending on Medicaid and ACA, which primarily pays for access to primary-care health services at community health centers, that access is gone," he said. "The patients are still going to need that care. They're just going to end up sicker and they're going to end up going to more costly and more complex environments like the emergency room at the hospital."

Helton said the cuts would hit hardest at health-care facilities such as those under Brevard, where 60% to 70% of patients use Medicaid or ACA plans.

While the Florida Policy Institute warns of clinic closures and reduced hours, supporters say the changes target inefficiencies, with House leaders claiming they'll reduce wasteful spending while protecting vulnerable patients.

Florida's community health centers, which serve one in eight Medicaid patients statewide, face what advocates call an impossible math problem: more patients but fewer resources.

"As the population in Florida increases, the number of our patients increase, the number of Medicaid enrollees decreases," said Jonathan Chapman, CEO of the Florida Association of Community Health Centers. "Therefore, by process of elimination, you're going to see more uninsured people on our doorstep."

The Congressional Budget Office projects Florida would lose $7.3 billion in federal Medicaid funds by 2030 under the House plan, with rural counties such as Gadsden and DeSoto facing severe strain. The bill remains stalled in the Senate, where Republicans are divided over many issues, including rural hospital protections.

After the Department of Government Efficiency cut AmeriCorps funding earlier this year, a federal judge last week granted a temporary halt to the cuts on behalf of a group of states that filed a lawsuit against the move. Montana is not on the list.

AmeriCorps is a national service program which has been running for three decades. In the year before the cuts, about 2,800 members, called VISTAs, served at 300 Montana host sites including food banks, schools, youth centers and more.

Rochelle Hesford, executive director of Southwest Montana Youth Partners, relied on AmeriCorps service in the group's five-year plan. But its VISTA member was on board for less than four months before funding was cut.

"We're in kind of that early critical stage where we really need to get that public support and get our name out there and build capacity for the organization," Hesford observed. "We're losing, like, a year's worth of work, I would say."

Two dozen states plus Washington, D.C., filed a lawsuit against the Trump administration arguing it did not provide sufficient notice or comment period according to law but because Montana was not a plaintiff, its AmeriCorps funding remains cut.

Groups hosting VISTA members pay about one-third of their income and AmeriCorps funding covers the rest.

Erin Switalski, senior program director for the Headwaters Foundation, which provides grants for groups across the state, said it is a big leg up for many Montana groups.

"We're a resource-scarce state in many ways, and AmeriCorps VISTAs can really come in and help organizations build new systems and find efficiencies," Switalski explained. "Losing that support is really critical."

Montana's population is one of the least dense in the country but it has the most nonprofits per capita, nearly 10 per every 1,000 residents, according to the Tax Foundation.

Switalski noted she worries cuts to AmeriCorps signal something bigger.

"It's tied to this broader trend that we're seeing in really just a gutting of civic infrastructure that helps hold our communities together in Montana," Switalski added.

The federal budget proposal now being hashed out in Congress would significantly reduce funding for programs aiming to prevent domestic violence and assault, and help support survivors.

Ohio groups are raising concerns about how the cuts could affect services across the state. The budget reconciliation bill now in the U.S. Senate includes a $200 million cut to grant programs under the Violence Against Women Act.

Maria York, policy director for the Ohio Domestic Violence Network, said the funding supports core services, such as legal assistance and victim advocacy.

"It eliminates millions of dollars in crime victim services funding," York pointed out. "The biggest grants that we were looking at is the Violence Against Women grants; a reduction in the VAWA grant funding means that these services would be cut from the shelters in Ohio."

The proposed budget also calls for consolidating the Office on Violence Against Women into the Office of Justice Programs, a move some advocates said conflicts with current federal law and could affect grant administration.

York noted Ohio reports higher rates of victimization than many other states. She pointed to a recent study estimating the economic cost of domestic violence in Ohio at $1.2 billion annually.

"When we're using these federal dollars it's actually, in the long run, saving money for Ohioans," York contended.

Ohio advocates are encouraging residents to contact members of Congress ahead of a National Day of Action on June 10, urging them to maintain and strengthen funding for victim services.