How Has Projected Medicaid Spending and Enrollment Changed Since Passage of the 2025 Reconciliation Law? Authors: Elizabeth Williams, Alice Burns, and Robin Rudowitz Published: Jul 1, 2026

https://www.kff.org/medicaid/how-has-projected-medicaid-spending-and-enrollment-changed-since-passage-of-the-2025-reconciliation-law/ The Congressional Budget Office (CBO), known as Congress’s “scorekeeper,” projects federal spending and revenues over the next decade and cost estimates of proposed legislation are measured against those projections. Those projections include spending on major federal programs, such as Medicaid. CBO also typically releases a detailed baseline for federal spending on Medicaid that includes estimates of enrollment by eligibility group and spending by service category. The 2025 reconciliation law, signed into law by President Trump on July 4, 2025, made major changes to federal revenues and spending, with CBO estimating the new law would reduce federal spending on Medicaid by $911 billion over the 2025-2034 period, relative to its January 2025 baseline projections of Medicaid spending under the law and regulations at the time.