Which States Will Be Affected by Key Medicaid Provisions in the 2025 Reconciliation Law? Authors: Alice Burns, Jennifer Tolbert, Robin Rudowitz, and Anthony Montano Published: Oct 7, 2026

https://www.kff.org/medicaid/which-states-will-be-affected-by-key-medicaid-provisions-in-the-2025-reconciliation-law/ Amidst challenging fiscal conditions and upcoming national and state elections, states are working to implement major federal changes to Medicaid. The 2025 reconciliation law made major changes to federal revenues and spending. Shortly after enactment, the Congressional Budget Office (CBO) estimated the new law would reduce federal spending on Medicaid by $911 billion over the 2025–2034 period and that the Medicaid changes would increase the number of people without health insurance by 7.5 million in the year 2034. Recognizing the risks such changes posed for rural areas, policy makers added a $50 billion rural health transformation program (referred to here as the “rural health fund”) to the reconciliation law. All 50 states have received first-year allotments from the rural health fund and are implementing new initiatives to support rural health care, although these funds will not offset reductions in federal Medicaid support.