President Donald Trump’s budget package cuts a number of social services and programs to help pay for other costs, like renewing tax cuts and increasing border spending.
In Missouri and Kansas, the cuts mean that, depending on your status, recipients of MO HealthNet, KanCare and the Supplemental Nutrition Assistance Program (SNAP) could see changes to their benefits.
The legislation is a massive package of proposals, totaling nearly 1,000 pages of changes. Here are some of the frequently asked questions about how the bill would impact your benefits or coverage.
What does the bill pay for?
The cuts are made to some programs to fund other priorities. Despite the cuts, the bill would add more than $3 trillion to the national debt over the next decade.
Broadly, here are some things the bill will pay for:
- Extend 2017 tax cuts, which largely benefit the wealthiest Americans.
- Eliminate taxes on tips and overtime for a few years.
- Reduce federal taxes for some Social Security beneficiaries.
- Increase spending for immigration enforcement.
- Increase military funding.
What was cut to pay for these costs?
Cuts to safety-net programs, like Medicaid or SNAP, were used to help reduce the cost of the bill. An analysis by the Congressional Budget Office (CBO) estimated that 16 million Americans would lose coverage under Medicaid over the next 10 years due to changes in the Affordable Care Act marketplace and as a result of work requirements.
The legislation will require those aged 19 to 64 who are on Medicaid, known as MO HealthNet in Missouri and KanCare in Kansas, to perform at least 80 hours of work, school or caregiving a month. Work requirements will also apply to SNAP recipients.
Parents with children 14 or older would be part of the group required to work to receive Medicaid benefits, while others would be exempt if they have children under 14 or certain medical conditions.
It’s estimated that approximately 130,000 people — or about 10.5% of all people enrolled in Missouri — could lose coverage over the next decade under the plan, while 8.6 million could lose coverage nationwide. The latest estimate from the CBO, a nonpartisan analysis office, shows that the new law would reduce federal Medicaid spending by $1 trillion.
Over the next decade in Missouri, the state will lose about $17 billion in federal funding for Medicaid, KFF estimates.
In Kansas, the law could impact KanCare coverage for 13,000 people over the next decade, and lose about $4 billion in federal funding.
The law also repeals rules from President Joe Biden’s administration that affected enrollment in the Affordable Care Act marketplace, like special enrollment periods, extending the open enrollment period and measures to simplify the enrollment process.
The federal government has previously taken on the entire cost of SNAP, but under the law, states will be required to pay for at least part of the program starting in 2028 if they have a certain payment error rate.
The new law would reduce federal spending on SNAP programs by $287 billion over the next 10 years.
An Urban Institute analysis of the law found that about 22.3 million families in the U.S. could lose all or some of their benefits, including about 318,000 families in Missouri and 92,000 in Kansas.
Who from Missouri and Kansas voted cuts to Medicaid and SNAP?
Broadly, all of the Missouri and Kansas Republican congressional delegations voted in favor of the legislation, while Democrats voted against it.
- Democratic Reps. Wesley Bell (MO-01) and Emanuel Cleaver (MO-05) voted ‘no’ on the legislation.
- Republican Reps. Ann Wagner (MO-02), Bob Onder (MO-03), Mark Alford (MO-04), Sam Graves (MO-06), Eric Burlison (MO-07) and Jason Smith (MO-08) voted in support of the legislation.
- In the Senate, Republican Sens. Josh Hawley and Eric Schmitt voted for the legislation.
- Democratic Rep. Sharice Davids (KS-03) voted against the bill.
- Republican Reps. Tracey Mann (KS-01), Derek Schmidt (KS-02) and Ron Estes (KS-04) voted for the legislation.
- Sens. Jerry Moran and Roger Marshall voted in support of the legislation.
How do work requirements work?
Only Georgia and Arkansas have attempted work requirements for Medicaid, but both states have encountered problems. Georgia is scaling back some aspects of its program, and Arkansas is working to revive its program after a legal challenge.
Notably, an analysis by KFF found that more than 90% of U.S. adults eligible for Medicaid as part of the Affordable Care Act expansion are already working or would be part of a group that is exempt from work requirements.
When will Medicaid changes start to happen?
Work requirements for Medicaid are set to take effect in December 2026, after the upcoming midterm elections, while other funding changes won’t take effect until 2028.
The legislation did not detail when changes for SNAP will begin.
How will the legislation affect other health care services that rely on Medicaid funding?
The legislation limits how states can funnel money into their Medicaid programs by putting a limit on provider taxes, which are fees that states collect from health care providers that help pay for Medicaid, starting in 2028.
Every state applies a different tax rate, but the new law lowers the cap that states can tax from 6% to 3.5% by 2032.
In response to concerns about the impact on rural hospitals, which rely on Medicaid reimbursements, lawmakers added in $50 billion to stabilize rural hospital finances. The money is set to be split between states and their hospitals. Experts estimate the $50 billion would cover less than half of the losses rural hospitals will see from the Medicaid changes.
States will likely look for other places to trim what is covered by Medicaid in their budgets. In Missouri, experts say, that could look like reducing some dental or mental health services, or potentially pulling back on a recent bipartisan law that covered women for up to one year after they give birth.
