Psychology Week 8, Assignment

New Medicaid Laws

Let’s Talk About It and What You Can Do

July 2025

A Reminder

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This information is intended to provide education and raise awareness about the impact proposals could have on people with disabilities, developmental disabilities, their families, aging adults, and people who use supports to live independently.

By sharing this information, the purpose is to help people be informed and prepared to engage in thoughtful dialogue regarding policies.

This training is part of our ongoing commitment to provide information for people to have access to needed community services, individualized supports, and other forms of assistance to promote their own self-determination, independence, productivity, and community living.*

*Developmental Disabilities Assistance and Bill of Rights Act of 2000, (Public Law 106–402; 42 U.S.C. Sec. 15001 et seq.) Section 101

The Situation

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July 2025, President Trump signed legislation to:

▪ $4.5 trillion tax cut

▪ $1.5 trillion cut in spending across the federal budget

▪ Of that, $1.3 trillion cut from health care and food supports:

▪ Medicaid and other health care – $1 trillion

▪ 17 million people in American lose health insurance, 3.4 million in California

▪ SNAP (Cal-Fresh) – $269 billion

▪ 3 million could lose food supports,

▪ This is the biggest cut to Medicaid and SNAP spending

▪ $5 trillion increase in debt limit

So what happens now? Source: What's in Trump's Big Policy Bill? - The New York Times; About 17 Million More People Could be Uninsured due to the Big Beautiful Bill and other Policy Changes | KFF; Here’s what’s in the big bill that just passed the Senate | PBS News

Overview

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Let’s talk about it…

▪What just happened?

▪What’s in it?

▪What happens now? And when?

▪What can I do?

What just happened?

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This year, over 7,700 people were engaged in conversations about Congress’ proposals to cut federal spending and Medicaid.

Telling Your Story

More than 2,600 individuals shared their stories, in their own words, many with powerful photos.

But they passed the cuts anyway

We are enough. Our stories are enough.

What just happened?

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I wrote to you after it passed and many replied.

“We are all trying to do the best we can with what little we get. There are no extras, no handouts. We’re just making it from day to day.”

“All the letter writing in the world won’t help”

And more…

What just happened?

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Our silence is permission

Our silence is acceptance

What just happened?

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What just happened?

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None can say they didn’t know…

What’s in it?

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It’s not just about budgets. It’s about values.

Source: What's in Trump's Big Policy Bill? - The New York Times

What’s in it?

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Tax cuts are the priority

▪ Tax cuts from President Trumps first term were going to expire at the end of this year

▪ Many people would have paid more taxes

▪ This bill keep these tax cuts from ending

▪ This bill adds more tax cuts

▪ No taxes on tips or overtime pay

▪ Raise the childcare tax credit by $200

▪ Help people in California who have expensive home loans

What’s in it?

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Who get the most?

People with more money get

more of the tax cuts

• The richest get 72% of the cuts

• About $66,000 each

• The poorest get 0%

• About $40 each

Source: Analysis of Tax Provisions in the Trump Megabill as Signed into Law:

National and State Level Estimates – ITEP

What’s in it?

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Tariffs are a tax

• Tariffs are a tax on things from

other countries

• Companies pay the tariff then

raise prices

• This is why people say tariffs

don’t work

• Almost 60% of people will pay

more as the price of things go

up than save from the tax cut Source: Analysis of Tax Provisions in the Trump Megabill as Signed into Law:

National and State Level Estimates – ITEP

What’s in it?

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To pay for part of the tax cuts, there are cuts to Medicaid and other services

Source: What's in Trump's Big Policy Bill? - The New York Times

Description Cut

Work

Requirements

Require childless adults and parents of

children older than 14 to work, volunteer or

attend school for 80 hours a month as a

condition of enrollment, unless they qualify

for an exception, DD excepted

$317 billion

Provider Taxes Freeze current taxes states use to pay its

part of the federal match and slowly lower

the allowed rates from 6% to 3.5%

$183 billion

Medicaid

Eligibility Rule

Allow states to require more paperwork and

more frequent eligibility checks for people in

Medicaid

$78 billion

What’s in it?

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Exempt from work requirements

“…person who is medically frail or otherwise has special medical needs, including an individual: who is blind or disabled…with a substance use disorder; with a disabling mental disorder; with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living; or with a serious or complex medical condition”

“…person who is the parent, guardian, caretaker relative, or family caregiver of a dependent child 13 years of age and under or a disabled individual”

Source: beginning on page 681 H.R. 1

What’s in it?

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To pay for part of the tax cuts, there are cuts to Medicaid and other services

Source: What's in Trump's Big Policy Bill? - The New York Times

Description Cut

More Eligibility

Checks

Require states to check eligibility of people

in the Medicaid expansion every six months

instead of once a year

$58 billion

Managed Care

Taxes

Prevent states from using taxes on

managed care plans to increase federal

funding (CA uses this to help pay its share of

Medicaid services)

$34 billion

Reduce

Emergency

Payments for

Immigrants

Lower the share of medical bills paid by the

federal government for undocumented

immigrants who are treated for emergencies

$28 billion

What’s in it?

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To pay for part of the tax cuts, there are cuts to Medicaid and other services

Source: What's in Trump's Big Policy Bill? - The New York Times

Description Cut

Nursing Home

Staffing

Cancel a regulation that required minimum

staffing ratios for nursing homes

$23 billion

New

Co-Payments

Require states to charge some Medicaid

patients co-payments of up to $35 for

medical services

$7.5 billion

Limit

Immigrant

Medicaid

Coverage

Limit eligibility after a 5-year waiting period

to green card holders and certain other

immigrants (current law includes all who are

“lawfully present”)

$6.2 billion

What’s in it?

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Cuts to Other Health Care

Source: What's in Trump's Big Policy Bill? - The New York Times

Description Cut

Obamacare

Verification

Require annual verification of income and

other changes

$82 billion

Obamacare

Penalties

Require people who estimate their income

incorrectly to refund the government for

more tax credit

$20 billion

What’s in it?

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Add to Medicaid

Source: What's in Trump's Big Policy Bill? - The New York Times

Description Adds

Home and

Community

Based Services

Allow states to apply for new waivers to offer

home care services to more people

$6.6 billion

What happens now? And when?

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When will it go into effect? Cut taxes now, cut services later

There may be a year or more before you see changes Source: What's in Trump's Big Policy Bill? - The New York Times

What? When?

Tax cuts Now in 2025

State have a plan for Medicaid

work requirements

January 2026

Medicaid work requirement go into

effect

December 31, 2026

Medicaid funding changes 2028

What happens now? And when?

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Federal Notification and Implementation Guidelines to States

Medicaid (Jan. 1, 2026)

Agency: CMS (Centers for Medicare & Medicaid Services)

Mechanism: State Medicaid Director Letters (SMDLs),

Medicaid Informational Bulletins, Technical Assistance

Calls/Webinars, Updates to Medicaid State Plan

Amendment (SPA) process and waiver templates

Audience: State Medicaid agencies, governors, health and

human services departments

SNAP (2028)

Agency: USDA, Food and Nutrition Service (FNS)

Mechanism: Program memos and formal guidance, Regional

office briefings and online trainings, Updates to policy handbooks and compliance

checklists

Audience: State SNAP agencies, departments of social

services/family assistance

Provider Tax Reform (2028)

Agency: Centers for Medicare & Medicaid Services (CMS)

Mechanisms: State Medicaid Director Letters (SMDLs),

Federal Register rules, Webinars and state consultation

calls, Updated SPA and waiver templates

Additional Considerations

States reliant on provider taxes (especially nursing home or

hospital taxes) should model alternative funding strategies.

CMS is expected to provide transition guidance to help

states adjust budgets and Medicaid financing tools by the

2028 deadline.

What happens now? And when?

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When the guidelines are clear and plans are in place, the policy changes go into effect. .

With less Medicaid dollars from Washington D.C. California will need to:

▪ Find other ways to pay for services, like by raising taxes or taking money from other parts of the state budget;

▪ Give services to fewer people;

▪ Give fewer services;

▪ Or a combination of these options

All are hard options for states! .

When will the Governor and Legislature do this?

What happens now? And when?

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What’s happening in California’s Capitol now?

July 17: Vote on the budget “clean up” bills

July 18 – August 18: Summer recess

September 12: Last day of the Legislative year

The Governor and Legislature will need to revise state Medicaid budgets to address gaps in all services and look at less money from provider taxes.

That may not be until the next fiscal year 2026-2027.

What happens now? And when?

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What will this mean for my services? My family?

It’s too early to know.

We are here

Me President signs

budget bill

CA understands what it means,

makes decisions

Departments (DDS, DSS, etc)

get directions

Agencies (regional centers, IHSS) take action

What can I do?

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Get Skills Connect Report Problems

What can I do?

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Build skills to talk with decision makers

Trainings like these help you prepare to share your story, express what matters most to you, and speak out when Medicaid cuts or other policy decisions affect your life or the services you rely on.

You will learn how to start a conversation, what to say, and how to follow up effectively.

Everyone is welcome, whether you are new to advocacy or already using your voice.

What can I do?

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Launching Medicaid Watch bit.ly/SCDDMedicaidWatch

Reductions in Medicaid-funded services have not yet happened.

When there are, you need to be able to do something. That’s Medicaid Watch.

We want to hear directly from you about what is changing because Medicaid is changing.

Whether you lost a service, experienced delays, lost people who provide care, or are just worried about what’s ahead, we want to know.

Your voice helps us hold systems accountable. Medicaid Watch is accountability.

Last Thoughts

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Our job is not finished.

We will keep showing up. We will keep telling the truth.

We will keep fighting for a California where everyone belongs.

We will keep working to make California the best place to live for people with developmental and other disabilities.

We know how to move forward: together

Questions and Discussion

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