These 15 Congressional Districts Would See Large Medicaid Funding Losses Under Republican House Budget Resolution

Medicaid and the Children’s Health Insurance Program (CHIP) cover essential, lifesaving health care for nearly 1 in 4 Americans—including low-income individuals and families; pregnant women; seniors; and people with disabilities. For the nearly 80 million people* covered by Medicaid or CHIP, those programs mean being able to see a doctor when they are sick; obtain the medication that they need; or afford home-based care or nursing home services near the end of life.

The Republican House budget resolution currently under consideration instructs the House Energy and Commerce Committee to cut at least $880 billion in costs through 2034. Based on previous proposals from House Budget Committee Republican leadership, these cuts are widely anticipated to come from the Medicaid program.

A new analysis from the Center for American Progress explores the potential reach of these cuts by congressional district. The analysis shows potential federal funding losses by district if the $880 billion in cuts were to be proportional to current Medicaid and CHIP enrollment using 2023 American Community Survey data from the U.S. Census Bureau. On average, each congressional district would lose $2 billion in federal funding over nine years.

The 15 congressional districts highlighted in Table 1 below could see especially high losses, totaling nearly $34 billion in federal funding.

While it is still unclear exactly how the Energy and Commerce Committee would achieve $880 billion in Medicaid cuts, proposals previously floated have included adding burdensome work requirements to the program or shrinking the federal medical assistance percentage (FMAP) that provides states with significant support to help finance their Medicaid programs. An analysis by the Urban Institute estimates that a reduction in the FMAP rate for just those Medicaid enrollees eligible under the Affordable Care Act’s Medicaid expansion option would lead to 15.9 million people losing Medicaid and CHIP coverage in 2026 if those states cannot make up the shortfall and drop their expansion, as a result. Urban’s coverage reduction estimates by congressional district for such a scenario are also shown in Table 1.

Cuts to federal Medicaid funding would have far-reaching consequences, with states being forced to either raise taxes or scale back program eligibility, limit covered benefits, or lower reimbursement rates to providers.

*Authors’ note: Administrative data will differ from survey data due to the time period, data collection methods, and the December 2023 enactment of Medicaid expansion in North Carolina.