On May 22nd, 2025, the U.S. House of Representatives passed a budget reconciliation bill by just one vote. The bill contains many provisions that will be catastrophic for people with disabilities. It includes at least $715 billion in Medicaid cuts over the next ten years. At least 13.7 million people will lose their health coverage. This is according to the Congressional Budget Office. This office is non-partisan. This means that it doesn’t lean towards one party.
We’ll be going over the biggest policy changes in this bill. And what it means for the disability community.
AAPD has also created an explainer for the budget reconciliation process. We encourage you to read the reconciliation explainer here.
Cuts to Medicaid and Changes to the Affordable Care Act
Medicaid had been around for 60 years. This bill has the largest cuts to Medicaid in its history. 73 million people rely on Medicaid. This includes disabled adults and children. It also includes older adults who do not have a lot of money. Many rely on Medicaid to cover costs that Medicare does not cover, such as premiums and copays.
There is also a risk of hospitals in rural areas closing. Many hospitals in rural areas rely heavily on Medicaid. Disabled people are more likely to live in these areas, and use these hospitals for regular care. This will negatively impact people who live in those communities. They will be in a “care desert”. This means there won’t be anywhere nearby to receive medical care.
Some of the new policies and requirements include:
Medicaid Work Requirements. If this bill passes, many people on Medicaid will need to work to keep receiving it. This policy is called “Medicaid work requirements.” AAPD strongly opposes Medicaid work requirements for many reasons. Work requirements cause harm. They address a problem that doesn’t actually exist. 92% of adults under 65 on Medicaid who don’t get Social Security benefits are already working. They are doing so without work requirements.
Medicaid work requirements are hard to put in place. They can also cause people to lose benefits due to inability to submit documentation. Additionally there can be difficulties hitting required hours or administrative errors. Arkansas and Georgia have put work requirements for Medicaid in place. This caused thousands of people in those states to lose their Medicaid coverage.
The text of the bill does make some exceptions for some people. People who are pregnant, have a disability are exempt. People who have a substance abuse problem or mental health disorder are exempt. People who take care of children or sick family members are exempt. But there are some big problems with this.
- Defining “disability” can be difficult. People who have disabilities that are not well understood can be left out. People who have a disability that makes it harder for them to work can also be left out. Especially if they don’t yet have an official diagnosis. Laws can reflect assumptions and bias about this.
- There have been states that have implemented these work requirements. We have seen that people in those states who should be exempt can still lose their benefits.
- People who get Medicaid already have spent so many hours getting paperwork together. And navigating the system that is already difficult to do. They do this so that they can keep the benefits they already have!
Work requirements also ignore something important. Sometimes, the services Medicaid provides are the reason someone can work at all. An example of this is Home- and Community-Based Services (HCBS). If Medicaid services like these are cut, people are going to lose access to the supports they need to have a job. If this bill passes, work requirements will begin by the end of 2026.
This bill also forces people to show proof of citizenship or immigration status to receive Medicaid. This change will go into effect right away. People are going to need to have time to meet these requirements. Many people do not have easy access to things like their birth certificate or their Social Security cards. This change would not give them the time they might need to do that.
This policy is based in anti-immigrant ideas. It is designed to target states that use their own money to extend healthcare coverage to undocumented people. These states have some of the largest populations of Medicaid recipients and disabled people in the country. This requirement could remove large numbers of people from Medicaid. As an example people in California who lost their homes in the wildfires of January 2025 could lose healthcare suddenly.
Reduced Medicaid Funding for States that Cover Undocumented Immigrants. There is more policy driven by anti-immigrant sentiment in the bill. The government will cut 10% of federal Medicaid funds if states use it to provide health insurance to undocumented immigrant adults, children, or both. This is bad for HCBS, a Medicaid service that disabled people use to acheive or maintain independence.
More Frequent Eligibility Determinations. Every year, people who are on Medicaid will need to submit documents to keep their benefits. This process is called “eligibility redetermination.” This bill will cut that time down to every 6 months. This is an added extra burden on people who receive Medicaid.
Restricting the Open Enrollment Period for the Affordable Care Act (ACA). When you sign up for health insurance, either through your job or on your own, you have to sign up at a particular time. This time is called the “open enrollment period”. This bill would shorten that window of time.
This bill would no longer allow low-income Americans to use the ACA marketplace to enroll in ACA-facilitated health coverage at all. If a low-income person suddenly lost their job, they would be unable to sign up for health insurance through Medicaid or the ACA marketplace.
Restricting States’ Ability to Finance Medicaid. Many states use provider taxes to finance their Medicaid programs. The bill also places a restriction on new or increased provider taxes. These taxes are put in place by states. Healthcare facilities pay these taxes. These taxes fund their share of Medicaid programs. This will reduce access to services for people on Medicaid in those states. This is because there is less money to pay for them.
New Cost-Sharing Requirements. Medicaid works by having the federal government pay for some of it. And having the states pay for another part of it. They share this cost. This bill will make it so even more is paid by the states. This is done by charging patients up to a $35 fee for each Medicaid-covered service they use. This will effect low-income people on Medicaid the most. Especially people with disabilities who use several services every month.
Most people on Medicaid do not have extra money to cover these fees. Many disabled people who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) also receive Medicaid. People who are on Social Security have rules about how much money they can earn and save. In 2025, any recipients under the age of of 66 cannot earn more than $23,400 per year.
Reductions in SNAP Benefits
The House reconciliation bill also includes major changes to the Supplemental Nutrition Assistance Program (SNAP), which helps many low-income individuals, people with disabilities, and their families buy food each month.
These reductions in SNAP funding will cause many to lose the benefits that help them buy groceries each month. For disabled people, high healthcare costs, lack of employment opportunities, and difficulty accessing food resources make them more likely to experience food insecurity. In fact, more than 37% of households that receive SNAP include a disabled adult, making SNAP a critical source of food for people with disabilities.
Taken together, these extreme cuts to Medicaid and SNAP will leave millions of Americans without access to healthcare, Home- and Community-Based Services, and food at a time of increasing economic uncertainty and rising prices. Lack of access to Medicaid will saddle many struggling families with increased medical debt, forcing them to make the awful, gut-wrenching choice between getting their prescriptions or putting food on the table.
Here is a summary of the changes to SNAP:
- Reduced Federal Funding for SNAP: The House bill would cut $267 billion in federal funding for SNAP over the next ten years. These cuts will reduce or completely cut current or future benefits for all 40 million SNAP recipients – children, parents, older adults, disabled people, workers, and other low-income people. Roughly 1 in 8 people in the U.S., and 1 in every 5 children relies on SNAP to eat.
- Increases Financial Burden on States: For the first time, states would be required to fund at least 5% of benefit costs, and could be required to pay as much as 25% in states with a high incidence of benefit payment errors. In addition, states would have to cover 75% of the costs of administering SNAP, an increase from the current 50%. This could lead some states to make very difficult decisions to reduce SNAP benefits, or cut other vital programs like public education or veterans services.
- Imposes Work Requirements: Currently, SNAP recipients aged 18-54 are required to work, look for work, or be enrolled in an educational or vocational training program in order to receive benefits. If signed into law, the bill passed by the House would expand SNAP work requirements for individuals up to age 64. Older adults may have difficulty getting a job to satisfy these work requirements and lose their SNAP benefits as a result.
- Restricts Existing Exemptions to Work Requirements: In addition to the expanded work requirements for SNAP, the House bill would restrict current exemptions from work requirements for parents who cannot work because they are caring for their children. The bill would limit the exemption to adults caring for children under the age of 7. This will lead many to lose their benefits if they cannot find or afford adequate childcare so that they can go to work. Others may be unable to work because they care for a disabled child over the age of 7 with significant care needs; they, too, would be forced to return to work under these exemption restrictions.
Increased Contributions to ABLE Accounts
The reconciliation bill passed by the House does include some good provisions, including an extension of the increased contribution limits and other enhancements to ABLE Accounts, which allow individuals with disabilities to save tax-free for future disability-related expenses.
Here’s a closer look at some of the ABLE provisions:
- Extension of the Increased Contribution Limit: If signed into law, the bill passed by the House would extend the increased contribution limits for ABLE Accounts, allowing contributions up to the federal poverty level for one person or the beneficiary’s earned income for the year, whichever is less.
- Extension of the Savers Credit for ABLE Contributions: The bill would also make permanent the Savers Credit for beneficiaries who make qualifying contributions to their ABLE Accounts. The Savers Credit is a tax credit designed to help low and moderate-income individuals offset the cost of saving for the future. The credit can reduce the amount of tax you owe, but it is nonrefundable, meaning you don’t get it back.
- Extension of Provision Allowing Rollovers from Qualified Tuition Savings Accounts: Finally, if enacted, this bill would permanently extend the ability to roll funds from qualified tuition savings programs, such as 529 Plans, over to ABLE Accounts tax-free.
While these ABLE Account provisions are good for people with disabilities, the positive impact of these ABLE provisions would be greatly diminished by the cuts to Medicaid and SNAP, which will significantly reduce the ability of people with disabilities to save money and drastically reduce disabled people’s economic security overall.
That is why, even though it contains these positive advances in ABLE Accounts, AAPD opposes this bill. AAPD believes that this budget resolution poses a major threat to the health, economic opportunity, and lives of millions of disabled Americans.
What Comes Next?
Now that the House has passed the bill, it goes to the Senate, where Senators will debate and amend the bill.
Some Senators have expressed grave concerns about the cruel Medicaid cuts proposed by the House and have indicated they intend to change or oppose these cuts. Senators are much more likely to change or oppose these cuts if they are hearing from their constituents that they do not want their elected official to support cuts to Medicaid.
The Senate bill may contain significant differences and changes from the bill passed by the House. If the Senate passes a version of this bill, the House and Senate will have to meet and come to an agreement on any differences, and the House will have to vote again on final passage before the bill goes to the President to be signed into law. This means we still have at least 3 votes left before these cuts are finalized, and many opportunities to stop this bill. You can learn more about where we are in the reconciliation process and what is next by reading AAPD’s Budget Reconciliation Explainer.
It has never been more important for you to use your power and speak out against these cuts. We need you, your family members, and your friends to contact your Senators and tell them NO CUTS TO MEDICAID OR SNAP! Use AAPD’s tool linked here to call and write your Senators in just a few clicks, then share it with 3 others and ask them to take action, too.