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, including at least $715 billion in Medicaid cuts over the next ten years, and at least 13.7 million people losing their health coverage.
This resource provides an overview of some of the most significant policies in the budget reconciliation bill, and how this bill would affect 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
The bill’s new requirements for Medicaid recipients and reductions in federal funding represent the largest cuts to the Medicaid program in its 60-year history. Medicaid currently covers more than 73 million people, including adults, children, people with disabilities, and low-income seniors. Many rely on Medicaid to cover costs that Medicare does not cover, such as premiums and copays. According to the nonpartisan Congressional Budget Office, these cuts will result in at least 13.7 million Americans losing their health insurance between now and 2034.
In addition, these requirements pose the risk of causing hospitals in rural areas to close, as many rural hospitals serve communities that rely heavily on Medicaid. Disabled people are also more likely to live in rural areas and to rely on these hospitals to access routine care. Medicaid recipients and non-recipients alike will be negatively impacted by losing access to rural hospitals, and more Americans than ever will live in a “care desert.”
Some of the new policies and requirements include:
Medicaid Work Requirements: If this bill becomes law, many Medicaid recipients will be required to work in order to continue receiving Medicaid. This policy is called “Medicaid work requirements.” AAPD strongly opposes Medicaid work requirements for many reasons. Work requirements cause harm in order to address a problem that doesn’t really exist: 92% of all adults under 65 on Medicaid (who also do not receive Social Security benefits) are already working, and doing so without work requirements.
Medicaid work requirements are difficult to implement and they cause people to lose their Medicaid benefits due to inability to submit required documentation, difficulty working enough hours to meet the requirements, and administrative errors. Arkansas and Georgia have implemented work requirements for Medicaid in recent years, which caused thousands of people in those states to lose their Medicaid coverage.
The text of the bill exempts individuals who are pregnant, have a disability, have a substance abuse or mental health disorder, and those who care for children or sick relatives. There are three major problems with this exemption:
- Historically, definitions of disability can leave out people who have disabilities that are not well understood, or have a disability that is impeding their ability to work, but has not yet been diagnosed. Policy can – and often does – reflect ableist assumptions and bias.
- In states that have implemented work requirements with similar exemptions, we have witnessed that many people who qualify for these exemptions still lose their Medicaid because of confusing and complicated paperwork processes.
- Even without work requirements, Medicaid recipients already spend multiple dozens of hours meeting documentation requirements and navigating bureaucracy and red tape in order to keep the benefits they have now.
Work requirements also ignore how the support provided by Medicaid services, like Home- and Community-Based Services (HCBS), are the only reason many people with disabilities are able to work at all. If their Medicaid services are cut even a little bit, many individuals to lose the very supports that are necessary for them to remain employed. If this bill passes, work requirements will begin by the end of 2026.
Proof of Citizenship or Immigration Status for Medicaid: The reconciliation bill also requires Medicaid recipients to provide proof of citizenship or immigration status to receive Medicaid. This requirement would go into effect immediately, creating a timely administrative requirement that many people would need time to fulfill. Many people do not have easy access to documents like birth certificates, Social Security cards, visas, or other documents to prove their citizenship or immigration status, and would need time to gather these documents. However, there is no waiting period for this requirement, which means the policy would not give them time to gather the proof they need.
This policy is based in anti-immigrant ideas. It is specifically designed to punish states like California, Minnesota, New York, Utah, and others that use state money to extend healthcare coverage to undocumented immigrants. These states have some of the largest populations of Medicaid recipients and disabled people in the country, which means this requirement could remove large numbers of people from Medicaid. For example, in California, Medicaid recipients who lost their homes – and important personal documents – in the January 2025 wildfires in LA could be thrown off their health insurance very suddenly by this policy.
Reduced Medicaid Funding for States that Cover Undocumented Immigrants: The bill includes a second policy driven by anti-immigrant sentiment – the federal government will cut 10% of federal Medicaid funds given to any state that uses state funds to provide health insurance to undocumented immigrant adults, children, or both. This will lead to devastating cuts in optional Medicaid services, such as Home and Community-Based Services (HCBS), which millions of disabled Medicaid recipients rely on to maintain their independence.
More Frequent Eligibility Determinations: In order to continue to receive Medicaid, all Medicaid recipients are required to submit extensive financial and medical documents once a year in order to certify their eligibility to remain on Medicaid. This process is called “eligibility redetermination.” The House bill requires states to do Medicaid eligibility redeterminations every 6 months instead of once a year. This will add yet another time-consuming paperwork burden on Medicaid recipients.
Restricting the Open Enrollment Period for the Affordable Care Act: The bill would shorten the open enrollment period, which is the time each year when Americans can sign up for health insurance on the Affordable Care Act (ACA) health insurance marketplaces in their state.
The bill would also no longer allow low-income Americans to use the ACA marketplace to enroll in ACA-facilitated health coverage any time throughout the year. This means if a low-income person experiences a sudden drop in income (for example, if they are one of the 28 million Americans with no paid leave and need to take time off to care for a sick parent) or loses their job, they may be unable to immediately sign up for health coverage through Medicaid or the ACA marketplace, and have to go weeks or months without health insurance.
Restricting States’ Ability to Finance Medicaid: The bill also places a restriction on new or increased provider taxes. Many states use provider taxes to finance their Medicaid programs. These taxes are levied by states on hospitals, nursing homes, and other healthcare facilities to help pay for their share of Medicaid programs. This will lead to significant gaps in state Medicaid budgets, which will reduce Medicaid recipients’ access to services.
New Cost-Sharing Requirements: To shift even more of the costs of Medicaid to the states, this bill will require states to charge patients a fee of up to $35 for each Medicaid-covered medical service provided. This will significantly burden low-income people on Medicaid, especially people with disabilities who often need multiple medical services a 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. Social Security recipients are subject to strict 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.