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What’s At Stake? The Future of Medicaid

For decades Medicaid has served as a critical safety net for millions of people with limited income and resources. Nearly 70 million people, including millions of children and adults with disabilities and low-income older adults, rely on the Medicaid program for health care coverage and assistance with basic life functions such as eating, dressing, and bathing.

Medicaid has never been a static program. Since its inception in 1965, the program has evolved to meet the changing needs of the people it serves, the providers who deliver services, the states that directly administer their program, and the federal government, which partners with states to fund and run the program.  However, a wave of proposals now moving through state capitals and awaiting federal approval could drastically impact the future direction of this critical program.

Changes on the Horizon

The Secretary of the Department of Health and Human Services has discretion under Section 1115 of the Social Security Act to waive certain federal Medicaid requirements and allow states to conduct “experimental, pilot, or demonstration projects” as long as they promote Medicaid’s primary objective of providing access to health care services to low-income individuals.

Through that allowed discretion, states are now seeking waivers for a range of new Medicaid eligibility requirements that are contrary to the program’s spirit and threaten the ability of many Americans to get basic needs met. Those waivers include:


Analyses indicate that each of these policies could reduce coverage, blocking benefits to people for whom they are intended. People would lose (or never receive) crucial life-sustaining coverage for simply being unable to comply with the requirements, or for merely not completing paperwork or performing reporting requirements. Even mistakes by program administrators could prevent coverage.

Looking Beyond Waivers

In addition to potential changes to Medicaid through waivers, there are a number of other policy issues, whether through program design or implementation, that will impact Medicaid enrollees, particularly older adults. In coming months, the Public Policy Institute will bring these issues to the forefront, including:



Across all of these projects, we will seek to amplify the voice of the Medicaid consumer and highlight first-hand experiences of those who rely on the program.

There is so much on the line that could impact millions of people. While general support for the Medicaid program has increased favorably over time, the debate over the future of the program has not stopped. To help inform these debates, the AARP Public Policy Institute will be releasing a series of blogs and reports to break through the noise, debunk the myths, and equip you with new information and insights about the critical role Medicaid plays in helping people meet their daily needs.  There is just too much at stake.