Major Medicaid and ACA Marketplace changes could be coming: What consumers need to know now

healthinsurance.org tracking proposals that could impact eligibility, enrollment and costs for millions

/EIN News/ -- Minneapolis, MN, April 08, 2025 (GLOBE NEWSWIRE) -- Millions of people who rely on Medicaid and ACA Marketplace coverage (Obamacare) could be impacted by sweeping federal policy changes under consideration. Healthinsurance.org is closely tracking these developments and breaking down what consumers need to know about enrollment, eligibility and the cost of coverage.

 “These proposed changes represent a significant shift in health coverage, and some could take effect sooner than you think,” said Louise Norris, health policy analyst for healthinsurance.org. “Millions of people could see significant changes to how they access coverage and how much it costs.” 

Medicaid work requirements, reduced funding could threaten access

More than 72 million people rely on Medicaid, the nation’s largest health coverage program, which is now at the center of funding debates. The joint federal and state health insurance program supports low-income people and provides coverage for more than one-third of the nation’s children and the majority of nursing home residents.

A recently passed House spending plan directs the House committee with jurisdiction over Medicaid, Medicare, and the Children’s Health Insurance Program to reduce the federal deficit by $880 billion over 10 years. This potentially puts Medicaid in the crosshairs, with federal work requirements and cuts to federal funding for Medicaid expansion under consideration.

Medicaid work requirements mandate that certain enrollees participate in “community engagement” activities – such as work, school, job training or volunteering – to maintain their coverage. There’s never been a federally imposed Medicaid work requirement, but interest is growing. Georgia implemented work requirements in 2023 for certain beneficiaries, and about a dozen more states are considering similar mandates or are already working toward gaining federal approval.

The impact to beneficiaries could be even more far reaching if the federal government reduces Medicaid funding to states, especially in states that adopted Medicaid expansion to cover more people with low incomes.

The federal government currently pays 90% of a state’s cost to cover its Medicaid expansion population. If federal funding is reduced, nine states have “trigger” laws that automatically terminate Medicaid expansion; three others would automatically require the state to review the Medicaid expansion program and potentially change eligibility rules. 

“Millions with Medicaid would lose health coverage if trigger laws were activated,” Norris said. “Even states without these laws would struggle with costs if the federal match were reduced, potentially leading them to also eliminate Medicaid expansion."

Proposed reduction for Marketplace enrollment period, coverage cuts for Dreamers 

More than 24 million people have Marketplace (Obamacare) coverage. A shorter annual open enrollment period, decreased funding to help consumers select coverage and higher health insurance premiums are possible changes that could impact these individuals in the coming year. 

The Trump administration announced in February it would slash Navigator funding for enrollment assistance by 90% to just $10 million per year starting with the grants that will be awarded in late summer 2025. This will result in fewer Navigators available to assist with enrollment in 2026 coverage. 

The administration has also proposed a rule that would:

• Shorten the annual open enrollment period – in every state – for Marketplace coverage so it runs Nov. 1 - Dec.15. It currently runs through Jan. 15 in most states.
• Eliminate the special enrollment period for people with low incomes.
• Cut off Marketplace eligibility for “Dreamers,” which the Biden Administration granted to the Deferred Action for Childhood Arrivals (DACA) population. In 19 states, DACA recipients are already ineligible due to a 2024 court ruling. 
• Require additional documentation for some consumers when applying for Marketplace subsidies and special enrollment period access.
• Increase maximum out-of-pocket limits by 15% to $10,600 for 2026 plans for single individuals.

The public can weigh in on the proposed rule through April 11. 

Also on the radar: Marketplace subsidy enhancements, which helped millions save on premiums for five years, are set to expire on Dec. 31, 2025. Without an extension, costs will rise for nearly all enrollees. In 2024, over 90% of Marketplace enrollees received premium subsidies.

“Newly proposed Marketplace rules, expiring subsidy enhancements and potential Medicaid funding cuts – could result in significant changes to health coverage access in the coming months,” Norris said.

Healthinsurance.org provides online resources for consumers about individual and family health insurance. Healthinsurance.org, owned by HealthInsurance.org, LLC, has been providing consumer information about health insurance and health reform for over 25 years.

Attachment

• States with Medicaid trigger laws

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