Threats to Medicaid in Tennessee
What is happening now:
Currently, a bill is moving through Congress in DC that proposes to make significant cuts to Medicaid. The bill uses a mechanism called the “reconciliation” process. This process allows the bill to pass the House and Senate with a simple majority, meaning that the Senate is unable to filibuster (block) the bill. Republicans have a majority in both the House and Senate, meaning that the bill is very likely, in some form, to pass. Reconciliation bills are somewhat limited, meaning they may only deal in mandatory federal spending, revenue and the federal debt limit. Those limits, however, are flexible and the bill may include many things that appear to fall outside that categorization.
The current reconciliation bill, titled “Big Beautiful Bill” (BBB), has passed through the House and is currently being deliberated in the Senate. The House version that has passed proposes over $800 billion in cuts to Medicaid. We know some of the ways that the bill intends to cut costs, including mandatory work requirements (with exceptions for people with disabilities), requiring redeterminations for eligibility take place twice per year rather than the current once per year and limiting a state’s ability to use a provider tax to draw down more federal Medicaid money. This is not all the bill does to Medicaid, but those measures are some of the primary mechanisms intended to generate savings. It is likely that the Senate will make changes to the BBB, but it is not clear what those changes might be.
What happens next:
The Senate will work on finalizing the bill. Republicans hold a very small majority in the Senate (53-47), meaning that they must finalize a bill that is acceptable to most Republican members. Some Republicans in the Senate have expressed concerns about the extent of the Medicaid cuts, others have expressed concern about how the cost of the bill would increase the national debt. This means that Senators will spend time negotiating in order to ensure that they have at least 50 votes (in the case of a 50-50 tie, the Vice President, Republican JD Vance, would cast the deciding vote). It is very likely that Senate will make some changes to the bill, but we don’t know what those are yet.
Senator John Thune, who is the Senate Majority Leader, has established a July 4th deadline for the Senate to vote on and pass the bill. This deadline is not a strict deadline, but it puts pressure on Senators to negotiate now. Ultimately, the bill, in some form and at some point, is very likely to pass. Given that the House, Senate and White House are Republicans, there is little to stop it from passing.
While specific cuts that have been proposed thus far are of course impactful, the cuts will also likely change the way state Medicaid agencies (like TennCare in Tennessee) operate. States will likely have smaller Medicaid budgets in total, which could impact people with disabilities and the care and services they receive. These are details we do not currently know, and will likely be different state by state. At this time, it is even difficult to speculate about what these changes might be.
Many of the cuts in the bill will also take time to implement. For example, the House’s version of work requirements will not take be mandatory for states to implement until December 31st, 2026. It will also take time to see the tangible effects of these cuts on states and the people enrolled in Medicaid programs. The impacts of these cuts will also evolve over time as state Medicaid agencies and state legislators respond to and evolve to accommodate the cuts. The BBB, in its current form, will likely impact TennCare and Tennesseans in known and unknown ways for years to come.
What it means:
In sum, this bill proposes a historically large cut to Medicaid. The specific cuts and the specific impacts, short and long term, are unknown at this point. However, it is very likely that states will be forced to reduce spending, either through cuts to services or eligibility. Again, it is unclear what those would look like and who they would specifically impact at this point.
What you can do:
As noted above, there is very little that can be done to stop the bill in its entirety. However, the details of the bill are not finalized, and those can be changed with enough pressure. Cuts like this, and the impact they will have on people with disabilities, should not go unchallenged - please consider reaching out to your Congresspersons.
You can find and contact your Senators and Representatives at this link.
It is important to make this issue as human as possible – you might talk about how you and your family are impacted and supported by Medicaid, what it might mean to lose access to that support and ask them to vote in a certain way.
Other resources:
Below are some resources that can help explain the current process, the “Big Beautiful Bill” and what some predict the impacts of the bill would be.
KFF – Health Provisions in the 2025 Federal Budget Reconciliation Bill
- This article describes in detail what measures are currently in the bill, how that represents a change from the current law, and offers additional resources on these measures.
- This article describes how the current version of the BBB would negatively impact people with disabilities
CBPP – 2025 Budget Impacts: House Bill Would Cut Assistance and Raise Costs for Seniors
- This article describes how the current version of the BBB would negatively impact Seniors
Tennessee Lookout – “Big Beautiful Bill” cuts to Medicaid, food aid raise alarm in Tennessee”
- This article features Tennesseans and Tennessee organizations describing how the BBB would impact Tennesseans with disabilities and those receiving food assistance (like SNAP)
- This article describes the impacts of the proposed cuts on the to rural and safety-net hospitals, noting that the bill would likely cause these hospitals to become financially unstable and at risk of closure
Georgetown University – Medicaid and Chip Cuts in the House-Passed Reconciliation Bill Explained
- This article describes the nuts-and-bolts policy changes and how that would impact how state Medicaid agencies finance and provide services