Congress is considering major cuts to Medicaid. This is the third in a series of blog posts designed to share resources to help understand what’s at stake. Part 1 focused on Medicaid work requirements, and part 2 focused on Medicaid’s economic outcomes.
The Medicaid expansion is one area that has received a lot of attention as a place that Congress might seek to cut.
What is the Medicaid expansion?
Before 2010, Medicaid was limited to children in low-income families and adults with low incomes who met specific criteria, such as having minor children, having a disability, or being over age 65.
That changed when the Affordable Care Act passed in 2010. The health law opened Medicaid up to any adults with low incomes. This new portion of Medicaid is known as the “Medicaid expansion.”
Connecticut was the first state in the country to expand Medicaid under the health law, and did so in 2010. The expansion is known in Connecticut as HUSKY D. The creation of HUSKY D was one of the main reasons Connecticut’s rate of uninsured residents fell from 9.1% in 2010 to 4.9% in 2016. (In 2023, the uninsured rate was 5.6%.)
Not all states have expanded Medicaid. In 2012, the U.S. Supreme Court ruled that states did not have to expand Medicaid under the law. As of 2025, 40 states and Washington D.C. have done so.
Who is covered by Medicaid expansion/HUSKY D?
HUSKY D covers 321,691 Connecticut residents, according to the state Department of Social Services. All are adults with incomes below 138 percent of the federal poverty level – that is, below $21,597 for an individual or $29,187 for a couple.
HUSKY D covers people in every city and town in the state. People covered include older adults, people who care for relatives or friends, people who work gig jobs such as driving for Uber or in restaurant jobs, and young adults who are in school.
Just over half – 57% – of HUSKY D clients are men. Sixty-one percent of HUSKY D clients are white, 26% are Hispanic or Latino, 20% are Black or African American, and 2.9% are Asian.
Nationally, one in three people covered by the Medicaid expansion has a chronic physical health condition, and one in four have a chronic behavioral health condition. Medicaid coverage allows people to get care to appropriately manage their chronic conditions.
>>> Faces of HUSKY D: Profiles of people covered by the Medicaid expansion, Connecticut Health Foundation, 2018
>>>5 key facts about Medicaid expansion, KFF, 2025
What effects did the Medicaid expansion have on health?
There have been lots of studies of the effects of gaining coverage under the Medicaid expansion. Benefits include patients getting diagnosed with cancer earlier, better access to care for people with mental health conditions, and fewer deaths among low-income Americans.
The Effects of Medicaid Expansion Under the ACA: Studies from January 2014 to January 2020, KFF, 2020
- This is a review of more than 400 studies on the effects of the Medicaid expansion on coverage, access to care, and other measures, including economic indicators.
- “Research indicates that the expansion is linked to gains in coverage; improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers.”
This literature review summarizes the results of nearly 200 studies. Some of the key findings:
- Medicaid expansion was associated with a significant drop in all-cause mortality. It was also associated with reductions in death rates from certain types of cancer, cardiovascular disease, and liver disease, as well as reduced maternal mortality.
- Studies found that Medicaid expansion increased rates of screening for some cancers and was associated with an increase in the percentage of cancer patients whose diseases were found at early stages.
- Medicaid expansion increased the percentage of adults and teens with diabetes who had health insurance.
- Adults with mental health conditions such as depression had more access to care because of the Medicaid expansion, in part because mental health care providers were more likely to accept Medicaid coverage.
Saved by Medicaid: New evidence on health insurance and mortality from the universe of low-income adults, National Bureau of Economic Research, 2025
- This recently released working paper used data to estimate the effects of Medicaid expansion – which occurred at different times in different states – on mortality rates.
- The study found that expanding Medicaid reduced the death rate among low-income adults by 2.5 percent.
- The authors estimate that expanding Medicaid reduced the number of deaths among low-income Americans by 3,200 per year on average.
How is Medicaid expansion funded?
Like other parts of Medicaid, the Medicaid expansion is funded by both the federal and state governments. In the case of Medicaid expansion, the federal government pays 90% of the cost (more than other portions of Medicaid).
Medicaid funding is money that pays hospitals, doctors, behavioral health clinicians, and other providers in states. Research has found that expanding Medicaid reduced uncompensated care costs for hospitals and other care providers.
What cuts are being considered?
As members of Congress look to cut spending, some of the options being discussed include cutting back the Medicaid expansion or adding barriers that could make it difficult for people to get coverage and keep it.
The proposal would require states to check the eligibility of people covered by the Medicaid expansion every six months. This typically happens once per year now. Every time people must re-demonstrate their eligibility, there is a risk they will lose coverage because of the administrative burden, even if they’re still eligible.
The proposal in Congress would also require states to impose cost-sharing on people covered by the expansion whose incomes are above the poverty level. Studies show that low-income people with high out-of-pocket costs were less likely to get care or fill prescriptions.
Adults without dependents or disabilities would also lose coverage if they don’t report at least 80 hours per month of work, community service, or participation in a work program or educational program. Research says these policies lead people to lose coverage – even if they’re still eligible – and these policies don’t increase employment.