Project 2025’s Radical Proposals Would Undermine Medicaid and Medicare and Jeopardize the Health of Women and LGBTQI+ Individuals

Medicaid is an essential source of health coverage for Americans, providing coverage to over 90 million parents, children, adults, pregnant women, elderly people, and people with disabilities. Women are the majority of the adult Medicaid population. Nearly one in five women (over 18 million people) receive vital health care services through Medicaid, such as wellness visits, reproductive health care, preventive screenings, and other physician and hospital services. LGBTQI+ individuals are also more likely than non-LGBTQI+ individuals to access health care services through Medicaid, with an estimated 1.2 million LGBTQI+ individuals covered by Medicaid. And all of these people could be harmed if Project 2025’s proposals to undermine Medicaid become reality. 

Project 2025 proposes radical changes to Medicaid financing. Medicaid is traditionally funded by both the state and federal government. For every dollar a state spends on Medicaid services, a percentage of the cost is paid by the federal government – aka the “federal match.”. Project 2025 proposals would upend this funding structure by introducing block grants, aggregate caps, per capita caps, and reduced federal matching rates. Block grants, aggregate caps, and per capita caps represent fixed amounts of federal funding and do not allow for changes in population needs. Any increase in the price of a benefit or service, or increase in enrollment, would shift costs to the states, putting significant strain on already tight state budgets. Proposals for “more balanced” federal match rates would do nothing more than reduce the amount of federal funds states receive to support their Medicaid programs.   

These Project 2025 proposals add up to terrifying results: severe Medicaid deficits and incentives for states to recoup funds by instituting higher deductibles and co-pays, undercutting benefits, restricting services, and reducing payments to providers. Each of these actions would harm women and LGBTQI+ individuals. Higher co-pays could mean delaying appointments and living with untreated symptoms. And restricting access to benefits, services, and providers could mean individuals losing access to needed care.     

Project 2025 would also devastate Medicaid enrollment by imposing work requirements and calling for “more robust” eligibility determinations. We’ve already seen work requirements at play and know that they harm Medicaid enrollees, and they have been successfully challenged in court. Medicaid exists to provide health coverage to low-income people.  Imposing administratively burdensome work reporting requirements goes against this core objective by causing eligible beneficiaries to lose coverage. 

Work requirements also disproportionately harm women and LGBTQI+ individuals.  Work requirements pose a greater risk to women of color, particularly Black women, transgender, and nonbinary individuals because these populations experience greater barriers to employment due to lack of support, discrimination, and harassment. These requirements also discount unpaid and caregiving work, responsibilities primarily borne by women.  

Proposals to institute “more robust” eligibility determinations, such as onerous paperwork and repetitive asset verifications, would also cause eligible individuals to lose Medicaid coverage. Previous attempts to implement these harmful tactics resulted in hundreds of thousands of people being wrongfully disenrolled from Medicaid. 

Project 2025 also proposes the unconscionable scheme of lifetime caps and/or time limits. These appalling proposals would permanently strip individuals of their Medicaid coverage. Individuals who otherwise qualify for Medicaid would have their enrollment revoked after a certain amount of time or utilization, regardless of their financial status or health care needs. Arbitrarily losing access to coverage would be devastating, particularly for women, who are more likely to have chronic health conditions.. 

Project 2025’s proposals would also weaken Medicare, harming older women and LGBTQI+ individuals. Medicare is an essential source of health coverage for Americans aged 65 and over. Medicare provides access to preventive screenings, physician and hospital services, and prescription drugs for over 66 million people.  Women make up more than half (over 35 million) of the Medicare population and nearly two-thirds of Medicare beneficiaries 85 and older.   

Project 2025’s proposal to repeal the Inflation Reduction Act (IRA) would force millions of older women and LGBTQI+ individuals enrolled in Medicare to pay more for their medications. Repealing the IRA would remove the $2000 out-of-pocket cap for prescription drugs covered under Medicare Part D. It would also end drug price negotiation, increasing the cost of commonly prescribed drugs. Women, particularly women of color, are already more likely than men to forgo or deny themselves prescription medication due to cost. These changes would only make it harder for older women and LGBTQI+ individuals to afford necessary medications and devastate those who take high-cost drugs for autoimmune conditions, chronic conditions, or cancer treatment.  

Ultimately, Project 2025’s health proposals on Medicaid and Medicare are simply attacks that would undermine these critical programs, jeopardize the health of millions of Americans, and disproportionately harm the health and well-being of women and LGBTQI+ individuals.