05/15/2025

House Energy & Commerce Advances Major Medicaid Cuts After Marathon Markup

After a 26-hour markup session, the House Energy and Commerce Committee voted Wednesday to advance a budget reconciliation package that includes historic cuts to Medicaid. The nearly $912 billion package proposes deep reductions across programs in the committee’s jurisdiction—most notably in the Health title, which accounts for the bulk of the savings.

The Medicaid provisions alone would significantly alter the program, including:

• Imposing mandatory community engagement requirements;
  
  
• Pausing implementation of the Nursing Home Minimum Staffing Rule and Medicaid Eligibility and Enrollment rules;
  
  
• Increasing the frequency of eligibility redeterminations;
  
  
• Limiting retroactive eligibility at 30 days; and
  
  
• Modifying provider taxes.
  

Republicans argued these changes are needed to ensure Medicaid’s long-term sustainability and prioritize resources for the most vulnerable. Democrats expressed alarm over the projected loss of coverage and framed the cuts as a tradeoff for extending tax breaks in the Ways and Means reconciliation bill.

What This Means for Providers and States

LeadingAge is deeply concerned about the implications of these cuts. At a time when most states are already facing capacity and funding challenges, this package would create substantial new administrative burdens and financial pressures. Notably, Ohio relies heavily on a tax on Medicaid managed care plans to draw down federal funding. It appears that this mechanism will be prohibited under the proposed language. Additionally, in Ohio’s recent history, its backlog in Medicaid applications peaked at 110,000, with many of those applications taking many months to clear. With the proposed policy in place now, it would have constituted many millions in losses – and likely many closures– of Ohio nursing homes. Even under the best circumstances, Medicaid applications are processed in around 45 days– not 30. 

Ohio could be forced to respond by limiting coverage, lowering provider reimbursement rates, or scaling back optional services—moves that would directly affect older adults and the providers who serve them.

What’s Next

The bill now moves to the House Budget Committee, which is scheduled to mark it up today. LeadingAge submitted a formal statement for the record outlining opposition, and our full analysis of the bill is available here.

The Budget Committee will compile the reconciliation bills before the House Rules Committee prepares the final version for floor consideration, which could happen as early as May 22. LeadingAge will remain fully engaged throughout the process and will issue an advocacy alert next week urging members to oppose the bill when it reaches the House floor. Members can read LeadingAge’s analysis of the bill here and stay find the latest information in this serial post.

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