Possible Major Changes to Medicaid: What You Need to Know

Posted on Jul 3, 2025 by

The Proposed Bill and Its Goals

The “Big Beautiful Bill,” passed by the House of Representatives in May and currently being discussed by Congress, may spell major changes for Medicaid. If adopted as it is now, eligibility for Medicaid will be drastically altered, potentially leaving millions without health insurance.

The Bill’s primary purported goal, helping to decrease Federal spending and lower our national debt, is certainly a noble endeavor. However, this particular area of cuts may prove more harmful than good, with two changes feeling especially detrimental for aspiring Medicaid applicants and current beneficiaries: retroactive coverage and work requirements. Now, even though Medicaid is a Federal program, there are some slight variations among the states about how it is implemented, so we’re going to focus on the changes we might be facing here in Wisconsin.

Wisconsin’s Position: Not a Medicaid Expansion State

The main fact that impacts the Bill’s effects on Wisconsin is that we are not a “Medicaid Expansion state.” Under the Affordable Care Act (ACA), states have the power to expand the coverage of Medicaid to include adults who may not otherwise be eligible. Much of the proposed changes in the Bill either specifically target these so-called “expansion enrollees” and individuals already enrolled under their state’s expansion. Other changes treat individuals differently depending on whether they enrolled under the expansion or under the “traditional” means. All Medicaid recipients and applicants in Wisconsin fall under the traditional category.

Work Requirements and Retroactive Coverage: Who Really Feels the Impact?

Now, let’s turn back to those two major changes we mentioned earlier: work requirements and retroactive coverage. Work requirements have been a long-debated issue when it comes to Medicaid, even though the history of their implementation hasn’t shown them to be effective in the ways they were intended. Throughout the nation, over 90 percent of adults on Medicaid either work enough to satisfy the requirements or satisfy the proposed exceptions. Yet, codifying the work requirements has shown to cut thousands of adults’ coverage without actually increasing employment rates, and it tends to increase the costs for the states. These consequences arise from the systemic overhauls needed to properly track, process, and inform recipients about the requirements. Luckily, the proposed requirements in the Bill only apply to adults covered under Medicaid expansions. So, while they may have hefty repercussions, Wisconsin recipients shouldn’t be affected by these provisions.

The portion of the Bill that will most impact Wisconsin recipients is the changes made to retroactive coverage. Under current law, when an individual applies for Medicaid, states are required to provide coverage retroactively for any qualified medical expenses that were incurred in the 90 days leading up to that application. This can be a tremendous relief to those whose applications were prompted by medical emergencies with costly treatments. The Bill, when passed by the House, proposed shortening this 90-day window to only 30 days. The Senate’s proposed language increases the window up to 60 days for traditional applicants, while leaving it at only 30 days for expansion applicants. So, in Wisconsin, being a non-expansion state, we might still be facing a 30-day cut to the retroactive coverage period. Given the costs of medical procedures, having even 30 more days without insurance can be insurmountably and prohibitively expensive. If the Bill passes in its current state, individuals facing these medical emergencies will have a much shorter window to understand the need for Medicaid, to gather the information needed to apply, and to navigate the application process.

What’s Next for Medicaid?

With the Bill still being discussed and negotiated in Congress, the future of Medicaid remains unclear. There are still many voices in Washington fighting to prevent any changes or cuts to Medicaid which might result in increased denials in coverage. We’ll just have to be patient, but, until the future comes into focus, we must also begin working to understand and prepare for the changes we may face.

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Reg P. Wydeven

Elder Law and Estate Planning Attorney at McCarty Law LLP
Hoping to follow in his father’s footsteps from a young age, Reg’s practice primarily consists of advising individuals on estate planning, estate settlement and elder law matters. As Reg represents clients in matters like guardianship proceedings and long-term care admissions, he feels grateful to be able to offer families thorough legal help in their time of need.
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