Medicaid Cuts and Coverage Changes

Overview

Medicaid policy changes at the state and federal level are affecting how audiologists and speech-language pathologists (SLPs) deliver care across the country. Following significant federal funding reductions in 2025, many states are adjusting their Medicaid programs—resulting in changes to payment, coverage, and administrative requirements that directly impact your practice.

If you have questions about Medicaid in your state, reach out to reimbursement@asha.org. If you are a Medicaid provider, you can also sign up for Medicaid provider bulletins to receive information from your state Medicaid agency.

What’s Changing—and Why

Medicaid is jointly funded by the federal government and states. (You can learn more about that funding mechanism in ASHA’s Medicare vs Medicaid guide.) States determine coverage, payment, and operational policies within federal guidelines.

In July 2025, the president signed the One Big Beautiful Bill Act (OBBBA) into law, cutting nearly $1 trillion from Medicaid programs. These reductions are now driving states to change their policies to balance their budgets. As a result, many states are:

Reducing provider reimbursement rates (e.g., North Carolina);
Limiting or eliminating services, including audiology or speech-language pathology services for certain populations (e.g., Idaho, Washington State); and
Changing billing, coding, and utilization policies that affect how clinicians document and deliver care.

What This Means for Your Practice

These policy changes are affecting day-to-day clinical and administrative work in several key ways:

Provider Payment: Rate reductions or freezes may impact practice sustainability and staffing decisions.
Coverage and Services: Optional services (e.g., some audiology and speech-language pathology services) may be reduced or eliminated, and utilization limits may restrict how often services can be provided.
Coding, Billing, and Documentation: Changes to CPT coding and reimbursement, documentation requirements, and prior authorization are increasing administrative burden. Increased program integrity efforts (audits) are also affecting providers’ ability to serve Medicaid patients.

Because Medicaid is administered at the state level, your experience may differ significantly depending on where you practice.

For example, North Dakota Medicaid updated its speech therapy policies, including unit limits and billing for CPT® code 92507. While reimbursement rates remain relatively high in North Dakota, these policy adjustments illustrate how quickly coverage and payment rules can shift in response to budget pressures.

To better understand coding and billing requirements, see ASHA’s resources on:

ASHA’s Role in Medicaid Advocacy

ASHA cannot set state Medicaid or Medicaid managed care policy, but we advocate to protect access to services and support our members.

ASHA’s advocacy efforts include:

Engaging with state Medicaid agencies and Medicaid managed care plans;
Submitting comments on proposed policy changes;
Collaborating with state associations to oppose harmful changes;
Participating in CPT and AMA RVS Update Committee (RUC) processes;
Convening payers and policymakers; and
Providing reimbursement guidance to members.

ASHA strongly opposed the 2025 Medicaid cuts, continues to support efforts to reverse them, and will fight further cuts as often as they are proposed. Below are some resources detailing ASHA’s Medicaid advocacy:

Webinars

News

ASHA’s Advocacy team has also partnered with state speech-language-hearing associations across the country to protect Medicaid: