Take Action for Medicaid

Update: April 14, 2025

The U.S. House of Representatives passed a budget resolution approving a framework to allow Republican lawmakers to engage in the reconciliation process. With this approval, both House and Senate Republicans will begin negotiating how to pay for tax cuts by possibly reducing Medicaid spending by up to $880 billion or more, along with calling for the House Education and Workforce Committee to make $330 billion in cuts for fiscal years 2025 through 2034.

Although the Senate-passed resolution directs its committees to make only $4 billion in cuts, Senate Majority Leader John Thune pledged to seek at least $1.5 trillion in savings through the reconciliation process—an amount that likely cannot be achieved without significant cuts to Medicaid.

As part of the budget resolution, committees have until Friday, May 9 to produce their respective reconciliation bills. It is expected that Republicans will try to move as quickly as possible through the upcoming May work period with the goal of passing the reconciliation bill before Memorial Day. When lawmakers return to DC on April 28, House Speaker Mike Johnson said that committees will begin holding markups on their respective instructions that will be combined into a single reconciliation bill.

There is likely to be robust debate over the size and scope of the promised spending cuts— particularly as they pertain to public benefit programs like Medicaid and education —in order to honor this May 9 deadline.

Won’t These Proposed Changes Just Eliminate Fraud, Waste, and Abuse?

Though some may think these cuts only aim to eliminate fraud, waste, and abuse, there are some misunderstandings over how the government could realistically target those concerns and what they represent.

On April 10, our ASHA advocates attended the spring Medicaid and CHIP Payment and Access Commission (MACPAC) meeting, where MACPAC addressed fraud, waste, and abuse concerns within the Medicaid program. MACPAC is a nonpartisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress. On slide nine of its “Medicaid in Context” [PDF] presentation, MACPAC shows 5% ($31.1 billion) of all Medicaid payments ($610.8 billion) were deemed "improper payments." Almost 75% of those improper payments are actually based on insufficient documentation. Something as simple as a claim paid where a provider forgot to fill in a field would qualify as an improper payment.

It is critical to accurately define "improper payments" in context to understand what actually is—and is not—fraud, waste, and abuse. If all improper payments were actually abuses to this critical safety net program—which we have shown they are not—eliminating 100% of those improper payments would net a savings of $31.1 billion. That leaves $848.9 billion in savings that Congress has to find to meet the House’s proposed savings amount in this budget. There is no possible way to reach the $880 billion in savings without making additional cuts to vital, effective services provided by Medicaid.

We would submit that patients should not lose access to care in order to root out documentation errors. (For more on fraud, waste, and abuse in the system, the Kaiser Family Foundation has another helpful resource.)

ASHA members can help ensure Medicaid is protected by contacting their members of Congress today using one of the methods below. ASHA Medicaid advocates have sent almost 23,000 letters, and we’d love to see that number surpass 30,000 before May 9.

Update: March 13, 2025

Join legislators and advocates for a day of action for Medicaid on March 18, 2025!

The U.S. House of Representatives committee with jurisdiction over Medicaid has been tasked with finding savings on programs under its purview. This means Medicaid—which provides vital services to over 70 million Americans, many of whom ASHA members and affiliates care for every day—is at risk of significant funding cuts and other changes that would reduce services for enrolled beneficiaries. We cannot let this happen.

Join ASHA in Action

Take two minutes to send letters to your legislators and urge them to protect and preserve Medicaid. Help ASHA advocates send 20,000 letters to Congress to preserve Medicaid. We're already close to 15,000. Click the link below to use ASHA’s easy-to-fill-out form.

Have a little more time? Call your legislators to share your support for Medicaid. Click the link below to select which legislator(s) you want to call and use our script to set your conversation up for success.

Want to organize a meeting? Your members of Congress will be in their home districts March 17-21. Contact their office to set up a meeting virtually or in person.

Your legislators need to hear from you about the issues that impact the professions and the people you serve. If you’ve already sent a letter or made a call, feel free to write or call again and share the links above with your friends and family.

Want to learn more? Check out a recording of our recent webinar “Proposed Medicaid Funding Changes Ahead: What Audiologists and SLPs Need to Know” and read on below.

What’s Happening to Medicaid

Medicaid is a health insurance program that covers low-income children, adults, and families, depending on the state. It is funded and governed jointly by the federal and state governments. Many people, including some government officials, don’t even know that Medicaid is structured and funded entirely differently from Medicare. There are many nuances to the Medicaid program (including just how different it is from Medicare) that you can read more about in ASHA’s Medicare vs Medicaid guide.

The U.S. House of Representatives recently adopted a budget resolution that will require steep funding cuts to Medicaid to help pay for other spending, such as renewing expiring tax cuts and increasing funding to Defense and the Judiciary. One of those requirements was that the Energy and Commerce Committee in the House, which oversees Medicaid, must eliminate a minimum of $880 billion from programs under its jurisdiction over the next 10 years. There are other programs that can and will be impacted, but considering that Medicaid accounts for a large majority of the spending the Committee oversees, it will be hit hard.

The Energy and Commerce Committee is considering various options that would impact those who rely on Medicaid in different ways. But all the proposals for reducing Medicaid spending would mean fewer people would receive critical services.

How Medicaid Could Be Cut or Transformed

There are several ways Congress could cut Medicaid. Some advocates are even being told “Medicaid won’t be cut” when they contact their members of Congress—but that’s simply not true. Understanding the potential changes can help you share how they impact you and other constituents. Skip to minute marker 22:47 in this video for an in-depth description.

For practitioners in healthcare settings, lowered federal spending can mean reimbursement rate cuts, changes in coverage (including telehealth or optional services that are home- and community-based), increased utilization management (like prior authorization), and audits.

For practitioners in schools, this may mean changes to staffing of special education and related services if the school loses an important source of funding. Even if a school doesn't bill Medicaid, there are many Medicaid-enrolled students who may have less access to care outside of school as a result of these changes.

There are ways all federal programs, including Medicaid, could be improved to better serve the populations they support. However, cutting the Medicaid budget and curbing coverage of services is extremely unlikely to improve anything for people who rely on this program.

What Is ASHA Doing?

ASHA Advocacy has been extensively advocating for Medicaid at both the federal and state level. We engage with elected officials and agency staff, ASHA members individually, state associations, ASHA’s State Advocates for Reimbursement (STARs), ASHA’s Health Care Economics Committee, ASHA’s Medicaid Committee, the Modern Medicaid Alliance, the Consortium for Constituents with Disabilities, and many other organizations. Check out this compilation of Medicaid resources [PDF] that includes some of our advocacy actions. We also hosted a webinar with over 300 ASHA members attendees called “Proposed Medicaid Funding Changes Ahead: What Audiologists and SLPs Need to Know” to spread awareness and answer questions. Information in the recording may help in your advocacy efforts.

Share Your Story

Real-life stories from you and your patients can support ASHA's Medicaid advocacy efforts. Fill out this form so ASHA advocates can share your story with elected officials and policymakers to demonstrate how Medicaid policy changes impact you.

By sharing your story in our meetings with lawmakers, we show them how their decisions directly impact real people, and we can better advocate for improved access to audiology and speech-language pathology services for Medicaid beneficiaries as well as better payment rates for providers.

Questions?

Reach out to reimbursement@asha.org if you have questions about Medicaid.