Medicaid Cuts Will Reverse Years of Progress in Coverage for Transition Age Youth
In an all-night session, the House of Representatives passed a comprehensive FY2026 federal budget bill early Thursday morning, May 22, 2025, by one (Republican) vote. This bill would cut hundreds of billions of dollars from Medicaid to help pay for massive tax cuts for the wealthiest Americans. It was pushed through the House Budget Committee late Sunday night, and then through the House Rules Committee on Wednesday evening by House Speaker Mike Johnson, without a single hearing or any debate.
The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 improved access to health insurance for young adults by expanding Medicaid coverage to non-disabled adults with income up to 138% of the Federal Poverty Line and offering subsidies for people with higher incomes to purchase insurance. The uninsurance rate of people ages 18 to 24 is 11.3% in 2025—the highest of any age group, but a vast and dramatic improvement from the 31.5% of young adults who lacked health insurance before the passage of the ACA. The disproportionately higher uninsured rate for young adults is mostly due to states that didn’t expand Medicaid coverage to low-income adults under the ACA – an abject failure to provide health insurance coverage to an age group that is the most poor, but least likely to qualify via other avenues. Young adults who are considered disabled by Social Security Administration (SSA) standards are eligible for Medicaid, regardless of whether or not their state expanded access under the ACA, but face challenges in maintaining eligibility due to strict resource limits and confusing program rules.
Medicaid expansion under the ACA also increased enrollment for former foster youth and advocates fought long and hard to ensure that youth who have aged out of foster care are eligible for Medicaid until age 26, regardless of income and regardless of the state in which they aged out. At first glance, the “big beautiful bill” doesn’t appear to undo these reforms, however, the depth of the cuts and the added layers of bureaucracy are extremely worrying. The estimated rate of uninsurance for former foster care youth at age 19 varies wildly depending on the state and is usually due to difficulties experienced during the Medicaid enrollment and renewal process caused by frequent address changes due to unstable housing, lack of knowledge about transition age youth among agency staff, and difficulty coordinating between state agencies (as well as mistrust of those agencies by former foster youth and homeless youth alike).
It is incontrovertible that Medicaid is one of the most effective tools we have to save young people’s lives and to ensure that they thrive. A recent study found “that younger adults, who many have long assumed have less to gain from insurance, saw strong life-saving effects” from Medicaid expansion. They found mortality reductions accrued not only to older age cohorts, but also to younger adults, “who accounted for nearly half of life-years saved due to their longer remaining lifespans and large share of the low-income adult population”. Coverage of mental health, preventative care, and substance use treatment for this age group is key.
Adding in ineffective and costly work requirements, requiring more frequent eligibility checks, prohibiting gender affirming care and other live saving services, capping or cutting payments to states that use their own funding to cover immigrant youth – this all means one thing: shifting whatever money is left away from the actual provision of healthcare to young people and spending it on eligibility workers, policy staff, agency hearing coordinators, and administrative law judges. What we really need is automatic and continuous enrollment of transition age youth in Medicaid so that we can focus on their actual healthcare and not their “eligibility” for it.
For information about how the SNAP (food assistance) changes and cuts in this bill will affect young adults, check out this article from the Urban Institute.
Sources:
https://files.gao.gov/reports/GAO-25-107286/index.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC8588631/
https://www.nber.org/system/files/working_papers/w33719/w33719.pdf
