Today, Congress passed and President Donald Trump is expected to sign sweeping legislation into law that includes significant cuts to health care programs. The final budget reconciliation bill creates barriers to Medicaid enrollment and severely cuts funding for the program — a vital source of coverage for nearly 40% of people with cystic fibrosis — as well as weakening the health insurance marketplace, making it harder for those with CF and other chronic conditions to access the affordable care they need.

“This bill includes the largest cuts to Medicaid since the program began, and will have profound negative ramifications for people with cystic fibrosis,” said Mary Dwight, senior vice president and chief policy and advocacy officer of the Cystic Fibrosis Foundation. “Throughout this debate, the CF community persistently advocated against these cuts, explaining to their lawmakers how critical Medicaid and affordable ACA marketplace coverage are for people with CF. Now our focus is on mitigating, to the best of our ability, the impact of these cuts and advancing policies that expand access to affordable coverage for high quality care, not take it away.”

What the Final Law Does

• Limits Medicaid funding in certain states beginning in 2028. The legislation caps certain state funds used to finance Medicaid. As a result, states will have to make up the funding shortfall with other revenue sources or make cuts to the program, which could include limiting benefits, adding cost-sharing or enrollment barriers, or reducing provider reimbursement rates.
• Adds work reporting requirements for certain adults by the end of 2026. The legislation will create additional administrative burdens, with new requirements for certain adult Medicaid enrollees to report work or community engagement activities as a condition of their eligibility or qualify for an exemption. This may result in people losing coverage if they fail to adequately document their work hours or obtain an exemption. The legislation also requires certain adult Medicaid enrollees to renew their coverage every six months, rather than annually.
• Makes marketplace coverage more expensive beginning in 2026 by failing to renew premium subsidy enhancements. The legislation fails to renew enhanced premium subsidies for marketplace enrollees, which will make coverage more expensive for many. On average, marketplace enrollees will see a 75% increase in their premiums beginning in plan year 2026.

What's Next? 

• How will these changes show up in the states? 
  • The impact of the Medicaid provisions will be different in every state, as the policies depend on how states finance their programs, which populations are eligible for Medicaid, and what Medicaid coverage looks like. The marketplace premium changes will also vary by state and by individual.
• What are ways the Foundation can help support the CF community through the challenges of these changes?
  • The Foundation stands ready to support our community as we grapple with the impact of these policies. We will continue tirelessly advocating on behalf of people with CF to ensure they are protected as much as possible as states implement these changes.
  • As these changes start taking effect, the Compass team is here to help. If you have questions or concerns, you can reach them by calling 844-COMPASS (1-844-266-7277), emailing compass@cff.org, or submitting an online request form.