This article is part of a series from the Center for American Progress exposing how the sweeping Project 2025 policy agenda would harm all Americans. This new authoritarian playbook, published by the Heritage Foundation, would destroy the 250-year-old system of checks and balances upon which U.S. democracy has relied and give far-right politicians, judges, and corporations more control over Americans’ lives.
Medicaid is a cornerstone of the American health care system, providing health care coverage to nearly 1 in 5 Americans, including low-income individuals and families, children, pregnant women, elderly adults, and people with disabilities. Medicaid coverage advances access to care, as well as reduces health disparities and supports financial security.
In the Heritage Foundation’s far-right policy manifesto, Project 2025, MAGA extremists call on the Centers for Medicare and Medicaid Services to impose “targeted time limits or lifetime caps on [Medicaid] benefits.” This would mean that once a person has been on Medicaid for a set amount of time—potentially over the full course of their life—they could lose eligibility for Medicaid coverage, regardless of their financial situation. Similar policies have previously been introduced, including a proposal to impose a 36-month lifetime maximum for Medicaid coverage.
If Project 2025 were enacted, it could cause devastating coverage losses. In 2021, 18.5 million Medicaid beneficiaries, or 20 percent of enrollees, were not aged (younger than 65), blind, or disabled (ABD)—meaning they qualify for Medicaid based on income alone. These individuals would be most at risk for losing their coverage—and with it, their access to affordable health care—if arbitrary lifetime limits were implemented.*
Project 2025 would have an especially harmful impact on people living in the 10 states that have not adopted the Affordable Care Act’s Medicaid expansion. In these states, Medicaid income eligibility levels for non-ABD adults who are also not pregnant is extremely low. For example, in order for a non-ABD adult who is not pregnant to qualify for Medicaid in Texas, that adult must be a caregiver, and their annual household income must effectively be less than 12 percent of the federal poverty level. In other words, if their household of two earns more than $2,452.80 per year, that adult makes too much money to qualify for the program. These stringent limits already create barriers to accessing care; imposing a lifetime limit on Medicaid would further restrict access for those who need help most. Individuals and families would have no option for affordable coverage and would be left to face steep out-of-pocket costs for care.
Project 2025 aims to reduce Medicaid “dependency” with lifetime limits but ignores the deeply harmful and broader economic fallout that would result. Cutting off Medicaid coverage could force low-income individuals to delay or skip necessary medical care due to high costs. People in better health are more likely to be employed, so without Medicaid, many low-income workers could struggle to maintain employment, further perpetuating economic instability and increasing reliance on the social safety net.
The loss of Medicaid coverage would hurt American families
The ripple effects of losing Medicaid coverage would severely undermine the economic security of families across the country. Take the Brownlee family living in Alexandria, Virginia.** Javona Brownlee is a single mother of three who runs her own cleaning business and works part time but does not have access to affordable private insurance options. Fortunately, Javona and her family are covered through Medicaid. Javona shared, “Not having Medicaid coverage would affect my ability to maintain employment. I use that insurance to keep myself healthy—things like eye exams, checkups, and mental health services. Losing Medicaid would be detrimental; it would mean losing stability in my home life and work life.”
An arbitrary lifetime Medicaid cap would hurt millions of families such as Javona’s, potentially forcing them into the impossible situation of having to choose between affording health care and meeting basic household needs.
Project 2025’s Medicaid proposal is a threat to the health and economic security of millions of Americans. Stripping people of their Medicaid benefits would leave many low-income enrollees, especially those in nonexpansion states, without any affordable coverage options, forcing them to forgo essential medical care and undermining their ability to work.
* Author’s note: While Project 2025 does not specify to which Medicaid enrollees lifetime caps or limits would apply, similar proposals have made exceptions for ABD enrollees.
** Author’s note: Javona Brownlee’s story and quote were provided to the Center for American Progress via phone call on June 17, 2024.