By the numbers: Who benefits most from Medicaid across New England?

Boston Globe

05-03-2025

Who does Medicaid cover, and how many people does it cover?
Medicaid helps cover medical costs for 21 percent of Americans nationally and 20.5 percent of people in Massachusetts. That includes coverage for
who are low income
.
Advertisement
In New England, four states — Maine, Rhode Island, Connecticut, and Vermont — have higher rates of residents enrolled in Medicaid than the national average.
Nearly two-thirds of nursing home residents in New England are also enrolled in Medicaid, which provides benefits like nursing home care and personal care services that Medicare doesn't cover.
In every New England state, Medicaid costs disproportionately go to elderly and disabled people, though those groups make up less than one third of enrollees. In Massachusetts, 29 percent of members are elderly or disabled, while 64 percent of expenditures go that group, according to an analysis by
the health policy organization KFF
.
Medicaid is
also a key source of coverage for children; on average 49 percent of Medicaid enrollees are children. They make up just over 40 percent of enrollees in New England and 43 percent in Massachusetts.
What could cutting Medicaid mean for New England?
The budget proposal, which doesn't specify how much would be slashed from the program, will leave it to the states to make
tough decisions around cuts, experts said.
'In many ways, that's why these cuts are attractive to federal policymakers because they're not explicitly enacting proposals that involve cuts to eligibility or benefits or higher premiums of cost sharing,' said Edwin Park, a research professor at Georgetown University who primarily focuses on Medicaid and the Affordable Care Act. 'It's basically passing the buck to the states and forcing the states to make the tough choices, the politically painful choices.'
Advertisement
If federal funding is cut, states could find other ways to finance expanded healthcare coverage — like raising taxes or cutting other parts of their budgets, like education — or, more likely, cutting some Medicaid benefits.
In a statement to the Globe, Governor Maura Healey said the Senate needs to 'reject this shameful attack on the health and wellbeing of children, families and seniors in Massachusetts and across our country.'
'This budget resolution threatens the health care of 2 million Massachusetts residents, including nearly half of the children in our state and 70 percent of nursing home residents. Additionally, cuts to Medicaid would cause further strain on our hospitals, nursing homes, home and community-based providers and community health centers. Providers would be forced to shut their doors or lay off staff,' Healey said.
Sarah Gordon, co-director of the BU Medicaid Policy Lab at Boston University, said she foresees expansions under the
Those covered under the expansion are mainly working-age adults without children.
'Compared to children, pregnant women, the elderly, and people with disabilities, the working age population is seen as least deserving [of health insurance] most often,' Gordon said. 'Of course, everyone deserves health insurance, but I think that could be the target.'
Beyond narrowing eligibility, Medicaid cuts could also mean cuts to benefits, which Park said could disproportionately impact the elderly and those with disabilities.
Advertisement
'[States] are either going to have to cut a large number of children who don't cost that much, or you cut seniors or people with disabilities who have significant health and long-term care needs,' he said.
People in rural areas could be the most vulnerable, as they
'We can see those who live in areas where there's already fewer hospitals in more rural areas being more affected by this because those facilities have a higher risk of closure,' Gordon said.
What is Medicaid?
Medicaid was established in 1965 along with Medicare, which provides health insurance for people 65 and older and some people under 65 with certain health conditions.
The exact share of funding the federal government provides for state
Medicaid programs
But before the ACA was passed in 2010, Massachusetts was already pioneering health care reform. In 2006, Massachusetts passed
Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology who was a key architect of the 2006 reform and went on to consult the Obama administration in drafting the ACA, called the federal bill a 'less generous version of the Massachusetts plan.'
Advertisement
After the ACA was implemented, Massachusetts kept its expanded benefits, but the cost was offset by federal funding, Gruber said.
The Biden administration
'That once again helped people in the state, because it made it cheaper, but also helped the state because now the feds were giving us money,' Gruber said.
How much does Medicaid cost for New England states and the federal government?
Currently, Massachusetts receives 50 cents back on the dollar from the federal government for Medicaid enrollees and 90 cents on the dollar for those eligible under the ACA expansion. State officials said this amounts to $13.9 billion in federal money that goes toward Medicaid in the state, known as MassHealth. The federal funding is 60 percent of MassHealth's budget, according to officials.
In Fiscal Year 2023, the federal government paid $606 billion toward Medicaid nationally, while states paid $274 billion,
What exactly are the Republicans proposing?
The House's budget resolution proposes to chop
Experts said there are three main ways the government could cut costs, which include
Advertisement
'These proposals all move in the same direction, which is trying to dramatically shrink the Medicaid program and lead to significant cuts affecting millions of beneficiaries, seniors, people with disabilities, kids, [and] pregnant women,' Park said.
Emily Spatz can be reached at