How many people in Kansas & Missouri will lose Medicaid after Trump’s megabill?
Health experts in Missouri and Kansas warn that the consequences of deep cuts to Medicaid will reverberate throughout both states’ health care systems for years to come.
The megabill recently passed by Congressional Republicans is expected to strip at least 130,000 Missourians of coverage over the next decade, according to an independent health consultant’s analysis.
In Kansas, where state lawmakers have resisted Medicaid expansion, an estimated 13,000 people could still lose coverage, Manatt Health found.
Medicaid, a federal program administered by the states, offers health coverage to low-income individuals, pregnant women, and people with disabilities.
Less federal funding will force difficult decisions in both states about what services to scale back or eliminate, said Sheldon Weisgrau, vice president of health policy and advocacy at the Missouri Foundation for Health.
Some lawmakers and supporters of the bill say its changes will help eliminate waste, fraud and abuse in the Medicaid program. Weisgrau described that argument as “a strawman.”
“There’s very little waste, fraud and abuse in the Medicaid program in terms of people who are ineligible for the program but are getting benefits,” he said. “Most of the waste, fraud and abuse in Medicaid is billing errors by providers, which are usually just errors but are often providers billing for services they didn’t provide.”
Sen. Josh Hawley, a Missouri Republican, argued forcefully against Medicaid cuts, calling it “morally wrong and politically suicidal” to make changes that the Congressional Budget Office now says could result in 10 million people losing coverage.
Hawley and other GOP holdouts eventually bent to the will of the White House and voted in favor of the spending package. But two weeks later, Hawley again reversed course, introducing a bill designed to roll back some of the major cuts he had just voted for.
Medicaid work requirements
The so-called “big beautiful bill” establishes strict new work reporting requirements for Medicaid recipients in states like Missouri that have expanded their programs.
“The large majority of people who are dropped from coverage will be people who are eligible for the Medicaid program but are unable to document either their exemption from the work requirement or the fact that they are working,” Weisgrau said.
Missouri’s record on the administrative side of Medicaid enrollment is abysmal, Weisgrau said, noting that the state consistently has some of the longest application wait times in the country.
The most recent federal data from March shows more than half of applications to MO HealthNet, the state Medicaid program, took between 31 days and more than 45 days to process. That was among the worst of any state that month.
Implementing work requirements will come with a heavy new administrative burden, necessitating an IT system that can track data and accept documentation of records. Compliance won’t be easy for everyone, he said.
“What does a farmer who works a family farm do to prove that he’s working on his farm? No one’s signing his paycheck,” Weisgrau said. “He has his own small business. It’s just really difficult to think of what documentation the state might want to see to demonstrate and then what they would do with it and how they would interpret it when they got it.”
Within the first six months of Arkansas adopting Medicaid work requirements in 2018, more than 18,000 people lost coverage, primarily because they either didn’t know they had to submit documentation or because they couldn’t navigate the online submission portal, Weisgrau said.
He worries a similar scenario could play out in Missouri.
“There’s a lot of reasons to believe that the impact in Missouri would be even higher than that 130,000 (people losing coverage) and more to the upper end of that scale.”
Kansas impact
Kansas hasn’t expanded its Medicaid program, but that doesn’t mean the cuts will have a minimal impact on the health care system. Over the next decade, Kansas is projected to lose nearly $4 billion in federal Medicaid funding for its KanCare program.
“Access to affordable healthcare is going to become much more difficult,” said April Holman, executive director of Alliance for a Healthy Kansas, a coalition of groups dedicated to expanding coverage.
“One of the really sad realities of Medicaid funding cuts is that the state then has to make really difficult decisions about how they are going to fund the remaining program with fewer dollars,” Holman said.
Some of those programs are required under federal law, while others are optional.
In Kansas, one of the highest-dollar spending items for optional Medicaid programs is in the area of home- and community-based service waivers for people with disabilities. Waivers are designed to help keep people out of nursing facilities.
Any cuts in funding to the waiver program would make already long waitlists even longer, Holman said, likely resulting in more people being sent to nursing facilities — even though institutionalized care ultimately costs taxpayers more.
Holman said other provisions in President Trump’s spending bill will make life more difficult for Kansas health care providers, including one requiring states that haven’t expanded Medicaid to incrementally reduce their state-directed payments to hospitals over time to no more than 110% of the Medicare reimbursement rate.
Those payments help hospitals make up the cost of providing care to patients without private insurance.
“That’s going to mean that every year until that phase-in is completed, we’re ratcheting down those state-directed payments that go to hospitals,” Holman said.
Rural hospitals
An analysis by Reach Health Care Foundation found that Kansas’ rural hospitals will lose $2.65 billion over the next 10 years as a direct result of the megabill’s passage.
A provision was added to the final version of the bill providing $50 billion for rural hospitals across the country. Kansas is expected to get about $811 million from that fund.
“But as you can see, if hospitals are losing $2.65 billion, that’s not going to make up the difference,” Holman said.
In Missouri, 21 hospitals have closed since 2014 and more are at risk now that the spending bill has passed, Weisgrau said.
He said he knows of some rural hospitals where a full 90% of patient revenue comes from Medicare and Medicaid. If coverage loss results in even more Missourians who can’t pay for their own health care, it will cause “real, tangible harm” to rural hospitals, Weisgrau said.
“These hospitals that are already operating on razor-thin margins are going to be faced again with the reality of the requirement to take care of everybody who walks into the emergency room and the fact that more of those people won’t have insurance.”
The Star’s Kacen Bayless contributed reporting
This story was originally published July 25, 2025 at 11:56 AM.
CORRECTION: A previous version of this story incorrectly spelled the name of the vice president of the Missouri Foundation for Health. His name is Sheldon Weisgrau.
