Tens of thousands of people in Washington are facing the possibility of losing their Medicaid coverage this year.
How did we get here?
Back in July 2025, President Donald Trump signed HR1, better known as the “Big Beautiful Act.”
This legislation brings significant changes to Medicaid, referred to in Washington as Apple Health. It makes the state responsible for its funding and introduces stricter eligibility requirements.
The impact? Federal Medicaid spending could drop by an estimated $1 trillion over the next decade.
Additionally, by December 31, 2026, states will need to enforce work requirements. This means eligible individuals aged 19 to 63 will have to work, attend school, or volunteer for at least 80 hours each month to keep their coverage.
Also, under HR1, these individuals will need to provide proof of eligibility every six months, not just once a year. According to the Washington State Department of Health, more than 620,000 residents may be affected by these changes.
The forecasting of billions in cuts in federal funding has added to the stress for many individuals dependent on Medicaid, like Susan Ben Rubin.
“I’m generally a very healthy person,” Ben Rubin shared, despite being diagnosed with breast cancer in 2015.
A Washington resident for nearly two decades, Ben Rubin is a cancer survivor, but her health issues didn’t stop there. She later learned she had osteopenia, which led to a severe form of kidney disease due to IV therapy.
Recently, issues with her health insurance have compounded her worries. After losing her job in May, she continued to receive benefits until the end of January. However, the cost of maintaining coverage through COBRA was around $2,000 a month—just for her and her child, who also has health issues.
Seeking alternatives, Ben Rubin turned to Apple Health. “You really have to keep track of everything to understand your health status, and that feels overwhelming,” she noted. “We’ve had a hard time figuring out the best insurance for us.”
Eventually, she managed to secure a plan for herself and her daughter, but it was not without its difficulties. Now that things are seemingly settled, she can’t shake her anxiety about potential system changes.
“If either of us lacks health insurance, we could face hefty out-of-pocket expenses each month,” Ben Rubin explained.
“Health care should be a right,” she asserted. “It shouldn’t be something people have to fight for.”
What can states do?
Washington spends around $21 billion annually on Medicaid, with more than half of that coming from federal funding.
The state is poised to lose billions in federal support, adding to its existing budget shortfall.
Rep. Nicole Macri (D-Seattle) stated, “Let me be clear: states don’t have the resources to fully recover from federal cuts. We know that many will lose their health insurance.”
According to Macri, the current uninsured rate in the state stands slightly below 5%. “We’re concerned this number will rise significantly once HR1’s provisions kick in,” she added.
However, she indicated that finding additional funding for Medicaid would likely lead to budget cuts in other areas. “Not everything will be addressed this session, but we’re working hard to prioritize the most severe impacts,” she noted. “Targeted investments are crucial to ensure coverage for the most vulnerable.”
The first wave of concern for Washington comes in October, when about 30,000 people will lose eligibility, particularly noncitizen adults like refugees.
Macri emphasized that among those, around 2,700 are receiving long-term care or reside in nursing facilities. “They require constant support,” Macri pointed out. “Losing insurance could jeopardize their ability to stay in those facilities.”
Moreover, HR1’s implications extend beyond Medicaid recipients. Macri warned that the state’s hospital system might face strain as more individuals lose their coverage.
“When people lose health insurance, that cost gets pushed onto all of us,” she said. “Some hospitals may struggle to offer services, which could limit access for insured patients in the future.”
On the other side, Sen. Chris Gildon (R-Puyallup) claimed a few months back that ensuring health care access for Washingtonians is crucial, and he acknowledged that HR1 would make a difference.
Still, he believes Medicaid should cater to those truly in need. “If you’re able-bodied but not meeting the requirements to search for work, you probably don’t need assistance,” he argued.
Gildon suggested states should focus on improving their processes, like maintaining accurate registries to avoid double enrollments, which he believes could save Washington millions.
Overall, he expressed that increased accountability for state-run Medicaid programs isn’t entirely negative. “The closer you are to the issue, the more responsive and understanding you become,” he said.
Both legislative chambers in Washington are scheduled to reveal their budgets this week, shedding light on potential cuts, tax increases, and how Medicaid will be funded in light of HR1.
Macri concluded by stating that the pivotal question remains “what is sustainable,” given the state’s budget constraints.
