Thousands of Virginians set to lose Medicaid coverage
The Trump administration’s cuts to the Medicaid program are expected to threaten healthcare coverage for some 300,000 Virginians. While the state government is taking steps to fill the gap, it won’t come close to making up the difference.
Trump’s “Big Beautiful Bill” (H.R. 1), passed by Congress in 2025, cuts the federal Medicaid program by a trillion dollars nationwide over the next 10 years. Virginia will lose about $1.8 billion to $2.8 billion a year beginning in 2028.
About 1.8 million Virginians rely on Medicaid for their health coverage, according to the Virginia Department of Medical Assistance Services (DMAS).
The legislation also weakens Medicare’s authority to negotiate prescription drug prices. Extra subsidies in the Medicare Part D program will expire at the end of the year. That program lowered drug prices for nearly 690,000 seniors in Virginia.
In addition to the funding cuts in H.R. 1, the legislation requires states to undertake significant changes in their Medicaid operations.
Beginning on Jan. 1, 2027, states will be required to implement the federal work requirement for the Medicaid Expansion, enacted in 2019, which expanded coverage to low-income adults ages 19-64. Traditional Medicaid is limited to specific categories, such as children, seniors, and people with disabilities.
Adults with incomes up to 138 percent of the federal poverty level who are not eligible for traditional Medicaid will be required to spend at least 80 hours a week working, doing community service, or participating in a training program – or enroll in an education program at least half-time. Certain medically frail individuals, disabled veterans, or people who are taking care of a child or a disabled family member are among those exempt.
The DMAS estimates up to 23,400 Fairfax County residents could be affected by the work requirement.
Beginning Oct. 1, a new definition of “qualified noncitizen” takes effect. Medicaid eligibility will be limited to U.S. citizens and Green Card holders after five years.
Eligibility will be canceled for conditional entrants, refugees, asylum seekers, victims of trafficking, and legally residing active-duty military members, veterans, and their spouses and dependent children.
Related story: Medicaid cuts would harm Virginians and the state budget
As of Jan. 1, states will be required to check the eligibility of Medicaid Expansion recipients every six months, rather than annually.
Also on Jan. 1, retroactive coverage for Medicaid will be reduced from three months to one month for Medicaid Expansion recipients and to two months for other Medicaid recipients.
Virginia’s biennial budget for 2026-28 provides $350 million to establish a Medicaid Reserve Fund to offset federal Medicaid cuts.
The budget also includes $150 million for targeted premium assistance on Virginia’s Insurance Marketplace.
The State Corporation Commission estimates that about 100,000 Virginians have lost health insurance coverage this year as a result of higher premiums.
A new health insurance affordability program in the biennial budget is expected to help 200,000 Virginians save as much as 70 percent on their monthly premium under a Virginia Health Benefit Exchange administered by the SCC.
The new program is targeted to Virginians with household incomes between 138 and 250 percent of the federal poverty level.
In 2026, Virginia Marketplace consumers saw an average increase of 75 percent in what they pay for health insurance premiums, according to the SCC. This increase was a result of a 22 percent increase in premiums by health insurance carriers and the expiration of the federal enhanced premium tax credits.
While some consumers enrolled in lower-tier plans with less costly premiums, the SCC says, others were priced out altogether or canceled their plans after just a few months. Enrollment has dropped by 20 percent compared to this time last year.