Understanding Medicaid Cost Sharing and Policy Changes from the 2025 Reconciliation Law

Summary: A new 2025 law is making big changes to Medicaid. Starting in October 2028, states must charge adults in the Medicaid expansion program up to $35 for each medical service. This affects people who make just above the poverty line (between 100% and 138% of the federal poverty level). Right now, only 19 states charge these fees, and they are usually just a few dollars.

Research shows that when people have to pay more out of pocket, they go to the doctor less and their health gets worse. Many people on Medicaid have chronic health problems like diabetes or mental health issues. Because they need more care, an average person could end up paying around $542 a year in new fees. Older adults and those with multiple health issues could pay up to five times that amount.

For more details, see KFF at kff.org/medicaid/understanding-medicaid-cost-sharing-and-policy-changes-from-the-2025-reconciliation-law/ (opens in new tab)