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Speaker of the House Mike Johnson, R-Benton, with House Republican Conference Chairwoman Lisa McClain, R-Michigan, from left, Rep. Tim Moore, R-North Carolina, and House Majority Leader Steve Scalise, R-Jefferson, speaks during a news conference at the Capitol, Tuesday, Feb. 25, 2025, in Washington.
Associated Press Photo by Manuel Balce Ceneta More than 1,000 members of Popular Democracy, including disabled Americans who rely on public healthcare, and partner organizations marched to demand no cuts to Medicaid or Medicare, lower prescription drug prices, and the protection of reproductive rights on Wednesday, March 12, 2025 in Washington. Kevin Wolf/AP Content Services for Popular Democracy President Donald Trump speaks as Health and Human Services Secretary Robert F. Kennedy Jr.
, from left, Dr. Mehmet Oz and Oz's wife Lisa Oz listen during a swearing in ceremony for Mehmet oz to be Administrator of the Centers for Medicare and Medicaid Services, in the Oval Office of the White House, Friday, April 18, 2025, in Washington. Associated Press Photo by Alex Brandon Facebook Twitter WhatsApp SMS Email Print Copy article link Save WASHINGTON – The future of Medicaid will be determined over the next few weeks after months of speculation over how potential cuts could affect Louisiana.
House Speaker Mike Johnson, R-Benton, and President Donald Trump are trying to pass "one big, beautiful bill" that will achieve Trump priorities like extending his 2017 tax cuts, tougher border security, more defense spending and exempting tips from taxation. To help pay for it, Republicans in the House want to cut the federal budget by $1.5 trillion — and the committee that oversees Medicaid has been tasked with eliminating $880 billion.
That has raised alarm among doctors, hospitals, and state budget officials, who fear reductions to Medicaid could leave low-income Americans without health insurance or blow holes in state budgets. Medicaid is a state-federal program that provides health insurance to 83 million Americans. Louisiana has one of the highest rates of residents on the program — 1.
6 million people, or about a third of the population. Louisiana congressmen will also play an outsized role in the debate: Johnson and Rep. Steve Scalise, R-Jefferson, are the House's highest-ranking members and are steering its budget strategy.
And Rep. Troy Carter, D-New Orleans, sits on the committee that is responsible for Medicaid. Republicans insist they will not be cutting actual health care for anyone on Medicaid who deserves it.
“No one has talked about cutting one benefit in Medicaid (to a beneficiary) who is duly owed,” Johnson said after recessing the House on April 10. “We have to root out fraud, waste and abuse. We have to eliminate, for example, on Medicaid people who are not eligible to be there.
” The House GOP says it will target waste, fraud and abuse in the program. Trump and Johnson say about $51 billion is lost to fraud and abuse each year; Scalise has estimated $60 billion. “That’s the theft of hardworking taxpayers’ money.
That’s taking healthcare away from the disabled who need it," Scalise said. Just how "waste, fraud and abuse" is defined and how it is applied to Medicaid could lead to an epic fight that could endanger Trump’s desire to revamp the federal government. Carter and other Democrats are skeptical of the changes Republicans seek under the banner of fighting waste.
“Obviously, we're open to finding opportunities, if they exist, to be more efficient and to root out waste, fraud or abuse. But we're going be ever mindful of dismantling systems and resources that mean something to the American people,” said Carter, who is a member of the Democratic minority on the House Energy's Health subcommittee that gets a first crack at the bill this week. What might cuts look like? House committee members working on Medicaid budget plans have been told not to discuss those proposals in public.
But according to an internal memo seen by The Advocate | The Times-Picayune and interviews with members of the health subcommittee from both parties, the panel is weighing roughly 21 scenarios to decide how many to include in the final bill. Those ideas match those reported by KFF – Kaiser Family Foundation, a San Francisco-based nonprofit that researches health issues – and Politico , the political trade publication. Some options would require states to pick up more of the cost of Medicaid , something many Republicans have long supported.
"Medicaid is meant to be a state-federal partnership. States are supposed to pay for 40% of the cost. Most states are paying for less than 15%," Sen.
Bill Cassidy, R-Baton Rouge, said April 16 on X . "States have been cutting Medicaid for decades. People should not be asking what is the federal government doing, they should be asking why aren’t the states doing more.
" One idea being considered by the House committee is to reverse a Biden administration decision to increase federal matching funds, which would save about $25 billion but cost states more. Other proposals would change the federal medical assistance percentage, or FMAP, the formula that determines how much the federal government contributes to each state's Medicaid program. If Congress lowered the FMAP percentage for every state that expanded Medicaid rolls under the Affordable Care Act, which includes Louisiana, it could save an estimated $561 billion — but require states to shoulder more of the costs.
Another proposal would reduce FMAP for higher-income states to the tune of $387 billion. Cuts to the federal share of Medicaid would have a major impact on Louisiana , where government-subsidized healthcare accounts for about $21 billion each year, of which state's taxpayers are expected to put up about $3.2 billion.
Another possibility on the table, which would save about $22 billion, is repealing a May 2024 minimum staffing rule for nursing homes. And up to $900 billion could be cut by limiting the total amount for services the federal government pays. Currently, states are guaranteed federal support for actual spending; states that exceed the “cap” would have to pay the overage.
Another $100 billion could be saved by requiring Medicaid beneficiaries to work. “What we’re talking about is returning work requirements, for example, so you don’t have able bodied young men on a program that’s designed for single mothers and the elderly disabled," Johnson said. "They are draining resources from people who are actually due that.
If you clean that up and shore it up you save a lot of money and you return the dignity of work to young men who need to be out working instead of playing video games all day. We have a lot of fraud, waste and abuse in Medicaid.” Carter said he and fellow Democrats on the committee will scrutinize those ideas closely.
“We will listen carefully. We will read the options and the suggestions that the Republican Party presents, or that the Trump administration presents, and we will go through it with a fine-tooth comb,” Carter continued. How much is spent improperly? Outright fraud does exist in Medicaid.
It's a huge program with lots of moving parts and thus a tempting target for scammers and thieves. But when individual cases are compiled, the data shows the amount of fraud is little different than what private insurance encounters, federal watchdogs say. The health department’s Office of Inspector General, the U.
S. Department of Justice and the Government Accountability Office found very few beneficiaries were gaming the system for monthly payments. Mostly it was people working for clinics, nursing homes, pharmacies, equipment supplies, physicians and the like seeking payments for ambulance runs not taken, prescriptions not filled, medical services not rendered, and the like, according the Health Department’s fraud and abuse control report.
Fraud units nationwide reported 1,151 convictions and $1.4 billion in recoveries for fiscal year 2024. A total of 94.
9% of the payments made on behalf of Medicaid in 2024 were proper, with all i’s dotted and t’s crossed, the Government Accountability Office found. About $31.1 billion were improper because providers did not correctly fill out the forms, according to the reports.
Usually it was physicians not submitting the proper documents supporting the medical necessity. “It's a big number," Timothy Hill, a commissioner with the Medicaid and CHIP Payment and Access Commission , which advises Congress and the Department of Health and Human Services, said Thursday at a KFF seminar. “But the vast majority of the improper payments, 74%, 75% across the country and consistently year to year, are around documentation issues.
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It doesn't mean that somebody didn't get care. What it does mean is that the rules that the agencies established for getting payment weren't followed." Hill said paperwork errors are not an issue that, if fixed, would reduce the cost of Medicaid.
"All those errors could be corrected. The total outlay of the program could still be the same, but they would be in compliance as opposed to be counted as an error," he said. What's the timeline? Johnson hopes the full budget legislation will clear both chambers and land on the president’s desk before Memorial Day in four weeks.
Republicans on the committee overseeing Medicaid hope to have a bill ready for a vote by May 9. It would then go before the full House. The Medicaid debate is only one piece of a larger budget puzzle.
Johnson and Scalise are trying to balance the demands of far-right members for deeper spending cuts with moderate Republicans who don't want Medicaid incapacitated. They can only afford to lose the support of three GOP members if Democrats stay united in opposition and everyone shows up for the vote. Carter says he wants to make sure the process isn't rushed.
“This is why we need in-depth research rather than just accept the talking points,” Carter said. “When we do it quickly, we risk the chance of missing things that are important and making bad policies that could hurt things. If you want to find the bug in the flour, you need sift carefully, not just toss out the bag.
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