Executive Summary
Proposed cuts to the federal budget could impact millions of people who rely on Medicaid for their health care. The 2025 Congressional Budget Resolution calls for the House Energy and Commerce Committee, which oversees Medicaid, to identify $880 billion in cuts over the next 10 years. Despite statements by President Trump and other congressional leaders to the contrary, the Congressional Budget Office has concluded that this budget goal cannot be reached without reducing Medicaid spending. Specific proposals to cut Medicaid spending under consideration include imposing work or community engagement requirements for Medicaid enrollees, reducing incentives for new states to adopt Medicaid expansion, requiring more frequent and stricter eligibility and citizenship checks, stricter screenings on providers who get Medicaid reimbursements, and federal Medicaid funding cuts to states that offer coverage to residents living in the U.S. illegally. Prior proposals have also included deeper cuts to the expansion of Medicaid under the Affordable Care Act (ACA) and limiting per capita spending on Medicaid enrollees more broadly.
This report examines the impact of potential cuts to Medicaid on LGBT adults. We analyzed pooled data from the 2021-2023 Behavioral Risk Factor Surveillance System (BRFSS) to show the degree to which LGBT adults rely on Medicaid as their primary source of health insurance; the increased reliance on Medicaid by LGBT adults as a result of Medicaid expansion under the ACA; and the potential impact of proposed work requirements on LGBT adults.
Key Findings
LGBT adults are approximately twice as likely as non-LGBT adults to have Medicaid as their primary source of health insurance (13% v. 7%). This difference is largely due to higher rates of poverty and disability among LGBT adults as compared to non-LGBT adults.
- Approximately 1.8 million LGBT adults have Medicaid as their primary source of health insurance, including more than 1.2 million lesbian and bisexual women
- 1 million LGBT adults living with a disability
- 560,000 LGBT parents who have children under 18 in their households
- 390,000 cisgender gay and bisexual men
- 185,000 transgender adults
In states that have adopted Medicaid expansion under the Affordable Care Act (ACA), LGBT adults are approximately twice as likely to have Medicaid as their primary source of health insurance and half as likely to be uninsured.
- In expansion states, 15% of LGBT adults rely on Medicaid as their primary health insurance, compared with only 8% in states that have rejected Medicaid expansion.
- In the states that have expanded Medicaid under the ACA, only 7% of LGBT adults are uninsured, compared with 18% in states that have rejected Medicaid expansion.
Proposed work and community engagement requirements for Medicaid enrollees will create additional barriers to applying for and maintaining Medicaid for LGBT adults, many of whom are already working, in school, or are unable to work.
- Approximately 8 out of 10 LGBT adults on Medicaid either are working (46%), have worked in the past year (9%), are current students (12%), or are unable to work (13%).
- The remaining 20% is composed of LGBT adults who report that they have not worked in the past year (12%), are homemakers (6%), or are retired (2%).