Potential Medicaid cuts raise alarm for states: ‘What do Trump and the Republicans think will happen to these people?’

Funded jointly by the federal government and states, Medicaid provides health insurance for roughly one in five Americans, from impoverished children and low-income adults to seniors and those with disabilities reliant on care at home.

Now it’s a target of House Republicans, who have weighed cutting the reimbursement the federal government provides to states to help underwrite their plans to extend President Trump’s 2017 tax cuts, which are due to expire by year’s end.

The budget resolution passed this week by the House eyes chopping $880 billion over the next decade from federal programs overseen by the House Energy and Commerce Committee, which includes Medicaid. The resolution doesn’t specify how much could be slashed for the program, and House Speaker Mike Johnson has said lawmakers would not pursue some of the most dramatic options, such as reworking the so-called Federal Medical Assistance Percentage, the formal name for the share of Medicaid costs the federal government provides to each state.

But given its outsized place in federal health care spending, any cuts to Medicaid would have to be significant for Republicans to realize the type of savings they’re pursuing, potentially putting health care benefits at risk for millions of Americans.

In Massachusetts alone, more than 2 million people rely on what’s known as MassHealth, including 45 percent of all children in the state, officials said. Massachusetts currently gets 50 cents from the federal government for every dollar it spends on most people in the program, but up to 90 cents for roughly 400,000 who receive coverage under an expansion of Medicaid through the federal Affordable Care Act.

Seniors in long-term care rely even more heavily on Medicaid funding. Senator Elizabeth Warren said about two out of every three people in a nursing home in Massachusetts get support from Medicaid. (Medicare, the federal health insurance program for older retirees and those with disabilities, doesn’t cover long-term nursing home care.)

“What do Trump and the Republicans think will happen to these people?” Warren said. “Is the idea to set them out on the street corner and have them carted away with tomorrow’s trash?”

Healey’s warnings appear to nod to the worst-case scenario. She told business leaders on Wednesday that if the House’s budget resolution is passed as is, “2 million residents, including 700,000 children and 200,000 seniors, would lose health care” — an apparent reference to all of those who currently rely on MassHealth.

“Who do you think is going to pay for that? What’s going to happen to health care premiums? What’s going to happen to our health care system, health plans, and all the workers and businesses who depend on that when that federal funding goes away?” she said a Greater Boston Chamber of Commerce event. “No one is immune or unaffected by these impacts.”

The state gets nearly $14 billion in federal reimbursements for MassHealth, which, if slashed, could force state officials to choose among cutting benefits, slicing elsewhere from the budget, or tapping emergency funds.

Massachusetts is sitting on more than $8 billion in its emergency savings account, but it’s unclear how willing officials would be to use it to offset Medicaid funding cuts. And significant cuts to MassHealth or other health funding could have a cascading effect across the state, especially within the health care industry, said Treasurer Deb Goldberg.

“We don’t have a lot of farmland. We don’t have oil wells. We don’t have a lot of other industries,” Goldberg said Thursday. “We need Congress to understand that what they are looking at is undermining our economy.”

Just reducing funding for the Medicaid expansion would, in many states, cause significant pain.

New Hampshire, for example, expanded Medicaid eligibility under the Affordable Care Act, but unlike other New England states, its legislature passed a law creating a so-called trigger clause to automatically sunset that expansion if the federal portion falls below 90 percent.

That means if congressional Republicans adjust the federal match below that 90 percent threshold, about one-third of Medicaid beneficiaries in New Hampshire — roughly 60,000 people — would lose coverage.

Kelly Ayotte, the Republican governor, is crafting changes to Medicaid benefits at the state level as part of her two-year budget proposal. She cautioned this week that the federal budget process has a long way to go.

“I can’t deal in hypotheticals,” she said.

In Rhode Island, 311,444 residents get full Medicaid benefits, and another 12,000 receive partial benefits, including children receiving early intervention services, according to state officials.

There’s another wrinkle: Medicaid reimbursements in Rhode Island are significantly lower than those in neighboring states, and hospitals and physicians say they are paid less than their actual costs, sometimes thousands of dollars less for a single procedure.

The situation means that “any potential cuts would be problematic for Rhode Island’s medical community and the entire state’s economy,” said Jessica Wharton, a spokesperson for Brown University Health, formerly known as Lifespan Corp.

For facilities with patients who rely more heavily on Medicaid, the hit would be dramatic. Dr. Amy Nunn, chief executive of the Rhode Island Public Health Institute, said about 30 to 35 percent of its patients at Open Door Health, a LGBTQ+ health clinic it owns, are on Medicaid.

“There’s a good chance that this would be a death blow to other health centers with much higher rates of Medicaid patients,” Nunn said.

Even Massachusetts, with its higher reimbursement rates, would suffer.

About two-thirds of acute care hospitals in Massachusetts lost money last year, citing inadequate reimbursement rates from MassHealth as one factor, said Steve Walsh, chief executive of the Massachusetts Health & Hospital Association.

Further cuts to Medicaid would be “catastrophic” for those financially ailing hospitals and the patients they serve, he said.

“Medicaid is the chassis that the entire health system is built upon,” Walsh said. “If you chip away at that, the ability to provide services in every other area becomes difficult, if not impossible.”

MassHealth was already under pressure before Congress’s potential budget slashing emerged. Pandemic-era federal funds have run out, while the program is strained by growing health care costs, state officials have said.

Last year, people with disabilities fought to protect a home care program largely funded by Medicaid from trims proposed by the Healey administration. Now, with the possibility Congress could make significant cuts, they fear the care they rely on through the Personal Care Assistant program could face an even greater threat.

“Whenever government looks to cut, they always look to cut services for the disabled and the most needy of our society,” said Jerry Boyd, 55, of West Roxbury.

Boyd has cerebral palsy, relies on a power wheelchair, and uses 38 hours a week of assistance from personal care assistants, whose services include helping him get ready for work and to bed at night, shopping, and preparing meals.

“If I get cut in hours, I’d have to really, really think about how best to use the hours that I have,” Boyd said.

Jon Chesto, Alexa Gagosz, Steven Porter, and Rob Weisman of the Globe staff contributed to this report.

Matt Stout can be reached at [email protected]. Follow him @mattpstout. Jason Laughlin can be reached at [email protected]. Follow him @jasmlaughlin.