Tens of thousands of Washingtonians could soon be in healthcare limbo

Tens of thousands of Washingtonians are at risk of losing their Medicaid coverage this year.

How did we get here?

In July 2025, President Donald Trump signed HR1, more commonly known as the “Big Beautiful Bill.”

A major portion of the controversial bill will drastically change Medicaid—known as Apple Health in WA State—putting more responsibility for funding onto the states, and tightening up parameters for eligibility.

Under HR1, it is estimated that $1 trillion in federal spending cuts will be made to Medicaid over 10 years.

And by Dec. 31, 2026, the bill requires that states implement work requirements, meaning eligible Americans ages 19-63 must be working, attending school, or volunteering at least 80 hours per month in order to maintain coverage.

Those eligible Americans must also submit their proof of eligibility every six months, rather than every year, under HR1.

According to the Washington State Health Care Authority, over 620,000 Washingtonians will be impacted by work requirements and changes to redeterminations, and the state expects to see a reduction of funding from the federal government to the tune of billions of dollars.

All the changes that will come within the next few months are proving stressful for tens of thousands of people who rely on Medicaid programs like Susan Ben-Rubin.

“I have been, generally, a very healthy person,” Ben-Rubin said. “I did get diagnosed with breast cancer in 2015.”

Ben-Rubin has been a Washingtonian for nearly two decades and is a cancer survivor. But after beating cancer, more health concerns came her way.

She was diagnosed with a bone condition known as osteopenia, and an infusion to treat that led to FSGS, a serious and chronic kidney disease.

And now, for the past few months, her health insurance has been an added stressor.

Ben-Rubin said she got laid off in May. She was covered by her company still until the end of January; to continue coverage through her company’s COBRA, she said it would have cost $2000 a month for herself and her child, who also has a chronic illness.

So, over the past few months, Ben-Rubin started looking at her options through Apple Health.

“You gotta keep up with all this stuff in order to figure out your healthcare. And it’s just taxing,” Ben-Rubin said. “We’ve been battling with trying to figure out how to get the best insurance for us.”

Eventually, Ben-Rubin was able to land on a plan for herself and one for her daughter, but not without complications. Now that things are finally getting sorted out, she cannot help but worry about changes coming to the system,

“I can’t go for any time without me or my child being covered by health insurance,” Ben-Rubin said.

That’s because if she or her daughter is uninsured, it will be thousands of dollars each month in out-of-pocket costs.

“Healthcare should be a right,” Ben-Rubin said. “It shouldn’t be something that somebody has to fight for.”

What can the state do?

The state spends about $21 billion to fund Medicaid coverage each year, with more than half of that money coming from the federal government.

Now the state expects to lose billions in federal funds at a time when Washington State is already facing a massive budget shortfall.

“I want to be very clear,” Rep. Nicole Macri (D-Seattle) said. “The state is not in a position to fully backfill the cuts from the federal government. We know that people are going to lose healthcare coverage.”

Right now, the state’s uninsured rate is just under 5%, Macri said.

“We are concerned, however, that that is going to go up dramatically as the provisions of HR1 start to go into effect,” she added.

But any sort of back-funding for Medicaid services, Macri said, will mean budget cuts in other areas.

“We know that we’re not going to be able to do it all this session, which is why we are really trying to focus on where the greatest harm is going to happen first and building from there,” Macri said. “We are looking at how we can make targeted investments to ensure coverage, particularly for the most vulnerable people.”

Macri said the first date of concern for Washington State comes in October, when an estimated 30,000 Washingtonians will lose coverage through reduced Medicaid eligibility for specific non-citizen adults (refugees, asylees).

Macri said right now, that is the first group that House Democrats are focused on through the state budget. She said of those 30,000 people, 2,700 are receiving long-term care services or living in nursing home facilities.

“They need round-the-clock help,” she said. “And when they lose their insurance coverage, they’re likely to lose their ability to stay in the facility where they are.”

Macri noted that it will not only be people who rely on Medicaid who might be impacted by HR1, but also people who are privately insured. She said that as more people lose coverage, it is going to put pressure on the state’s hospital systems.

“And as folks lose their health insurance, that cost gets spread across us all,” Macri said. “And we will see hospitals that will struggle to maintain services, so that means any of us, if we have insurance, we will not have as much access in the future either.”

On the other side of the aisle, Sen. Chris Gildon (R-Puyallup) said, in an interview a few months back, that ensuring that Washingtonians have access to healthcare is a top priority, and he agreed that HR1 will create changes.

But he said Medicaid should be for people who truly need it.

“If you’re an able-bodied person and you’re just not complying with the requirement to go try to find a job, then probably you don’t need the assistance,” he said.

Gildon said the state should take a different approach, like cleaning up the rolls to ensure that someone is not enrolled in two states. He said doing that could save Washington State a couple of million dollars.

Overall, Gildon said he does not think that putting more responsibility on the state to run the Medicaid program is all bad.

“I’ve always said, the closer you are to the problem, the more reactive you can be to it and the better you understand it,” he said.

This week, both the Washington House and Washington Senate will unveil their budget proposals, where we will get a better idea of where things are slashed, where taxes are increased, and how Medicaid will be funded in light of HR1.

Macri said the big question is going to be “what is sustainable” given the state’s “budget constraints.”

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