“Children are the world’s most valuable resource and its best hope for the future”

Former President John F. Kennedy, July 1963 

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Despite the evident and urgent needs of young people and parents and caregivers, the U.S. House of Representatives passed their reconciliation bill on May 22, which includes more than $715 billion in cuts to health care programs, with the majority coming from Medicaid, and over $300 billion in cuts to the Supplemental Nutrition Assistance Program (SNAP)—two programs that are proven to lift families out of poverty and ensure they have access to nutritious food and health care. These cuts are being championed and celebrated by Congressional leaders despite ample research and analysis demonstrating the direct and indirect harm that these cuts will have not only on young people, but on entire communities and state economies. 

Medicaid is a Vital Program for Virginians Across
the Lifespan

Medicaid and the Children’s Health Insurance Program (CHIP) provides critical health care coverage to nearly 2 million Virginians – including 740,000 children. Medicaid is a state and federal partnership, meaning that it is jointly funded through Virginia’s state budget and the federal government. The proposals passed by the U.S. House of Representatives would create deep holes in Virginia’s Medicaid budget and force state leaders to make impossible decisions about who Virginia’s Medicaid program serves and which services it covers. Due to the substantial number of young people enrolled in Medicaid, any reduction in funding would compromise their access to care, eligibility criteria, and the breadth of covered services. 

In order to realize $715 billion over the next ten years in “savings” from health care programs, the Energy and Commerce Committee – which has jurisdiction over Medicaid – established several policy proposals that will result in more than 10.3 million Americans losing Medicaid/CHIP coverage and at least 7.6 million becoming uninsured by 2034. Estimates for Virginia indicate that as many as 397,000 Medicaid enrollees could lose coverage under the proposals included in the bill.  

These proposals will put pressure on state agencies and make it harder for people to
successfully enroll in Medicaid, even if they technically qualify:

• Establishing Medicaid Work Requirements  
  Effective December 31, 2026, this proposal would establish the requirement that enrollees aged 19 – 64, who aren’t caregivers and who do not have a disability, do some combination of work, community service, or education for 80 hours per month. The proposal says it would exclude pregnant individuals, foster youth and former foster youth under age 26, individuals with disabilities, and those who are in compliance with work requirements under TANF or SNAP.
  
  Under this proposal, up to 480,000 Virginians could be impacted and at risk of losing coverage. Many of those who would lose benefits under this proposal are actually employed but could lose their benefits anyway due to red tape and confusing paperwork requirements.  Many parents would be at risk of losing their Medicaid coverage, which could impact their children’s coverage and access to care. 
  
• Increasing Frequency of Eligibility Checks 
  Effective October 1, 2026, this proposal would increase the redetermination frequency from once a year to once every six months for Medicaid Expansion members. As we saw during Medicaid Unwinding, more frequent eligibility determinations put strain on our local agencies and create administrative roadblocks that will result in procedural disenrollment and churn within the program, even for people who qualify for Medicaid. 
  
  Under this proposal, we will see people lose coverage not because they were determined no longer eligible for Medicaid, but because they didn’t receive a notice, didn’t understand what they needed to do to keep their coverage, didn’t return documents on time, or the Medicaid agency didn’t process the paperwork in a timely way. The reduction in caseloads would come from eligible people not enrolling and the cost savings would come at the expense of low-income people’s access to health care.  
  
  This could also impact the health of children in families where parents are covered under Medicaid Expansion. Specifically, this could lead to confusion that the children are no longer covered and could cause children to miss routine appointments. Medicaid Expansion had a “welcome mat” effect on children, leading to increased health coverage among children already eligible for Medicaid/CHIP when their parents become eligible as well. 
  
• Establishing Cost-Sharing for Medicaid Expansion Enrollees 
  Effective October 1, 2028, this proposal would require states to impose cost-sharing on Medicaid Expansion enrollees with incomes between 101% and 138% FPL ($32,472- $44,367 per year for a family of 4). It would set a maximum of $35 per service and an annual maximum of 5% of an individual’s income. Cost-sharing would not be included for primary care, prenatal care, pediatric care, or emergency room visits – but it would be required for non-emergency care received at an emergency department. 
  
  Virginia currently has no cost sharing for services covered under Medicaid or FAMIS. This would require 147,000 Virginians covered under Medicaid Expansion with incomes between 101% and 138% FPL to pay a portion of their medical costs – with maximum out-of-pocket costs for a family of 4 ranging from $1,624 – $2,218.  
  
  Under this proposal a household of 4 just above the federal poverty limit (an income of $32,472) would be expected to pay up to $1,624, out of pocket, for covered services that are not exempted. Higher out of pocket costs, especially for low-income individuals, lead to reduced use of care and worse health outcomes. 
  
• Imposing an FMAP Penalty on States that Cover Immigrants 
  Effective October 1, 2027, this proposal would reduce the federal match (FMAP) for Medicaid Expansion by 10% – from 90% to 80% – for states that provide Medicaid coverage to undocumented individuals through state funds to replicate a state coverage program. 
  
  This would be a huge barrier to Virginia achieving its goal of passing “Cover All Kids” legislation to create a state-based health coverage program for children who are ineligible for Medicaid due to their immigration status. Roughly 13,000 children in Virginia are unable to access affordable health care coverage due to these eligibility rules. But Virginia is a “trigger law” state, meaning that we have language in our state budget tied to the Medicaid Expansion which denotes that any percentage decrease in the federal match for expansion would automatically end the coverage for those enrolled. Even a 1% reduction in federal funding for Medicaid expansion would lead to the automatic disenrollment of approximately 630,000 Virginians, which includes pregnant people and parents.  
  
  This is a direct attack on immigrant children and their families and forces state lawmakers to make a difficult and cruel trade-off in deciding who gets health coverage. 
  
• Prohibiting Changes to Provider Taxes 
  Effective upon enactment, this proposal would restrict states from increasing current provider taxes or establishing new provider taxes. Under federal rules, states may impose taxes and assessments on hospitals and other providers to raise revenue that pays for a portion of their share of Medicaid costs.  
  
  Virginia imposes a provider tax on private acute hospitals to finance our 10% share of Medicaid expansion costs. Though this will not repeal the provider tax, it will prohibit Virginia and the hospitals from negotiating future changes to the structure or amount. If federal FMAP is reduced, Virginia would be unable to increase the provider taxes to make up for the differences in cost. 
  
• Impeding Access to Gender Affirming Care 
  Effective upon enactment, this proposal would prohibit Medicaid from paying for certain gender affirming care services for children, as well as adults. It also prohibits gender affirming care services from being considered an Essential Health Benefit, which would eliminate protections and make coverage fluctuate across different insurers.  
  
  Virginia’s Medicaid program covers gender affirming care services for children under the age of 18 and would have to remove this coverage. This is a direct attack on LGBTQ+ youth and will not only impact their physical well-being but will directly harm their mental health as well. 

There are additional proposals that will cumulatively result in Medicaid enrollees having a more difficult time accessing the care and services they need. During a time of such economic uncertainty, when families are dealing with the rising cost of living and the impending price hikes as a result of tariffs, now is not the time to cut basic needs programs and add administrative red tape. Families and children need more support, not less, and we must stop making it harder on them and shutting them out of services. Make no mistake: any dollar cut from Medicaid will harm young people’s health and well-being.  

SNAP Boosts the Economy, Reduces Food
Insecurity, and Improves Health

 SNAP is the nation’s largest anti-hunger program and one of the most effective tools we have to combat poverty and build thriving communities. In Virginia, SNAP helps nearly 830,000 people put food on the table – including more than 329,000 children. Families that receive SNAP spend those dollars in our local economies, fueling production for local agriculture and farmers and business for local retailers. In fiscal year 2024, SNAP benefits infused $1.8 billion into Virginia at nearly 6,400 retailers. 

Unlike Medicaid, SNAP nutrition benefits are funded solely by the federal government, while states pay half of administration costs and handle screening for eligibility and issuing benefits. The proposals that passed in the reconciliation bill cut $300 billion from the SNAP program, including shifting a portion of the costs to states. Requiring states to pay even a portion of the costs will create an unfunded mandate that would be incredibly difficult to finance, resulting in states taking food assistance away from the people who need it the most.  

This reconciliation bill makes historic and devastating cuts to the SNAP program that will impact families, farmers, grocers, schools, and local and state governments. These cuts will force Virginia lawmakers and state agency leaders to choose between cutting eligibility or absorbing unmanageable and unsustainable costs.  

These proposals will leave families with children vulnerable to hunger, particularly
with increased food prices: 

• Freezing Updates to the Thrifty Food Plan  
  This proposal would prohibit USDA from making future increases to the cost of the Thrifty Food Plan—essentially freezing SNAP benefit amounts outside of inflation—ignoring future changes to dietary guidelines, food purchasing patterns, or changes in food costs. The Thrifty Food Plan (TFP) was updated in 2021 and increased the average SNAP benefits by 21% compared to 2019 benefit levels. Capping future increases would be a direct cut to SNAP benefits’ purchasing power, a cut that grows deeper over time.  
  
  Currently, Virginians on SNAP only get roughly $6 per person per day, an average of $178 per month. Restricting future adjustments to the TFP to only account for inflation will cut roughly $30 billion from SNAP over the ten-year budget period. Because the TFP determines SNAP benefit amounts, SNAP participants in future years would receive less benefits under this proposal. For Virginia, that means a benefit cut of roughly $580 million from fiscal years 2027-2033. 
  
• Imposing a State Cost Share for SNAP Benefits
  Beginning in fiscal year 2028, this proposal would require all states to contribute at least 5% of the share of benefits costs. The percentage of state share is dependent upon the state’s SNAP error rate. States with error rates between 6 – 8% must pay 15%; states with error rates between 8 – 10% must pay 20%; and states with error rates of 10% or higher must pay 25% of costs. 
  
  These cost shifts will lead to benefit cuts, such as ending Broad-Based Categorical Eligibility (BBCE), as our state general fund would be unable to maintain the full costs of the program for all currently enrolled beneficiaries. In FY23, Virginia’s SNAP Error Rate was 9.86%. So, based on this proposal, Virginia would be placed in the 20% share of benefits costs category. That cost for Virginia would be at least $353 million per year. 
  
• Increasing State Administrative Cost Share 
  This proposal will increase the administrative costs to states by increasing their share from 50% to 75%. Currently, states pay half of administrative costs and handle screening for eligibility and issuing benefits and the federal government pays the other 50% share of administrative costs. In FY23, Virginia’s state administrative costs were $174 million, and the federal government covered $175 million. Under this proposal, for Virginia to cover 75% of administrative costs, it would cost Virginia an additional $88 million – totaling $262 million per year.
  
• Imposing Zero Tolerance for Payment Errors 
  This proposal would reduce the payment error tolerance from $57 to $0. This proposal penalizes states for minor mistakes, potentially disincentivizing efforts to streamline enrollment so that states can minimize risk. For example, if a SNAP benefit was $1 less or more than the amount of SNAP benefits the household should have received (called an underpayment or overpayment), it will count as an error. Paperwork mistakes also count towards error rates.  
  
  We know that our local Department of Social Services agencies are already underresourced and understaffed. Adding more red tape while simultaneously decreasing federal funding would only exacerbate these issues and lead to more errors. These types of small errors will likely increase Virginia’s error rate to 10%, pushing our state share into the 25% state share category. A 25% share of SNAP benefit costs would cost Virginia at least $442 million per year. 
  
  • A note on the combined impacts of Implementing a State Share and Increasing Administrative Cost Sharing: Virginia would incur roughly $441 million in additional annual costs through a 20% state share of SNAP benefits and a 75% share of administrative costs. If the zero-tolerance payment error provision is included, that could push Virginia into the 25% state share bracket and increase total annual costs for benefits and administration to the Commonwealth by $530 million per year. 
    
• Expanding SNAP Work Requirements 
  SNAP currently has general work requirements and are strictest for able-bodied adults without dependents (ABAWD) between ages 18 to 54. Currently, these adults are limited to receiving SNAP benefits for three months in a three-year period unless they work or participate in a job training program for at least 20 hours per week or have an exemption, such as having a disability.  
  
  This proposal would expand the current SNAP work requirements for adults up to age 64 (from age 54) and for parents and caregivers in households with children aged 7 and older. This includes a change in how a “dependent child” is defined – from “under 18 years of age” to “under age 7.”  An exemption to the work requirements is carved out for a parent of a child aged 7 and older, but the parent must be married and live with a partner who meets the work requirements. 
  
  Under this expansion of work requirements, an estimated 76,000 non-disabled adults in Virginia with school-aged children (age 7 and older) are at risk of losing SNAP. If an adult is cut off SNAP, food benefits are decreased for their entire household. As a result, 176,000 Virginia households with school-age children could lose some or all of their SNAP benefits and be at risk of not having enough food assistance to feed the family. 

There are additional proposals included in the reconciliation bill that will layer onto the above proposals to reduce benefit amounts for families, increase administrative burden and red tape, and force Virginia to choose between cutting eligibility or absorbing unmanageable and unsustainable costs. Moreover, these proposals – as well as the proposals to Medicaid – come with administrative and systems expenses, which will take additional state money and time to upgrade systems and to train and hire staff. 

With 1 in 7 Virginia children living in food insecure households and 78% of Virginians struggling to afford groceries, protecting and strengthening SNAP is more important than ever. Parents will be forced to make difficult trade-offs, such as deciding to get ultra-processed food rather than fresh fruits and vegetables or having to decrease portion sizes to feed the entire family.  

SNAP creates jobs, and without SNAP we will have less grocers and farmers, and Virginia’s rich agricultural sector and food supply chain will suffer alongside hungry families and children. Despite rhetoric about “Making America Healthy,” this proposal dismantles our most effective anti-hunger program and will leave families with children vulnerable to food insecurity, particularly as food prices increase. 

Cuts to SNAP and Medicaid Create Ripple Effects
that Directly Impact Young People

It is important to also take a step back and look at how these cuts would intersect with each other. The same households would be impacted by cuts to both Medicaid and SNAP, losing critical lifelines for health and food at the same time. Nationally, two-thirds of children who participate in Medicaid, SNAP, or both are children of color – placing Black and Latino children at heightened risk from proposed cuts.  

Cuts to SNAP and Medicaid will be detrimental to children’s health—and it’s important to note that we will especially see the impacts of these cuts in the classroom. 

Cuts to Medicaid and SNAP are Cuts to School Meals

Children can’t learn when they are hungry, and for so many children, school has been a guaranteed two meals a day—but these cuts threaten student’s access to those guaranteed school meals. While school nutrition programs and the Community Eligibility Provision (CEP) were not cut in the House Education and Workforce’s budget mark-ups, any cuts to Medicaid and SNAP are direct assaults on school nutrition programs.  

Children who are enrolled in SNAP are “directly certified” for free school meals – meaning they automatically qualify – and Virginia uses Medicaid data to directly certify students for free and reduced-price school meals. The proposal to cut Medicaid and SNAP will reduce the number of families that are eligible, and children will lose direct access to school meals, causing more students to fall through the cracks due to administrative barriers and navigating the complex application process. 

Additionally, schools would see a decrease in the number of “identified students.” For some schools, that means they would no longer be eligible for CEP. For schools that are still eligible to participate, it could make it less financially viable because federal reimbursements are primarily based on the number of students who are directly certified through programs like SNAP, TANF, and Medicaid.  

We are already seeing a decrease in the number of “identified students” post-Medicaid Unwinding, in which over 130,000 children across our Commonwealth were disenrolled from Medicaid between April 2023 and September 2024, despite many remaining eligible. This is a small-scale case study for what is to come if Virginia is faced with more children and families losing Medicaid and SNAP coverage. School divisions will be faced with tough decisions of weighing the option to continue participating in CEP or not. And it is a decision that impacts children who are eligible for free meals and those who are already falling through the cracks. 

Teachers are reporting regularly seeing students come to school hungry and say that they worry about students’ ability to access nutritious meals when they are not in school. We cannot continue to widen this gap to accessing nutritious food. Any cuts to Medicaid and SNAP will lead to more hunger in the cafeteria and at the dinner table. 

Cuts to Medicaid and SNAP are Cuts to Child Nutrition Programs

Like direct certification for school meals, children enrolled in SNAP and Medicaid are also eligible for several other child nutrition programs:  

• The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 

• SUN Bucks (Summer EBT) 

• *Summer Food Service Program 

• *At-Risk Afterschool Meal Program 

*These programs utilize data sources, such as direct certification data, to determine where those meals can be served and which locations can participate in summer and afterschool meals. 

Cuts to Medicaid and SNAP are Cuts to Jobs and Hits to the Economy

Virginia is required to balance its budget each biennium, and without additional ways to raise revenue, the state general fund cannot backfill the hole that the loss of federal SNAP and Medicaid funds would create. In addition to the benefits cuts that would need to take place to afford these proposals, the loss of billions of dollars in federal funding would weaken Virginia’s economy and cause substantial job loss across health and food sectors.  

Families that receive SNAP spend those dollars in our local economies, fueling production for local agriculture and farmers and business for local retailers. Virginia Fresh Match, the statewide nutrition incentive network, partners with more than 150 Virginia businesses and organizations to offer SNAP matching funds for produce, with a collective annual impact of more than $3.3 million. Cutting SNAP benefits for Virginia families means a direct hit to the 1,200 farmers and 6,400 retailers who earned income through feeding families with SNAP benefits.

Learn more about the direct impact cuts would have on local grocers by reading about the impact that SNAP has on The Market at 25^th, Richmond’s East End grocery store.

Additionally, more than one-third of Virginia’s rural hospitals are operating in the red, and cuts to Medicaid would put many hospitals that mainly serve residents in Southwest and Southside at risk. Virginia has 28 health care facilities that fit the Centers for Medicare and Medicaid Services’ definition of “rural hospitals”, and they serve populations with higher rates of poverty. Because these hospitals are largely financed through Medicaid and Medicare and get lower reimbursement rates for much of their patients’ care, more than one-third reported operating within negative margins in 2022, a problem that predated the COVID-19 pandemic. 

If federal Medicaid and SNAP funding are cut, the combined economic loss to Virginia in 2026 is estimated at $2.6 billion, and job losses in the health care and agricultural/food sectors are estimated to be over 24,000. These hits to the economy and state budget would undermine health and economic gains that Virginia has made in recent years through policy change and investments in the state budget. Nonprofits, food banks, and other community-based resources play a vital role in supporting families, but they aren’t equipped to fill the gap and replace the foundational support provided by programs like Medicaid and SNAP. 

Any significant cuts will create the perfect storm of policy failure that will worsen hunger and profoundly impact the health and well-being of young people in Virginia for years to come.

TAKE ACTION NOW

Rather than divesting from basic needs programs and reducing access to nutritious food and quality health care, Congress should be investing in the programs that are proven to lay the foundation for children and their families to thrive. 

Instead, in just ten days, House Congressional leaders fast-tracked their path through budget reconciliation and omitted the public from the process. Mark-ups on the policy proposals were heard in committee on May 13, and on May 21 at 1 AM, the House rushed through an overnight vote in the House Rules Committee and then pushed for a full House vote only hours later at 9 AM.  

The reconciliation bill will now go to the Senate, where it will almost certainly undergo more changes before returning to the House for a final vote. Congressional members are on Memorial Day recess through June 3, so now is the time to call them while they are back home in your district and let them know that children and families are counting on them to do the right thing!

Send this action alert to your Congressional Representative and Senators urging them to Oppose Cuts to Medicaid! 

Send this action alert to your Congressional Representative and Senators urging them to Protect Young People from Hunger!

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