Tens of thousands of Washingtonians risk losing Medicaid coverage this year following sweeping changes to the federal program signed into law by President Donald Trump in July 2025.
HR1, known as the “Big Beautiful Bill,” shifts more funding responsibility to states while tightening eligibility requirements for Medicaid, called Apple Health in Washington. The legislation cuts an estimated $1 trillion in federal Medicaid spending over ten years. By Dec. 31, 2026, states must implement work requirements mandating that eligible Americans ages 19 to 63 work, attend school, or volunteer at least 80 hours monthly to maintain coverage. Eligible recipients must also submit proof of eligibility every six months instead of annually.
The Washington State Health Care Authority estimates over 620,000 Washingtonians will be affected by work requirements and eligibility changes. The state expects to lose billions in federal funding at a time when Washington already faces a massive budget shortfall. The state spends roughly $21 billion annually to fund Medicaid coverage, with more than half coming from federal sources.
Rep. Nicole Macri of Seattle said the state cannot fully replace lost federal funds. “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,” she said. Washington’s uninsured rate currently sits just under 5%, but lawmakers expect it to rise dramatically as HR1 provisions take effect. The first major impact comes in October when an estimated 30,000 non-citizen adults, including refugees and asylees, will lose coverage through reduced Medicaid eligibility. Of those, 2,700 receive long-term care services or live in nursing facilities.
Macri warned the changes will affect privately insured residents as well. “As folks lose their health insurance, that cost gets spread across us all. 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,” she said. Sen. Chris Gildon of Puyallup said Medicaid should serve 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.
Both the Washington House and Senate will unveil budget proposals this week addressing how Medicaid will be funded under HR1. Macri said the central question is “what is sustainable” given the state’s budget constraints.
