As Congress continues to threaten deep cuts to the Medicaid program, a new KFF report shows how some of the proposed changes could end coverage for an estimated 20 million people nationwide, more than 800,000 in Illinois. One idea targets the Medicaid expansion federal match rate. The federal government currently pays 90% of the costs for people covered under what's known as the Medicaid expansion, that extended coverage to nearly all low-income adults.

Liz Williams, senior policy analyst with KFF, explained that if the federal match rate drops, Illinois would have two options: come up with more than $40 billion to cover expansion costs or drop it altogether.

"Illinois has a law where the state is required to automatically end expansion coverage if the match rate drops, so in those trigger law states, there's 12 of them, enrollees are at greater risk of losing coverage," she explained.

Nearly 30% of Medicaid enrollees in Illinois have health-care coverage because of the Medicaid expansion and would be at risk of losing it should these changes go through.

The Medicaid expansion under the Affordable Care Act was enacted to reduce the number of uninsured people nationwide. It provided states with an increased federal match rate to help pay for their health-care costs. Williams added that if states can't afford to pick up the added costs from decreased federal support, the number of uninsured people will dramatically increase, and any gains in financial security and health outcomes associated with the expansion would be reversed.

"Medicaid is jointly funded by states and the federal government, so any restrictions in federal Medicaid spending really leaves states with tough choices about how to offset reductions," she continued.

She said states have a few options, including increasing state tax revenues, decreasing spending on non-Medicaid services such as education, or decreasing coverage for other groups. Governor J.B. Pritzker has already proposed eliminating Medicaid coverage for non-citizen adults aged 42 to 65 as a way to make up for the state's $1.7 billion-budget gap.


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Minnesota lawmakers this session are emphasizing new protocols to shield state agencies from fraud. A watchdog group says so far, it appears they're on the right track.

The motivation to address this issue is tied to the high-profile "Feeding our Future" case, when dozens of people were accused of stealing pandemic relief money intended for kids' meals. It's estimated roughly $250 million was misspent, and dozens of convictions have since followed.

At the state Capitol, both Republicans and Democrats have openly discussed the need for tighter controls, which is encouraging to Matt Ehling, a board member for Minnesotans for Open Government.

"It's been a growing problem for quite a few years now," he said, "so it's nice to see that both sides of the aisle are focused on this issue this year."

One bill calls for a new state Office of Inspector General to get ahead of suspicious behavior. Ehling said the Office of Legislative Auditor does good work, but sees the need for another arm that goes beyond reviewing problems after the fact.

A separate proposal could stir backlash by no longer awarding some grants to nonprofits without a bidding process. Backers of keeping that option have argued it helps smaller groups in underserved areas get access to funding.

The Minnesota Council of Nonprofits has said it agrees that state funds must be used for their intended purpose, but worries some restrictions would make inequities worse.

Ehling said it's unfortunate that, at the height of the pandemic, federal relief packages meant to help people in need were targeted by fraudsters.

"Bad actors were able to take advantage of that, because the money was coming in so fast," he said, "and the resources to oversee the money were simply not appropriately put in place."

When those COVID spending packages were approved, states were tasked with distributing aid. Ehling's group hopes that if there's a new Office of Inspector General, it will operate with transparency. And a bipartisan group of lawmakers has said that with grant reforms, there should be assurances that smaller community groups are given a fair shot.


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AARP says it's getting thousands of phone calls from seniors worried about getting through to Social Security, as program operations are dramatically overhauled by the Trump administration. The concern is being felt in North Dakota. From staffing cuts to pursuing the closure of nearly 50 regional field offices, the White House and top advisor Elon Musk are seeing backlash over these moves. There are reports of wait times stretching several hours. It comes amid a new requirement that says beneficiaries can no longer verify their identity by phone. They have to do it in person or online.

Josh Askvig, state director of AARP North Dakota, says that could be tough in a largely rural state.

"It would be possible that folks would have to drive three to four hours or more to get to a location. And if you're not comfortable working with apps on your iPhone or Android device, you're looking at potentially a full day of driving, and that's a significant barrier," he explained.

The national AARP says it's fighting to protect these services, so that monthly payments aren't disrupted. It also calls on the administration to scrap the new verification rule and restore the phone option.

The White House says it's trying to root out fraud while insisting benefits won't be cut. But Democrats argue these changes will lead to missed or late checks for beneficiaries.

Askvig said the chaos that's unfolding could lead to another problem lurking in the shadows.

"We're also concerned that this change will lead to scammers using the confusion the agency has created around this to potentially exploit and prey on Americans as well," he added.

AARP and other senior advocates hope their allies reach out to Congress to intervene. They say Social Security operations have been under-resourced for some time, and they hope their renewed calls for service improvements turn more heads amid public frustration. Nearly one in six North Dakota residents receive Social Security benefits.

A federal funding freeze affecting a broad swath of U.S. programs has left many organizations in limbo, with new fallout coming every day. Court challenges have so far stalled many impacts of the Trump administration's order to end or reduce government grants, loans and other assistance.

Isaiah Torres, statewide policy manager with the state's Center for Civic Policy, says New Mexico is fortunate to have a large Land Grant Permanent Fund and Early Childhood Trust Fund. He believes they give the state some maneuverability others may not have.

"Not relying so much on general-fund revenue - in categories such as education and health care - to allow us to make strategic decisions moving forward," he explained.

New Mexico Attorney General Raul Torrez joined a lawsuit with 22 other states to block Trump's order, which claims the president doesn't have the authority under the U.S. Constitution to take money away from the targeted programs. The White House said the freeze would give the administration time to review each agency program to determine the best use of funding.

Alissa Barnes, executive director with Progress Now New Mexico, says the freeze is nonetheless creating chaos and uncertainty. And not every program that receives federal funding is likely to get a reprieve.

"It is all encompassing for how New Mexico is able to support New Mexicans. And a lot of the dollars that the state puts up in their general allocation also relies on matching funds or grants from the federal government," she explained.

Barnes previously worked for the state's Roadrunner Food Bank - one of thousands across the country already affected by the government's halt in shipments of produce, poultry and other items distributed to needy residents.

"Not knowing if money is going to stop, not knowing when it might stop - not knowing any of those details makes it really hard to not only plan but to continue providing direct services," she continued.

Infrastructure projects funded by the Biden administration also are in jeopardy. New Mexico was awarded $156 million in grants last year for solar projects to help low-income, disadvantaged and tribal communities decrease energy costs by reducing household electric bills. Without federal funding, many won't go forward.