As Crystal Lyon was preparing to give birth last spring, she took steps to ensure her daughter was enrolled in Medicaid as soon as she was born. 

Her daughter’s father had been born with retinoblastoma, a rare form of eye cancer. That type of cancer is caused by a genetic mutation, and soon after their daughter Ari was born they started to suspect she may also have the mutation. 

Their suspicions were confirmed, and less than three months after she was born, Ari was diagnosed and began chemotherapy treatments. Throughout the process, Crystal was unable to work while she took care of Ari, and her family relied on one income to make ends meet. 

Just over a year later, Ari is in remission. But the $425,000 price tag for her treatment could have pushed her family into a financial crisis. 

Now, as Congress debates cuts to Medicaid and implementing work requirements for the program and other assistance, Lyon is fearful of what it could mean for her family and her community of Foristell, Missouri. 

“It’s very scary. I’m not only worried about my daughter, but I worry about all these people around me who might not be able to get the care they deserve,” she told The Beacon. 

Recently, the nonpartisan Congressional Budget Office (CBO) released a new analysis of President Donald Trump’s budget bill, which aims to extend tax cuts for some of the wealthiest Americans, increase military spending and immigration enforcement and provide some tax cuts on tips and overtime pay. 

To fund tax cuts and other spending, which would dramatically increase the federal deficit if passed alone, the legislation proposes cuts to Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, and a rollback of clean energy funds. 

The CBO report estimated that those cuts, coupled with proposed changes to the Affordable Care Act, could lead to 16 million people losing insurance coverage by 2034. 

And the impact is higher in rural areas, where more residents rely on programs like Medicaid and SNAP.  

How proposed changes to Medicaid could impact Missouri and Kansas 

Researchers at the nonpartisan Center for American Progress used the CBO report and other data sources to create estimates of what coverage losses could look like across the country. They created proportional weights for each congressional district using 2024 enrollment data. 

In Kansas, one of 10 states that haven’t expanded Medicaid, an estimated 75,000 people could lose health insurance coverage by 2034. 

And in Missouri, where voters approved a constitutional amendment to expand Medicaid, an estimated 210,000 people could lose coverage by 2034. 

The legislation would implement things like work requirements for Medicaid enrollees or those who were eligible for Medicaid under the Affordable Care Act. Those aged 19-64 would be required to work or participate in activities like community service or school for at least 80 hours a month. Some adults, like those with disabilities or caregivers, would be exempt from work requirements. 

It would also increase the requirements for states to conduct eligibility checks on Medicaid enrollees. 

“We expect — and the CBO expects — that will lead to millions of people losing their Medicaid coverage,” said Andrea Ducas, the vice president of health policy at Center for American Progress. “Not because they don’t meet the requirement, but because the red tape is just impossible to get through.” 

The legislation limits ways states could use federal funds to pay for their Medicaid programs, shifting the responsibility onto state budgets. So, it would be left to states to figure out the best way to balance their budgets in the face of increased costs due to a lack of federal funding, Ducas said. 

States could change their Medicaid reimbursement rates, which industry experts say are already perilously low, in order to recoup some of the costs. 

“That results in fewer resources actually flowing into hospitals and clinics, and less state flexibility to pay for Medicaid benefits that we all associate with the program,” Ducas said. 

That could be a problem in Missouri and Kansas, where rural hospital closures have become a recent trend. The Center for American Progress data show that 28% of hospitals in Kansas are on the brink of closure, while 17% in Missouri are at risk. 

A decline in revenue for hospitals could lead to them cutting services that are not profitable, like maternity units, Ducas said. 

How would SNAP change in Kansas and Missouri? 

Researchers at Center for American Progress also evaluated how many Americans may see their SNAP benefits put at risk in the bill. New proposals to alter SNAP include expanding work requirements for those with children aged 7 or older and Americans up to age 64. 

“These are folks that are nearing retirement, or folks that are winding down from the labor market, trying to take fewer hours on purpose after putting decades of their life into possibly physically demanding jobs at the lower end of the income scale,” said Kyle Ross, a policy analyst who worked on the report. 

Some estimates put about 8 million Americans, including 2.5 million children and more than 500,000 adults over 65 or who have a disability, at risk of losing some food assistance because of the work requirements. 

The report found that in Kansas about 43,000 people could lose access to their SNAP benefits. In Missouri, that figure is 150,000. 

And the authors said the estimates were conservative. 

Ross said the cuts would likely have impacts on the economy, especially in rural areas. Retailers that rely on customers using SNAP benefits could see a downturn in profits. 

“If that store faces financial hardship from reductions in sales from their customer base that relies on SNAP, stores could reduce staff (or) cut back plans to expand their operation,” Ross said. “That financial shortfall does not only harm all of the rural SNAP recipients in those areas, it just harms the entire community that those stores serve.”