With Medicaid funding and access under increasing scrutiny, the 2025 Michigan State of Reform Conference came at a critical moment. Violet joined a committed group of health plan leaders, providers, policymakers, and advocates to explore what’s at risk—not only for the Medicaid program itself, but also for the individuals and communities who depend on it every day. 

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One of the most insightful discussions of the day featured Dominick Pallone, Executive Director of the Michigan Association of Health Plans; Brian Peters, CEO of the Michigan Health and Hospital Association; and was moderated by Farah Hanley, Managing Principal at Health Management Associates. Together, they unpacked the very real implications of proposed federal changes and what they could mean for Medicaid in Michigan.

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Discussions focused on the widespread consequences of proposed cuts, which are expected to affect every health care consumer. By the time this article is published, some of the proposals discussed may have shifted or evolved, but the central challenge remains: how do we protect access to care in a changing political environment?

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Here’s what we know so far. 

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Essential funding is under pressure, and the narrative around it matters.

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“Waste, fraud, and abuse” has become a common talking point in conversations about Medicaid, particularly in Washington. But these phrases are often used to justify efforts to reduce or eliminate critical funding mechanisms such as State Directed Payments and provider taxes. These financial tools are central to how states sustain Medicaid access and are reviewed annually by CMS. Weakening them could destabilize provider networks and disrupt care for everyone, not just those enrolled in Medicaid.

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Provider taxes are certainly under the microscope right now on Capitol Hill. If those provider tax programs were to be significantly eroded in some way or eliminated entirely, potentially it would create, number one, an enormous hole in the Michigan budget, a hole that we could not fill. But more importantly, it would affect human lives.

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–Brian Peters CEO of the Michigan Health and Hospital Association

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This isn’t a debate about bureaucracy or budget lines. It’s a debate about access to care. Undermining these programs could limit care options in both rural and urban communities, impacting safety-net providers and the patients who rely on them most.

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We’re still fighting misconceptions about who Medicaid serves.

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There is still a widespread misconception that Medicaid primarily supports “able-bodied adults who don’t want to work.” But the reality is far different. The majority of Medicaid enrollees are children, pregnant individuals, people with disabilities, older adults, and those working in low-wage jobs or have unreliable sources of income (including contractors, gig workers, seasonal employees, etc.) Many are essential workers who perform the very tasks that keep communities running. 

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Medicaid is a more modern and efficient program than it is often given credit for. Mischaracterizing the population it serves creates a distorted public narrative and can pave the way for harmful policy decisions. Setting the record straight is an important part of protecting Medicaid’s future.

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Work requirements are missing the mark.

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Work requirements, where Medicaid recipients must prove they’re working or looking for employment, remain politically popular in some circles, but the policy implications tell a different story. When you consider all the people who would be exempt—such as children, people with disabilities, caregivers, students, and people who are already working—very few enrollees remain subject to the rules.

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Far from encouraging employment, work requirements often result in eligible people losing coverage because of paperwork errors or administrative hurdles. The policy looks good on a press release—but it fails in practice.

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Training cuts threaten necessary specialized care.

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One attendee—a provider from a Detroit-based HIV clinic—shared a sobering reality: their entire model of care depends on specialized training programs and drug discount savings that are now at risk of being cut. Programs like the AIDS Education and Training Centers (AETCs) provide critical education that helps frontline staff offer respectful, informed care to people living with HIV. Without them, providers are left without the tools they need to serve people who already face barriers due to poverty, stigma, and complex medical needs.

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On top of that, proposed changes to the 340B Drug Pricing Program and Ryan White funding would reduce clinics' ability to stretch their limited resources. These programs allow providers to reinvest savings into patient care—funding social workers, case managers, or transportation for patients who need it. The fear expressed at the conference was clear: if these cuts go through, patients could lose access to the trusted clinics they rely on.

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Conference speakers urged attendees to start telling these stories now—as part of ongoing state budget conversations—so that decision-makers understand what’s really at stake. These aren’t just line items on a spreadsheet. They’re lifelines for people who need care the most.

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Advocacy is more important than ever.

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One of the clearest messages of the day was the need for proactive communication with lawmakers. When elected officials do not hear from constituents, they often assume programs like Medicaid are functioning just fine. But as many speakers noted, that silence can be misinterpreted as approval or indifference.

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Advocacy does not require policy expertise or political connections. Simply sharing personal stories about how Medicaid affects real people—patients, providers, and families—can help shift the conversation. With state-level budget planning already underway, now is a critical time to make those voices heard.

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Key terms to know

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• State Directed Payments (SDPs): State-authorized Medicaid payments to providers aimed at supporting access to care, especially in underserved areas.
• Medicaid provider taxes: Fees that states collect from health care providers, like hospitals, which the state then uses to get more matching money from the federal government to help fund Medicaid.
• Ryan White Program: Federal funding that supports comprehensive HIV/AIDS care for uninsured or underinsured individuals.
• 340B Drug Pricing Program: Allows safety-net clinics to purchase medications at reduced prices so they can stretch their resources and provide more care to people with low incomes or who live in underserved areas.
• Work Requirements: Work requirements are rules that make some Medicaid recipients prove they’re working, looking for a job, or doing certain activities—like job training—in order to keep their health coverage. They’ve been shown to reduce coverage without increasing employment.

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