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A congressional budget fight over Medicaid has raised fears that thousands of Northern Virginia residents could lose health coverage or critical long-term care services.

Medicaid, jointly funded by federal and state governments, covers low-income families, people with disabilities, older adults and pregnant women. It serves about one in five Americans, including 150,000 Fairfax County residents, more than 2 million Virginians and 72 million people nationwide.

For Fairfax resident Mary Lee Ruby, the debate is deeply personal. Medicaid pays for services used by her 24-year-old grandson, Austin, who was severely and permanently disabled by a brain bleed during birth.

Ruby provides Medicaid-funded home care for Austin outside the hours he attends a Medicaid-funded day center, giving his mother a break. Austin is blind, weighs about 65 pounds and cannot move his hands or care for himself.

“When you walk him through a door, you have to move his hands in because otherwise he’ll get stuck in the doorway,” Ruby said. “He really requires total and complete care.”

Austin can hear and smile, she said. “He has a beautiful smile.”

Ruby said losing Medicaid assistance would be devastating, even though she would continue caring for her grandson regardless of whether the program paid for that work.

Congress clashes over the numbers

The dispute intensified after the U.S. House approved H.Con.Res.14 on Feb. 25, establishing a federal budget framework for fiscal 2025 and proposed budget levels through 2034.

The House plan included $4.5 trillion in tax cuts and sought at least $1.5 trillion in federal spending reductions. The Senate had approved its own resolution on Feb. 21, but the chambers’ plans differed and would have to be reconciled before Congress could move forward under a shared framework.

Democrats argued that the House resolution would make enormous Medicaid reductions unavoidable. Republicans disputed warnings that the program was under threat.

Rep. Brendan F. Boyle of Pennsylvania, the ranking Democrat on the House Budget Committee, said the plan directs the Energy and Commerce Committee to cut $880 billion over 10 years. Because Medicare and Medicaid account for more than 97% of the spending overseen by that committee, Boyle argued in a March 18 fact sheet that the target could not be reached without major Medicaid cuts.

Rep. Gerry E. Connolly, a Democrat whose district included parts of Fairfax County and the City of Fairfax, described defunding Medicaid as unacceptable. He said the Republican budget would cut Medicaid by $881 billion to help finance tax reductions.

Federal and state Medicaid spending totaled about $880 billion in fiscal 2023. The federal share varies by state, from a minimum of 50% to 77% for the traditional program, with lower-income states generally receiving a larger contribution.

Most Americans oppose reductions

A KFF Health Tracking Poll released March 7, 2025, found little public support for cutting Medicaid. Seventeen percent of adults wanted funding reduced, while 42% favored an increase and 40% wanted funding to remain about the same.

KFF focus groups also found that Medicaid recipients emphasized the program’s importance to their families.

Ruby, who was not involved in those focus groups, expressed the same concern. She said it would be terrible for Austin to lose the care Medicaid covers.

Austin’s father works as a Fairfax County fire marshal but does not earn enough to replace all that support easily, Ruby said.

Virginia proposes more state funding

Virginia determines its own Medicaid eligibility rules, health priorities and method of paying the state share of the joint program.

Gov. Glenn Youngkin unveiled amendments to the state’s 2025 budget legislation on March 24 and said they would fully fund Virginia’s Medicaid obligations.

The Republican governor proposed another $824.5 million for health and human resources over the biennium. That included $720.5 million from the general fund to cover forecast increases for Medicaid and the State Children’s Health Insurance Program.

Youngkin said the proposal would bring support to $16 billion from Virginia’s general fund and $53 billion from general and nongeneral funds combined.

That state commitment could ease some immediate concerns, but it would not settle how much the federal government will contribute. The possibility of federal reductions or less direct program changes remains unresolved.

Virginia’s trigger law raises the stakes

Virginia is among nine states with laws tying continued Medicaid expansion to federal support.

Under the Affordable Care Act’s expansion formula, the federal government pays 90% of the cost and Virginia pays 10%. Virginia law calls for enrollment or benefit reductions if the federal contribution falls below that threshold.

Connolly said nearly 90,000 residents of his district were directly at risk of losing health coverage. He also warned that the effects would reach beyond expansion enrollees because Medicaid helps seniors obtain nursing-home, memory-care and assisted-living services. Nationally, the program covers about 40% of births.

The Virginia Network of Private Providers said trigger provisions in nine states could end expansion coverage for roughly 3 million people if federal funding declined. Most of those laws activate when the federal contribution falls below 90%. Arizona’s trigger takes effect if the share drops below 80%.

Advocates take their case to lawmakers

Labor and disability advocates have organized town halls, rallies and lobbying events as the congressional debate continues.

David Broder, executive director of the SEIU Virginia State Council, said March 27 that the union would hold public meetings even when congressional representatives did not attend.

Broder said SEIU had conducted roundtables with three members of Virginia’s congressional delegation and helped organize an event attended by more than 400 people in Rep. Jennifer Kiggans’ district. Care workers and people with disabilities also traveled to Capitol Hill to lobby lawmakers.

For Ruby, the political fight ultimately comes down to whether Austin can continue receiving the extensive daily assistance he needs.

“He’s my grandson,” she said. “I would take care of him whenever they needed it, but it would be devastating.”