AMNA NAWAZ: As Republicans work to advance a massive bill containing much of President Donald Trump's domestic agenda, one of the central flash points is its potential impact on Medicaid, affecting health care access for millions of lower-income Americans, the elderly and people with disabilities.

Geoff Bennett recorded this conversation about that earlier today.

GEOFF BENNETT: That bill remains subject to change as it moves through the legislative process, but, in its current form, the House version proposes cutting more than $600 billion from Medicaid.

It would also impose work requirements for adults without dependents or disabilities up to the age of 64, require 80 hours of work a month, with documentation twice a month in most cases, and reduce funding for state Medicaid expansion.

We're joined now by Jennifer Tolbert, the deputy director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation.

Thanks so much for being here.

JENNIFER TOLBERT, Deputy Director, Program on Medicaid and the Uninsured, KFF: Thank you.

GEOFF BENNETT: So this bill introduces a work requirement for Medicaid in 2026.

What exactly would that look like, given what we know about what happened in states like Arkansas and Georgia when they implemented a work requirement?

JENNIFER TOLBERT: Right.

So this bill for the first time imposes a national work requirement on the Medicaid program.

It would require people, certain individuals covered by Medicaid, to work at least 80 hours a month or to engage in community service or work training or to be enrolled in school.

Now, there are some exemptions.

Parents who -- of dependent children, as well as people who are medically frail, are exempt from these requirements.

But, nevertheless, new rules are being added to Medicaid, despite the fact that the majority of people who will be subject to the new requirements are in fact already working or are not working for reasons that would likely qualify them for an exemption, because, for example, they are caring for young children or aging parents, or they're in school, or they have a chronic condition or other health condition that limits their ability to work.

And what we know about experience in Arkansas and Georgia, two states that have implemented work requirements at the state level, is that these new rules pose barriers to people enrolling in coverage and lead to coverage loss.

And this is losses of coverage among people who are eligible for the requirements, but who have difficulty navigating the reporting requirements and providing the documentation needed to verify that they in fact meet the requirement.

GEOFF BENNETT: So how would the states that have the Medicaid expansion protections, how would they navigate these changes coming from Capitol Hill?

JENNIFER TOLBERT: Right.

So this bill really does take aim at the Medicaid expansion.

This was -- allowed states to expand coverage to parents and adults without dependent children with incomes up to 138 percent of poverty.

And it was adopted as part of the Affordable Care Act.

So, today, 40 states and D.C. have adopted the Medicaid expansion.

And this bill really does try to weaken that expansion coverage in a number of ways.

First, it imposes work requirements, so the expansion adults are the subject of the new work requirements.

It also requires more frequent eligibility determinations and imposes new cost-sharing requirements on this population.

In addition, states that have adopted this expansion coverage and also provide coverage to certain immigrant children and adults using their own funds are at risk of losing certain federal funding for this group because of that coverage they provide to immigrants.

GEOFF BENNETT: So, if the federal government is reducing funding to states, and if states can't offset the costs, then what happens?

JENNIFER TOLBERT: Medicaid financing is shared between the states and the federal government, so any loss of federal funding will shift cost onto the states.

So, the Congressional Budget Office has estimated that this bill and the changes included for Medicaid would lead to a reduction of over $700 billion in federal Medicaid spending over the next 10 years.

So, states are going to face some tough choices over how or whether they offset those costs or that loss of federal funding.

And, if they don't, if for some reason they are unable to or choose not to offset the costs, it is estimated that over 10 million people will lose Medicaid coverage.

GEOFF BENNETT: Well, let's talk about elderly Americans who rely on Medicaid for long-term care services, for nursing home services.

How might they be affected by these cuts?

JENNIFER TOLBERT: Right.

So this bill really does take aim at that Medicaid expansion population, but the effects are definitely more widespread.

One of the things it does is rescinds a rule that had been implemented during the Biden administration that made it easier for seniors and people with disabilities who also have Medicare coverage to enroll in Medicaid, which will then pay for their premiums and cost-sharing, as well as provide them access to supplemental benefits that Medicare doesn't provide, including long-term care, dental benefits, as well as vision care.

So the Congressional Budget Office estimates that over a million people, these seniors and people with disabilities, will lose their access to Medicaid and therefore will lose their access to those additional benefits.

GEOFF BENNETT: Certainly more to come.

Jennifer Tolbert, thanks so much for sharing your insights with us.

We appreciate it.

JENNIFER TOLBERT: Thank you.

It was a pleasure.