Thousands of Montgomery County residents may lose coverage because of recent cuts to federal health care programs, representatives of the county’s Department of Health and Human Services told the County Council during a briefing Tuesday morning. 

The cuts at issue are part of the One Big Beautiful Bill Act that President Donald Trump signed into law in July. Those covered through the Affordable Care Act’s Medicaid expansion are specifically targeted by the cuts, including younger adults and certain immigrants. 

“When we think about who makes up that expansion population, that’s our county’s self-employed business owners, including our farmers up in the [Agricultural] Reserve … it’s our workforce that’s employed by our small businesses … it’s our students,” said Nina Ashford, the county’s chief of public health services, during the briefing.  

Republicans in Congress hope the cuts will decrease the amount of money the federal government spends on health care. Democrats argue that the cuts will shift costs onto states, employers and individuals who may not be able to absorb them.  

To reverse some of the cuts, most Congressional Democrats have withheld their support for a resolution to keep funding the federal government, resulting in the ongoing shutdown that began Oct. 1. 

According to Ashford, 19% of Montgomery County residents – around 205,000 people – are currently covered by Medicaid.  

Of those, Ashford said, up to 23,000 could lose coverage between 2026 and 2028 because of new requirements they are unable to meet or the burden of having to prove their eligibility more frequently as a result of the new law. 

That figure includes 3,000 Montgomery County residents who can expect to or already have lost coverage entirely, Ashford said. Among them are asylees, refugees and people in the Deferred Action for Childhood Arrivals program. 

County health officials hope that many of those who lose Medicaid coverage in the coming years will be able to benefit from county programs such as Montgomery Cares and Care for Kids, which provide access to primary care, oral health care and other limited services. 

Those programs – while helpful – aren’t a substitute for insurance, Ashford said. And while the programs have the capacity to support all of those who may lose Medicaid coverage under the new law, there isn’t sufficient money in the programs’ budgets to do so. 

“The bottom line is there’s an increased risk of worse outcomes and higher cost for our clients,” said Monica Martin, the county’s chief of behavioral health and crisis services. 

Mitigation efforts

The council recently announced a $7.75 million spending package aimed at offsetting the local impact of recent federal actions.  

The package, which was introduced Tuesday and will come up for a final vote on Nov. 18, includes money for food assistance, short-term housing, LGBTQIA+ resources, economic development and nonprofit organizations.  

Asked during her media briefing Tuesday afternoon if the council is open to similar cash infusions for Montgomery Cares and Care for Kids, council President Kate Stewart (D-Dist. 4) said county officials are still working to understand the full impact of the federal cuts. 

“At this time, it is not included in the resolution that we put together,” Stewart said. “However, as was discussed this morning, we will continue to work with the Primary Care Coalition, our Department of Health and Human Services, our other nonprofit partners, to address the needs as they arise.” 

Last month, Gov. Wes Moore (D) unveiled a new program to help offset an expected rise in insurance premiums for many Marylanders during a press conference at the Montgomery County Department of Health and Human Services center in Silver Spring.  

Premiums are expected to increase in part because enhanced premium tax credits put in place during the COVID-19 pandemic were not extended under the One Big Beautiful Bill Act.  

Also expected to impact premiums is an increase in uncompensated care, or care that hospitals are legally required to provide to uninsured people, but that the federal government won’treimburse. 

Through the Maryland Premium Assistance Program, Moore hopes people covered through the state’s health insurance marketplace will see projected increases in their premiums reduced by two thirds, amounting to about $500 in yearly cost savings.  

But local and state officials acknowledge they won’t be able to counteract all the recent changes to federal health care programs. 

“There will be people who are going to be hurt by this legislation, who will not get care, whose care will be delayed, who will be sicker because of it,” Chief Medical Officer Kisha Davis said during the council briefing.  

“While we as a county have, I think, shown today that we are ready to address as much as we can, there will still be gaps. And we will not be able to address all of it.”