ASHA Medicaid Committee Members Share Their Experiences and Urge Lawmakers to Protect Medicaid

August 7, 2026

July 8-10, ASHA's Medicaid Committee members flew to Washington, DC from all over the country to participate in 13 meetings with their members of Congress. These advocates-representing audiologists and speech-language pathologists (SLPs) across red, blue, and purple states-urged their legislators to protect and support Medicaid at a time when Medicaid funding is being slashed across the country.

The Medicaid program will face almost $1 trillion in cuts over the next 10 years due to the One Big Beautiful Bill Act (OBBBA). ASHA fought hard with many provider and consumer organizations last year to avoid even more large-scale cuts, but OBBBA has already had a dramatic impact on ASHA members. OBBBA's Medicaid cuts are currently causing audiology and SLP provider payment cuts, higher administrative burden, restricted telehealth coverage, more audits, and other barriers to care.

ASHA Advocacy staff briefed the committee members before their meetings to make sure they were prepared to discuss funding issues, pending legislation, and political opposition to Medicaid. In their meetings with congressional staff, ASHA members shared their experiences of delivering care in outpatient clinics, hospital settings, and schools. Members also discussed how defunding Medicaid is a major problem for them.

Funding Cuts and Work Requirements

Many lawmakers view Medicaid as a piggy bank they can dip into to pay for unrelated federal spending priorities. Following congressional elections in November, some lawmakers are considering fast-tracking additional funding cuts and program changes under the guise of reducing waste, fraud, and abuse-even though states are already lowering payment rates and restricting eligibility because of OBBBA.

OBBBA implemented a variety of new policies aimed at programmatic improvement for Medicaid. But in practice, this means Medicaid agencies are being told to do more with less money than they have ever had.

For example, OBBBA requires Medicaid Expansion enrollees (low-income adults) to verify that they are working or that they qualify for an exemption. Implementing work requirement verification is an expensive and time-consuming effort for Medicaid agencies. Diverting funds for this new federal mandate will take time, energy, and money from covering much-needed services-like those provided by audiologists and SLPs-to Medicaid-enrolled beneficiaries.

Provider Taxes and State-Directed Payments

Medicaid is funded jointly by the state and federal government. (Learn more about the structure of Medicaid here.) The federal government pays anywhere between 50% and 83% of Medicaid expenses in a state for traditional Medicaid populations and 90% for Medicaid Expansion populations.

OBBBA changed the way states can pay for their own share of Medicaid expenditures by limiting the way provider taxes (not levied on individual audiologists or SLPs) and state-directed payments (SDPs) are structured and allowed.

Two new proposed rules related to these funding mechanisms will limit states' flexibility to use SDPs and provider taxes to address workforce shortages and appropriately tailor reimbursement to encourage more providers to enter the network. The SDP rule could worsen existing provider shortages, increase wait times, and make it harder for Medicaid enrollees to remain safely in their homes and communities. The limits on provider taxes will lower Medicaid funding for states that are already struggling financially. Overall, these changes will reduce beneficiary access to care.

What ASHA Is Doing to Protect Medicaid

ASHA has continued to forcefully advocate against additional Medicaid funding cuts and program changes, recently submitting testimony [PDF] for a Senate Budget Committee hearing highlighting OBBBA's harmful impact on patients and providers and urging lawmakers not to make a bad situation worse.

ASHA also submitted comments [PDF] on the Interim Final Rule regarding the Centers for Medicare and Medicaid Services' (CMS) implementation of OBBBA work requirements, sharing the difficulties (and expense) it will create for providers and beneficiaries alike.

What You Can Do to Protect Medicaid

Even if you don't take Medicaid payment in your setting, everyone is affected by Medicaid cuts as consumers in a complex health care system. For example, safety net hospitals rely heavily on Medicaid funding to provide care. With less Medicaid funding due to OBBBA, there are 446 hospitals across the country at risk of closure. Fewer hospitals means fewer options for patients to access care.

The same is true for ASHA members. Many ASHA members have already begun closing offices due to reduced payment rates linked directly to the strain OBBBA is putting on state Medicaid agencies.

Meetings with congressional staff help connect the dots between narrative talking points and real life impact. Your members of Congress need to hear from you about how Medicaid cuts are affecting your practice. Please join us in taking action to help protect audiology and speech-language pathology services for Medicaid beneficiaries.

ASHA Resources

• Medicaid Cuts and Coverage Changes
• Medicaid Coverage of Speech-Language Pathologists and Audiologists
• Medicaid Payment for School-Based Services
• Medicaid Advocacy in 2026: Partnerships and Progress
• A Domino Effect: The One Big Beautiful Bill Act's Medicaid Repercussions
• What Will It Take to Transform Rural Health Care?