Introduction

Forty-four states face budget shortfalls this fiscal year or next.  Because of Medicaid's prominence in state budgets – accounting for 17 percent of spending – the program is often a target for cuts. Twenty-six states and the District of Columbia have cut Medicaid this fiscal year by reducing eligibility, benefits or provider payments and increasing patient co-payments. The outlook is equally grim for next year.

To prevent harm caused by Medicaid cuts, defenders must persuade policymakers that:

• Cutting eligibility, benefits or rates, or creating barriers to enrollment are bad ideas
• There are better alternatives

This guide distills lessons from Medicaid defense work in a number of states and provides tools to fight cuts and introduce the most promising alternatives.