When Megan Thomas moved out of the troubled Lowry Apartments in downtown St. Paul, she quickly moved into a 390-square-foot apartment at Summit Hill Senior Living, an assisted living community on the city’s East Side, through the help of Catholic Charities, an administrator of her support services.
“I’m disabled and I can’t work,” said Thomas, 59, who suffered a diabetic seizure a few years ago. “If I didn’t have medical assistance, I’d be dead.”
Megan Thomas shares her in her apartment in a senior living complex with her two cats, Bella, near and Coya, rear, in St. Paul on Tuesday, July 2, 2025. (John Autey / Pioneer Press)
Her Community Access for Disability Inclusion waiver, better known as a CADI waiver, is a state-sponsored program that builds on federal Medicaid benefits, one of the leading ways the federal government helps states support the health needs of disabled and low-income populations. Qualifying for Medicaid is often the threshold for accessing other social service benefits.
“You have to be on Medicaid to qualify for housing stabilization services, which I needed last year,” Thomas said.
Medicaid-sponsored services are an essential safety net for thousands of Minnesotans in need of public medical assistance, from basic health insurance to in-home therapy and nursing home care, according to Thomas, Catholic Charities and other providers.
That safety net is now facing a dramatic challenge as federal lawmakers attempt to cut funding for both Medicaid and public nutrition programs while raising the bar for accessing services.
Added costs of additional screenings
House and Senate versions of the GOP budget bill — dubbed the “One Big, Beautiful Bill” — propose fundamental changes to Medicaid to sharply reduce federal public assistance allotments to states and counties and impose new eligibility requirements, including twice-a-year screenings, at a time when demand for food, medical and emergency assistance is rising.
Some 71 million Americans receive Medicaid benefits, including about 1.16 million Minnesotans, adding up to $12 billion in Minnesota in 2023 alone.
Under the Senate version of the budget bill, 137,000 Minnesotans could lose healthcare in the near term, and another 89,000 residents would have to pay higher insurance premiums through the Affordable Care Act’s marketplace, according to some estimates. Longer-term impacts could touch everything from childbirth deliveries to in-home therapies and housing.
“More than half of Minnesotans in nursing homes rely on Medicaid,” said Laura Mortenson, a spokesperson for the Minnesota Budget Project, a project of the Minnesota Council of Nonprofits, in a conference call with news agencies on Wednesday. “It supports people in our affordable housing and childcare systems.”
Minnesota is one of 10 states where individual counties handle Medicaid screenings, and some counties have already reported being overwhelmed by growing administrative demand in the years since the pandemic. By doubling those annual screenings without compensating for the increased administrative burden, Minnesota counties could shoulder $30 million to $50 million in added costs, said Linnea Mirsch, director of director Community and Human Services in St. Louis County.
“It’s difficult to measure and estimate the impact of this additional workload,” said Mirsch, who predicted those costs will ultimately be passed on to property owners through higher county tax levies.
The goal, said some providers, appears to be to discourage Medicaid recipients like Thomas from wrangling with the added paperwork and to get them instead to simply walk away from the system.
“By making her recertify every six months, you’re just adding to the complexity of a really difficult life already,” said Keith Kozerski, chief program officer with Catholic Charities.
The bill has strong support among Republicans in Congress, including from U.S. Rep. Pete Stauber, who represents Minnesota’s 8th Congressional District. A Duluth News-Tribune story earlier this week included a statement from Stauber in which he said he supports the bill because “it will deliver much-needed economic relief to the American people.”
He cited a figure from the White House Council of Economic Advisers, which said a family of four could have an after-tax take-home pay increase of $7,600 to $10,900 in the first four years after the bill’s passage.
Some changes delayed to 2027
Meanwhile, certain changes in the “One Big, Beautiful Bill” would be scheduled to roll out gradually, some not taking effect until early 2027, which is after the mid-term elections, Mortenson noted.
Among them, significant cuts proposed to the Supplemental Nutrition Assistance Program — or SNAP, once commonly known as food stamps — could overwhelm an already overburdened emergency food assistance network struggling to keep up with increased demand since the outset of the pandemic, said food shelf providers on the call.
Certain aspects of the bill are predicted to increase energy costs for many families, which will have a trickle-down effect as households reduce food budgets to compensate, said Zach Rodvold, a spokesperson for Second Harvest Heartland, a hunger-relief organization that supports more than 1,100 food shelves and food programs. For low-income families balancing budget priorities, that means more trips to food shelves to make ends meet.
“Food shelves will see very quickly an increase in demand … and certainly over a period of years, there will be a major increase in demand, barring some other kind of intervention,” Rodvold said.
Some foresee heavy impacts on retailers, especially in poor areas.
More than 3,600 Minnesota retailers — mostly convenience stores and groceries — currently accept SNAP benefits. “On some days, up to 50% of their total sales are SNAP transactions,” said Steve Barthel, a spokesperson for the Minnesota Grocers Association, who predicted store closures. “In lower-income neighborhoods, losing a grocery store means losing access to fresh, vital foods.”
Providers also predicted stark impacts on farm growers, food distributors and hospitals.
“I’m not actually getting money,” said Thomas, interviewed in her apartment at Summit Hill Senior Living, where a majority of residents receive some form of public assistance. “The health aide is getting money. The owner of this building is getting money. … If Medicaid is cut, there are thousands of jobs that would be affected.”
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