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How work requirements may reduce access to Medicaid

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Protect Our Care supporters display “Hands Off Medicaid” message in front of the White House ahead of President Trump’s address to Congress on March 4 in Washington, D.C. 

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Cuts to Medicaid will have to be on the menu if House Republicans want to meet their budget goals, the Congressional Budget Office said in a report this week.

The chamber’s budget blueprint includes $880 billion in spending cuts under the House Energy and Commerce Committee, which oversees the program.

Medicaid helps cover medical costs for people who have limited income and resources, as well as benefits not covered by Medicare such as nursing home care.

To curb Medicaid spending, experts say, lawmakers may choose to add work requirements. Doing so would make it so people have to meet certain thresholds, such as 80 hours of work per month, to qualify for Medicaid coverage.

Republicans have not yet suggested specific changes to Medicaid. However, a new KFF poll finds 6 in 10 Americans would support adding work requirements to the program.

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Imposing work requirements may provide a portion of lawmakers’ targeted savings. In 2023, the Congressional Budget Office found implementing work requirements could save $109 billion over 10 years.

Yet that change could also put 36 million Medicaid enrollees at risk of losing their health-care coverage, estimates the Center on Budget and Policy Priorities. That represents about 44% of the approximately 80 million individuals who participate in the program. The estimates focus on adults ages 19 to 64, who would be most likely subject to a work requirement.

The idea of work requirements is not new. Lawmakers have proposed work hurdles to qualify for other safety net programs, including the Supplemental Nutrition Assistance Program, or SNAP.  

The approach shows an ideological difference between the U.S. and European social democracies that accept a baseline responsibility to provide social safety nets, said Farah Khan, a fellow at Brookings Metro’s Center for Community Uplift.

“We view welfare as uniquely polarized based on which party comes into power,” Khan said.

When one party frames it as a moral failing to be poor because you haven’t worked hard enough, that ignores structural inequalities or systemic injustices that may have led individuals to those circumstances, she said.

Medicaid work requirements prompt coverage losses

Loss of coverage has been a common result in previous state attempts to add Medicare work requirements.

When Arkansas implemented a work requirement policy in 2018, around 1 in 4 people subject to the requirement, or around 18,000 people total, lost coverage in seven months before the program was stopped, according to the Center on Budget and Policy Priorities. When New Hampshire attempted to implement a work requirement policy with more flexible reporting requirements, 2 in 3 individuals were susceptible to being disenrolled after two months.

“Generally, Medicaid work requirements have resulted in coverage losses without incentivizing or increasing employment and are a policy that is really unnecessary and burdensome,” said Laura Harker, senior policy analyst at the Center on Budget and Policy Priorities.

The “administrative barriers and red tape” from work requirements broadly lead to coverage losses among both working individuals and those who are between jobs or exempt due to disabilities, illnesses or caretaking responsibilities, according to the Center on Budget and Policy Priorities.

Rep. Ro Khanna: Democrats oppose $2 trillion in Medicaid cuts and tax breaks for the wealthy

Notably, around 9 in 10 Medicaid enrollees are already working or qualify for an exemption, Harker said.

Separate research from the American Enterprise Institute finds that in a given month, the majority of working-age people receiving Medicaid who do not have children do not work enough to meet an 80-hour-per-month requirement.

Consequently, if work requirements are imposed on nondisabled, working-age Medicaid recipients, that would affect a large number of people who are not currently in compliance, said Kevin Corinth, deputy director at the Center on Opportunity and Social Mobility at the American Enterprise Institute.

Either those individuals would increase their work to remain eligible or they wouldn’t, and they would be dropped off the program, Corinth said.

“If you put on work requirements, you’re going to affect a lot of people, which could be good or bad, depending on what your view of work requirements are,” Corinth said.

Lawmakers may also cut Medicaid in other ways: capping the amount of federal funds provided to state Medicaid programs; limiting the amount of federal money per Medicaid recipient; reducing available health services or eliminating coverage for certain groups.

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How students choose a college

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Is it best to go to college or dive straight into the working world?

Ethan Bianco, 17, waited right up until the May 1 deadline before deciding which college he would attend in the fall.

The senior at Kinder High School for the Performing and Visual Arts in Houston was accepted to several schools, and had whittled down his choices to Vanderbilt University and University of Texas at Austin. Ultimately, the cost was a significant factor in his final decision.

“UT is a much better award package,” he said. In-state tuition for the current academic year is $10,858 to $13,576 a year, which would be largely covered by Bianco’s financial aid offer.

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Vanderbilt, on the other hand, consistently ranks among the best private colleges for financial aid and promises to meet 100% of a family’s demonstrated need.

The school initially offered Bianco $35,000 in aid, he said. With that package, “it would be about $40,000 more for my family to attend Vanderbilt per year.”

However, he successfully appealed his award package and leveraged private scholarships to bring the price down further — and committed to Vanderbilt on National College Decision Day.

How cost plays into college choices

For most graduating high school seniors, the math works out differently. The rising cost of college has resulted in a higher percentage of students enrolling in public schools over private ones, according to Robert Franek, editor-in-chief of The Princeton Review.

“Currently, it is about 73% of the undergraduate population — but this year, with increasing uncertainties about financial aid and changing policies about student loans, it is very likely that number will go up,” Franek said.

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Soaring college costs and looming student debt balances have pushed this trend, and this year, there are added concerns about the economy and dwindling federal loan forgiveness options. As a result, this year’s crop of high school seniors is more likely to choose local and less-expensive public schools rather than private universities far from home, Franek said.

Price is now a bigger consideration among students and parents when choosing a college, other reports also show. Financial concerns govern decision-making for 8 in 10 families, according to one report by education lender Sallie Mae, outweighing even academics when choosing a school

“Choosing a school is a personal and individual decision,” said Chris Ebeling, head of student lending at Citizens Financial Group. Along with academics and extracurriculars, “equally important is the cost,” he said. “That needs to be weighed and considered carefully.”

Carlos Marin, 17, on National College Decision Day.

Courtesy of AT&T

On National College Decision Day, Carlos Marin, a senior at Milby High School, also in Houston, enrolled at the University of Houston-Downtown. Marin, 17, who could be the first person in his family to graduate from college, said he plans to live at home and commute to classes.

“The other schools I got into were farther away but the cost of room and board was really expensive,” Marin said.

College costs keep rising

College costs have risen significantly in recent decades, with tuition increasing 5.6% a year, on average, since 1983 — outpacing inflation and other household expenses, according to a recent report by J.P. Morgan Asset Management.

Deep cuts in state funding for higher education have also contributed to the soaring price tag and pushed more of the costs onto students. Families now shoulder 48% of college expenses, up from 38% a decade ago, J.P. Morgan Asset Management found, with scholarships, grants and loans helping to bridge the gap.

Nearly every year, students and their families have been borrowing more, which boosted total outstanding student debt to where it stands today, at more than $1.6 trillion.

A separate survey by The Princeton Review found that taking on too much debt is the No. 1 worry among all college-bound students.

Incoming Vanderbilt freshman Bianco qualified for a number of additional private scholarships and even received a free laptop from AT&T so that he could submit the Free Application for Federal Student Aid and fill out college applications. He said he is wary of taking out loans to make up for the difference.

“I believe that student loans can be beneficial but there’s also the assumption that you’ll be in debt for a very long time,” Bianco said. “It almost becomes a burden that is too much to bear.”

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Here are the HSA contribution limits for 2026

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The IRS on Thursday unveiled 2026 contribution limits for health savings accounts, or HSAs, which offer triple-tax benefits for medical expenses.

Starting in 2026, the new HSA contribution limit will be $4,400 for self-only health coverage, the IRS announced Thursday. That’s up from $4,300 in 2025, based on inflation adjustments.

Meanwhile, the new limit for savers with family coverage will jump to $8,750, up from $8,550 in 2025, according to the update.   

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To make HSA contributions in 2026, you must have an eligible high-deductible health insurance plan.

For 2026, the IRS defines a high deductible as at least $1,700 for self-only coverage or $3,400 for family plans. Plus, the plan’s cap on yearly out-of-pocket expenses — deductibles, co-payments and other amounts — can’t exceed $8,500 for individual plans or $17,000 for family coverage.

Investors have until the tax deadline to make HSA contributions for the previous year. That means the last chance for 2026 deposits is April 2027.

HSAs have triple-tax benefits

If you’re eligible to make HSA contributions, financial advisors recommend investing the balance for the long-term rather than spending the funds on current-year medical expenses, cash flow permitting.

The reason: “Your health savings account has three tax benefits,” said certified financial planner Dan Galli, owner of Daniel J. Galli & Associates in Norwell, Massachusetts.  

There’s typically an upfront deduction for contributions, your balance grows tax-free and you can withdraw the money any time tax-free for qualified medical expenses. 

Unlike flexible spending accounts, or FSAs, investors can roll HSA balances over from year to year. The account is also portable between jobs, meaning you can keep the money when leaving an employer.

That makes your HSA “very powerful” for future retirement savings, Galli said. 

Healthcare expenses in retirement can be significant. A single 65-year-old retiring in 2024 could expect to spend an average of $165,000 on medical expenses through their golden years, according to Fidelity data. This doesn’t include the cost of long-term care.

Most HSAs used for current expenses 

In 2024, two-thirds of companies offered investment options for HSA contributions, according to a survey released in November by the Plan Sponsor Council of America, which polled more than 500 employers in the summer of 2024. 

But only 18% of participants were investing their HSA balance, down slightly from the previous year, the survey found.

“Ultimately, most participants still are using that HSA for current health-care expenses,” Hattie Greenan, director of research and communications for the Plan Sponsor Council of America, previously told CNBC.

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There’s a higher 401(k) catch-up contribution for some in 2025

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If you’re an older investor and eager to save more for retirement, there’s a big 401(k) change for 2025 that could help boost your portfolio, experts say.

Americans expect they will need $1.26 million to retire comfortably, and more than half expect to outlive their savings, according to a Northwestern Mutual survey, which polled more than 4,600 adults in January.

But starting this year, some older workers can leverage a 401(k) “super funding” opportunity to help them catch up, Tommy Lucas, a certified financial planner and enrolled agent at Moisand Fitzgerald Tamayo in Orlando, Florida, previously told CNBC.

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Here’s what investors need to know about this new 401(k) feature for 2025.

Higher ‘catch-up contributions’

For 2025, you can defer up to $23,500 into your 401(k), plus an extra $7,500 if you’re age 50 and older, known as “catch-up contributions.”

Thanks to Secure 2.0, the 401(k) catch-up limit has jumped to $11,250 for workers age 60 to 63 in 2025. That brings the max deferral limit to $34,750 for these investors.   

Here’s the 2025 catch-up limit by age:

  • 50-59: $7,500
  • 60-63: $11,250
  • 64-plus: $7,500

However, 3% of retirement plans haven’t added the feature for 2025, according to Fidelity data. For those plans, catch-up contributions will automatically stop once deferrals reach $7,500, the company told CNBC.

Of course, many workers can’t afford to max out 401(k) employee deferrals or make catch-up contributions, experts say.

For plans offering catch-up contributions, only 15% of employees participated in 2023, according to the latest data from Vanguard’s How America Saves report.

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However, your eligibility for higher 401(k) catch-up contributions hinges what age you’ll be on Dec. 31, Galli explained.

For example, if you’re age 59 early in 2025 and turn 60 in December, you can make the catch-up, he said. Conversely, you can’t make the contribution if you’re 63 now and will be 64 by year-end.   

On top of 401(k) catch-up contributions, big savers could also consider after-tax deferrals, which is another lesser-known feature. But only 22% of employer plans offered the feature in 2023, according to the Vanguard report.

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