What could Trump's return mean for Minnesotans on Medicaid and safety net programs?

Voters feeling the crunch of high prices helped return President-elect Donald Trump to office. But for some of the lowest income and most vulnerable Minnesotans who rely on federal safety net programs, last week's election rekindled familiar concerns.

In his last term, Trump proposed cuts to a slew of programs that help poor families and people with disabilities afford health care, food and housing. It remains to be seen whether he will resurface those efforts, many of which failed to make it through Congress or were later blocked.

But as Republicans seek to extend tax breaks set to expire in 2025, policy experts predict the president-elect will be looking at entitlement programs — namely Medicaid — to help offset costs.

Trump has said little about Medicaid on the campaign trail but has stressed that he "will not cut one penny" from Medicare or Social Security.

"Where else are you going to look?" asked Edwin Park, a research professor at the McCourt School of Public Policy at Georgetown University. "The obvious one is Medicaid."

Proposals from congressional Republicans and conservative think tanks show "a clear consensus to go after Medicaid to make it a target for really deep and damaging cuts," he said.

Medicaid provides health coverage to millions of people, including low-income adults and children, people with disabilities and older adults. It pays for workers who help people get dressed, fed and out the door and ensures that kids with disabilities can access health care services to learn and grow, said Katy Neas, CEO of the Arc of the United States, which advocates for people with intellectual and developmental disabilities.

"Medicaid is the No. 1 program that influences the independence for the rest of their life," Neas said, noting that there are already huge unmet needs in the program, with about 700,000 on waiting lists for home- and community-based services.

National and local advocates for poor and vulnerable populations are not just watching Medicaid. During Trump's last round in office, his administration proposed changes to programs from food stamps to Supplemental Security Income to Section 8 housing vouchers. The Trump transition team did not respond to specific policy questions from the Minnesota Star Tribune.

"The American people re-elected President Trump by a resounding margin giving him a mandate to implement the promises he made on the campaign trail. He will deliver," spokeswoman Karoline Leavitt said in a statement.

The Star Tribune reviewed policy and budget proposals from his previous term, campaign trail comments and platform documents and spoke with experts tracking the issues to assemble some of what he has considered in the past and what might be ahead.

Cash assistance

Trump has stressed that he wouldn't cut Social Security benefits. However, during his last term he proposed trims to two monthly payment programs run by the Social Security Administration: Supplemental Security Income (SSI), which benefits people with disabilities and older adults who have little or no income, and Social Security Disability Insurance (SSDI), which helps those who have a disability that limits or prevents them from working.

Trump's proposals included reducing a portion of a child or parent's SSI if another family member was also getting the benefit, and halving the retroactive benefits people are eligible for under the disability insurance program.

He also suggested cuts to Temporary Assistance for Needy Families (TANF).

Food stamps

Trump sought to tighten work requirements for recipients of the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps.

His administration aimed to more strictly enforce limits on how long "able-bodied adults" younger than 50 who didn't have dependents could receive the food help. The rule could have removed nearly 700,000 people from the program, but a federal judge blocked the change amid the COVID-19 pandemic.

Under Trump, the U.S. Department of Agriculture also suggested replacing about half of the grocery money many SNAP participants get with "harvest boxes" of nonperishable food items selected by the government. That idea was estimated to save billions, but it was widely criticized and Congress did not pass it.

"Any cuts or reductions in benefits would just send more people to food shelves, and that's the reality. There's just not enough food to go around now, and adding more people to those lines would make it even worse," said Zach Rodvold, director of public affairs at Second Harvest Heartland, a Brooklyn Park-based food bank.

He said he also worries tariffs and immigration policies could lead to higher food prices and a lack of farmworkers, resulting in more hunger.

Housing assistance

Trump's budgets would have reduced funding for rent help programs, like housing choice vouchers. He suggested increasing the limit on how much working renters needed to contribute, from 30% of their adjusted income to 35% of their gross income.

The former president repeatedly called for the elimination of some housing-related programs, including the Low Income Home Energy Assistance Program (LIHEAP), which helps cover heating and cooling bills.

In Minnesota, community action agencies often run or refer people to programs like LIHEAP and SNAP.

"What we've found is Congress always protects us," said Pam Johnson, director of policy and advocacy for Minnesota Community Action Partnership.

She said they'll push Minnesota's congressional delegation to support key programs, and President-elect Trump "is just one part of the whole equation."

Medicaid

The Trump administration allowed states to add work requirements for Medicaid recipients.

"A Medicaid program that locks people into poverty begins to look less like a safety net and more like a trap," Centers for Medicare & Medicaid Services Administrator Seema Verma said in a speech at the time.

During Trump's previous four years, he authorized such work requirements for 13 states. But a federal judge blocked some of the work requirements, and President Joe Biden later sought to undo the approvals. Georgia is now the only state with a work requirement.

Trump and GOP lawmakers have also sought to overhaul the way states get Medicaid dollars, shifting to a block grant or per capita limit on how much federal funding a state can get. Those models allow states more flexibility but would reduce how much federal money they receive.

The president-elect has distanced himself from the controversial Project 2025, the policy blueprint created by the conservative Heritage Foundation. That document echoes some of the Medicaid changes the Trump administration and Republican lawmakers have suggested. It also suggests "time limits or lifetime caps on benefits to disincentivize permanent dependence."

Robert Greenstein, founder of the progressive Center on Budget and Policy Priorities, said he was stunned by that idea, which he said could remove Medicaid from people with medical conditions or those who can't find work or are in a low-income position that doesn't offer health coverage.

"While they may not use the term 'Repeal the [Affordable Care Act],' they may actually seek policies that are harsher and go beyond those," Greenstein said of GOP leaders. "Because they may seek much, much larger dollar savings from Medicaid and the related health programs than they did in 2017."

Paid parental leave

Trump proposed a nationwide six-week paid leave program during his last term for families with a newborn or newly adopted child. States would have had to establish the programs using their unemployment insurance funds. The proposal did not succeed, but the Trump administration did enact up to 12 weeks of paid leave for federal employees.

Paid leave was a key priority for Trump's daughter Ivanka Trump, who was an adviser during his last term. But she has taken a step back from politics in the past couple of years.

Tax credits

Trump boosted the child tax credit in the 2017 Tax Cuts and Jobs Act from $1,000 to $2,000 a year, although many low-income families don't qualify for the full credit. Vice President-elect JD Vance has proposed raising the credit to $5,000 per child and said he'd like it to apply to families of all incomes.

Trump has promised to end several taxes, including the one on Social Security benefits. Individuals with a combined income of less than $25,000 and couples below $32,000 currently don't have to pay that tax.

Trump has also said he supports a caregiver tax credit for people who are taking care of a parent or loved one.