Federal dollars support a wide array of public services and systems that touch the lives of all West Virginians — from health care and food assistance to child care and public schools. Under both the Trump Administration and Congress, many of these programs are being considered for deep cuts or significant reductions — in large part to pay for extensions of tax cuts that mostly benefit corporations and the wealthy. Cuts to federal funding would have a disproportionately harmful impact in West Virginia, a state that funds a larger share of its budget through federal dollars than most, devastating vital services that advance health coverage for children, people with disabilities, and the elderly; provide school meals and disability accommodations in public schools; and support workforce development, public health, and state infrastructure.
Emerging proposals from the Trump Administration, Project 2025, and key congressional leaders threaten to drastically reduce federal funding for programs that West Virginians rely on, which would shift significant costs and difficult decisions to state policymakers. This cost-shifting would force state leaders to either replace lost federal funding with state revenue (just as the state is facing its own budget crisis) or drastically cut benefits and services to their constituents, likely creating significant harmful impacts on residents and the state’s broader economy.
A significant share of federal funding for West Virginia flows through the state budget. For the current fiscal year (FY 2025), West Virginia’s enacted budget includes $9.63 billion in federal funding, representing over 50 percent of the state’s total $19.2 billion budget. Nearly all of this funding is for permanent programs. While recent years temporarily saw higher federal funding for pandemic aid, nearly all of that has been exhausted and what remains is primarily regular federal funding.
West Virginia is more reliant on federal funding than most states at 50.15 percent of its total FY 2025 budget. On average, federal funds comprise about one-third of states’ annual spending.
Medicaid accounts for a significant percentage of the state’s federal funding, with anticipated federal funding of $4.1 billion in FY 2025. The FY 2025 state budget anticipates $5.3 billion in federal dollars to flow to the Department of Human Services, which in addition to Medicaid, also administers the Child Care and Development Block Grant, Temporary Assistance for Needy Families (TANF), the Low-income Home Energy Assistance Program (LIHEAP), and child welfare, foster care, and adoption programs.
Other significant sources of federal funding to West Virginia flow to early childhood and public assistance programs, economic development, environment, and K-12 education. Based on the public positions of the Trump campaign, Congressional leadership, and the policy positions described in Project 2025, many of these programs are at risk of reduced or eliminated funding.
Medicaid is West Virginia’s largest program in terms of funding and is expected to be among those most vulnerable to changes in federal funding and policy in 2025. A number of proposals have been floated to reduce federal spending on Medicaid including block grants and spending limits, per capita caps, and onerous bureaucratic proposals including work reporting requirements.
In FY 2023, Medicaid spending in West Virginia totaled $5.427 billion, with $4.443 billion, or 82 percent of the program, coming from federal dollars. Medicaid provides health coverage for just over 500,000 West Virginians, or nearly one-third of the state’s population, and is the largest source of coverage for births, child health care, substance use treatment, and long-term care for West Virginians benefiting those across the state’s population. It is also vital to our state’s hospitals and providers, with research showing Medicaid expansion has resulted in reduced uncompensated care, increases in hospital operating margins, and decreases in closures of hospitals and obstetrics units. Medicaid improves hospital finances by extending coverage to patients who would otherwise be uninsured and require hospital charity or uncompensated care.
In all proposals outlined above, federal funds to the state would decrease by hundreds of millions of dollars, shifting the costs of providing health care for low-income residents onto state policymakers, health care providers, and families themselves. The WVCBP estimates that work reporting requirements on non-elderly adults under the Medicaid expansion population only could cause an estimated 40,000 residents to lose health coverage, reduce federal funding to West Virginia by more than $240 million annually, and cost nearly 4,500 jobs in the health care and other sectors. Per capita spending caps would also dramatically reduce federal funding to the state, with an analysis showing that had they been enacted in 2018, the state would have lost $469 million in federal funding in FY 2022 alone.
The Trump Administration and congressional Republicans have also proposed to decrease or divert federal funding in several other policy areas — including for K-12 public education — which could have significant harmful impacts in West Virginia, where child care assistance funding falls short of need. The state has a considerable funding gap in providing special education services with existing federal dollars, and child welfare outcomes are the worst in the country.
Other services are also at risk, including some that are funded with federal dollars that flow directly to West Virginians outside of the state budget — such as federal food assistance provided through the state’s SNAP program and federal Supplemental Security Income (SSI) payments for low-income seniors and people with disabilities.
Additionally, nonprofit and state entities are already experiencing disruptions, pauses, and uncertainty in federal grant programs they administer given the Trump Administration’s pause and subsequent chaos related to vital federal grant programs.
To be clear, any proposal to freeze, cut, or divert federal funding would shift costs onto West Virginia, at a time when funding for existing state programs is already in doubt. West Virginia, a state more reliant on federal dollars than most, would be disproportionately harmed by any of these proposals.
