For the first time since the creation of Medicaid, recipients of the healthcare plan for low-income Americans can be required to work if states decide to apply for a waiver.

Additional policy changes under Trump in 2018 include the end of funding for hard-to-reach communities for Medicaid, and a range of targets against LGBTQ+ people, people with disabilities, and immigrants. This includes the creation of a "denaturalization" task force that can strip a citizen of their citizenship.