This report analyzes Medicaid in Virginia, the needs-based social health insurance program providing health coverage to children, pregnant women, working parents, the disabled, and elderly who cannot afford health costs on their own. It supports the value of the Medicaid program to these beneficiaries’ long term health, the healthcare sector, cost control and Virginia’s economy. Additionally, it analyzes healthcare policy looking at what effects the Affordable Care Act has had in improving healthcare access and what effects healthcare reform under president-elect Donald Trump’s administration and the Republican controlled 115th United States Congress might have targeting healthcare cost. Ultimately this leads to a recommendation that in order to protect those who are most at risk of harm amidst transition and in order to protect Virginia’s long term solvency, any efforts that put federal Medicaid funding at risk should be opposed.