This paper examines the coverage and financing impacts of the Medicaid provisions of the American Health Care Act (AHCA), including the reduction in the federal matching rates for ACA and pre-ACA expansion populations and per capita caps. Estimates for three scenarios of state responses to the bill’s changes are provided. The first scenario assumes that states make no reductions in Medicaid eligibility or coverage but rather they increase their own revenues devoted to the program or cut benefits and/or provider payments rates to offset federal funding losses. The second scenario estimates the impact of states deciding to reduce enrollment by eliminating coverage for the ACA expansion population while increasing their spending to compensate for federal funding reductions on other eligibility groups. The final scenario assumes that states not only eliminate their ACA expansions but also make additional enrollment cuts in response to per capita caps and reduced federal funding for the pre-ACA expansion populations. The first scenario would reduce federal spending by $373.6 billion from 2019 to 2028, the second by $803.2 billion, and the third by $938.3 billion.