The Modern Medicaid Alliance released four new issue briefs outlining the harmful impact of Medicaid policies included in the House’s reconciliation package, the One Big Beautiful Bill Act (H.R. 1). Combined, the proposed changes would destabilize hospitals and providers that serve local communities, place significant new burdens on states and result in more than 7.8 million Americans losing Medicaid coverage and benefits.
Each brief takes a closer look at a different provision and the far-reaching consequences it would have for patients, providers and state Medicaid programs:
- Harmful Cost-Sharing Requirements: The bill requires states to impose new out-of-pocket costs on Medicaid expansion enrollees, creating financial barriers to care for low-income individuals. Research shows that even modest cost-sharing leads to reduced preventive care, worse health outcomes and increased emergency room use, especially for those with chronic conditions.
- Ineffective Work Requirements: This provision mandates that Medicaid expansion enrollees work at least 80 hours per month or regularly prove they qualify for an exemption. Past attempts at similar policies led to significant coverage losses — not because people weren’t working, but due to complex red tape. These requirements don’t increase employment but do increase administrative costs and burdens for states.
- Burdensome Eligibility Restrictions: The legislation would require states to conduct Medicaid eligibility checks every six months and slash the retroactive coverage period from 90 to 30 days. These changes would cause eligible individuals to lose coverage, increase medical debt and burden hospitals, all while driving up administrative costs for states.
- Restrictive State Financing Rules: If passed, the bill would impose vague and overlapping restrictions on key Medicaid financing tools, such as provider taxes and state-directed payments, that nearly every state relies on to fund their programs. Undermining these mechanisms would weaken Medicaid’s foundation and threaten access to care in underserved communities.
Together, these proposed changes would drastically undermine the Medicaid program and put coverage, care and state budgets at serious risk.
For more information on Medicaid’s vital role, visit https://modernmedicaid.org.