On May 22, the House of Representatives passed the “Big Beautiful Bill Act” (H.R. 1) by a 215-214 vote. This reconciliation bill proposes changes to Medicaid, the Affordable Care Act, food nutrition programs, and the nation’s debt limit, among other things.
If this bill were signed into law, several potential impacts to states include:
- Increased coverage loss for noncompliance with work requirements.
- Future challenges for states to fund their share of Medicaid and SNAP.
- Limitations on how states incentivize high-quality care or improve access to care as a result of caps on future state-directed payments.
- Potential increase in food insecurity for vulnerable populations.
For more information, view the full bill text of the legislation.
The Association for State & Territorial Health Officers (ASTHO) put together a good summary of the impact the bill would have if the Senate passes it as (which is very unlikely). Here are some of the impacts in a nutshell:
Medicaid
Work Requirements
Requires states to implement work requirements by December 31, 2026. The work requirements would require able-bodied adults aged 19-64 to work (or perform other qualifying activities) for at least 80 hours a month. There would be exemptions for certain individuals (e.g., pregnant women, those with serious medical conditions, and tribal members).
Note: The real savings here come as Medicaid members who are actually meeting the new requirements are unable or for some reason don’t properly report on their work or community engagement. Some states will make the process difficult to remove as many Medicaid members as possible.
Medicaid Expansion
Lowers the federal match for the expansion population (from 90% to 80% FMAP) if a state “provides any form of financial assistance, through Medicaid or under another program established by the state” that allows undocumented immigrants, except for children and pregnant women (doesn’t apply to AZ)
Requires states to conduct eligibility determinations for their expansion population every six months by December 31, 2026.
Provider Taxes
Prohibits states from setting up new provider taxes and freezes existing provider taxes at current rates. Modifies the criteria HHS must use to decide whether taxes are redistributive when considering a waiver of uniform tax requirement (could apply to Arizona – upsetting our Hospital Assessment that pays the state match for 500,000 childless adults).
Reproductive Health and Gender Transitions
Prohibits federal funding for Planned Parenthood and other abortion providers described as “nonprofit organizations, which are essential community providers that are primarily engaged in family planning services or reproductive services, provide for abortions other than the Hyde Amendment exceptions, and which received $1,000,000 or more.”
Food Nutrition Programs
Revises the Supplemental Nutrition Assistance Program by implementing work requirements for able-bodied adults without dependents.
Creates a state cost-sharing requirement for SNAP allotments beginning in FY 2028, with the federal share dropping to 95%. This state share would increase to 15%, 20%, or 25% when a state’s payment error rate exceeds 6%, 8%, or 10%, respectively. Would have a big impact on the AZ General Fund beginning in 2028 unless AZ decides to quit the SNAP program.