On July 4, 2025, President Trump signed the Congressionally-passed budget reconciliation law, known as “One Big Beautiful Bill,” into law. As we have talked about extensively, this law will drastically cut federal funding for Medicaid and hamstring states’ ability to fund their portion of the federal-state partnership. Many of the law’s provisions target Medicaid expansion adults with work reporting requirements and required cost-sharing for many services. It also takes away eligibility for some lawfully present immigrants in Medicaid, Medicare, and the Marketplaces. Additionally, as Sabrina Corlette from the Georgetown Center on Health Insurance Reforms recently detailed in our joint explainer, this law failed to extend enhanced subsidies and restricts eligibility for and enrollment in Marketplace plans. The Congressional Budget Office estimates that over 10 million individuals will lose health insurance coverage as a result of the law..
In the aftermath of the law’s enactment, states are beginning to grapple with the new reality that will take shape over the next decade. While the law cut funding at the federal level, many of the changes will take place operationally at the state level, creating not only a funding gap but also a major administrative burden for state Medicaid agencies to tackle. States will be required to implement these new requirements with decreased funding and the inability to raise additional provider tax revenue. However, the provisions will affect each state differently.
Our new resource details each of the law’s provisions that pertain to Medicaid, Medicare or the Marketplace and which states are affected by each provision. Additionally, CCF researchers have included pertinent information about the implementation date, affected populations, and exemptions allowed. The document buckets the provisions into the following categories:
- Immigrant Provisions
- Medicaid Financing
- Eligibility, Enrollment, and Renewal-Related Provisions
- Marketplace Provisions
- Administrative Actions and Penalties
- Medicaid Longterm Services & Supports (LTSS) and Medicare
- CHIP Provisions Excluded in Moratorium on E&E Rule
Over the next few months (and years), CCF will continue to detail the different effects this law will have on individuals living across the country. For now, we hope that advocates and stakeholders will find this a helpful resource alongside our explainer to determine what will impact folks in their state, and when.