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Implementing Costly Medicaid Work Reporting Requirements: Who Will Foot the Bill?
Introduction The budget reconciliation bill enacted in July 2025 (H.R. 1) includes two major changes to federal Medicaid law that will impose large implementation costs on most states. One mandates the states that extend Medicaid coverage to low-income (“expansion”) adults require those adults to report 80 hours of work or community service per month. The other…
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Let’s Start a Conversation about Data to Monitor the Impact of H.R. 1’s Work Reporting Requirements
Monitoring the implementation of work reporting requirements in Medicaid will be incredibly important to assessing the policy’s impact, identifying bottlenecks or glitches in the system, and enabling rapid response to address problems. We have a baseline of data from the Medicaid performance indicators, which have been in place since 2014, and were expanded to more…
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New CMS Guidance on H.R. 1’s Restrictions of State Directed Payments
On February 2, 2026, the Centers for Medicare & Medicaid Services (CMS) issued new guidance implementing section 71116 of H.R. 1 (the “One Big Beautiful Bill Act” or P.L. 119-21), which restricts state-directed payments (SDPs) to hospitals and other health care providers. Under SDPs, states may require Medicaid managed care plans to increase provider rates or…
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CMS Issues Final Rule Implementing H.R. 1’s Prohibition of Certain Uniformity Waiver Provider Taxes
On January 29, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing the H.R. 1 provision prohibiting certain “uniformity waiver” provider taxes that states use to support their Medicaid programs. (The rule is scheduled to be published in the Federal Register on February 2, 2026). Nearly all states use taxes…
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House Republican Study Committee Pushes for Second Budget Reconciliation Bill and More Damaging Medicaid Cuts
On January 13, the House Republican Study Committee (RSC) unveiled its plan for a second budget reconciliation bill for this Congress, in addition to H.R. 1 (the “One Big Beautiful Bill Act” or P.L. 119-21) which was enacted on July 4, 2025. The plan includes a number of proposals to cut Medicaid, on top of…