President Donald Trump signed the One Big Beautiful Bill Act (OBBBA) into law last week. The legislation includes deep spending cuts and major changes to federal healthcare programs, including Medicaid.
The bill passed narrowly through the House and Senate, with Republicans pushing it forward on party-line votes. Over the next decade, it’s expected to cut about $1.2 trillion in federal spending, mostly from healthcare.
The Congressional Budget Office estimates the bill will leave 11.8 million more people without health insurance by 2034. That includes 1.4 million people without legal status who will no longer qualify for Medicaid.
One of the bill’s most controversial changes is a new federal work requirement for Medicaid. Able-bodied adults must now complete 80 hours a month of “community engagement” to stay eligible.
These engagement activities include working, attending school, volunteering, or earning enough income to meet the federal minimum wage for those 80 hours. The rule applies to nonpregnant, nondisabled adults without children between ages 19 and 64.
Before receiving benefits, new applicants must also meet this 80-hour threshold. Some people are exempt, including disabled veterans, caregivers for young children or disabled family members, and individuals with serious medical conditions.
States can also grant temporary “good cause” exemptions. These include being hospitalized, living in a disaster zone, facing high unemployment locally, or needing to leave home for medical treatment.
The law also rewrites Medicaid expansion rules from Obamacare. It removes the five-percentage-point bonus in federal funding for states that newly expand Medicaid.
For states that offer Medicaid to certain immigrants, the federal match will drop from 90% to 80%. And everyone enrolled under Medicaid expansion must now be reviewed for eligibility every six months instead of once a year.
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Author: Mike Vance
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