On July 4th, 2025, the One Big Beautiful Bill Act (OBBBA) became a federal law under President Donald Trump’s administration. This law affects people, companies, and different organizations by introducing substantial changes to tax and spending laws, public assistance programs, and other areas.
Due in part to the removal of at least 10.5 million participants from Medicaid and Children’s Health Insurance Program (CHIP) benefits by 2034, the nonpartisan Congressional Budget Office (CBO) projected that the OBBBA would result in a $1.02 trillion reduction in government spending on these programs.
In response to these changes, States will find it more expensive to maintain Medicare and Medicaid programs,
particularly if they are barred from enacting new taxes or raising current taxes on health care providers to help pay for their portion of the program’s expenses. States therefore, need to consider three options: increasing taxes, restricting coverage, or lowering/removing essential benefits that are not specifically mandated by federal law.
The OBBBA itself was formally signed into effect on July 4th, 2025. However, changes to healthcare programs will be phased in later.
As for Medicaid, the expansion retermination (eligibility checks happening every 6 months) will begin on January 1, 2027. Additionally, reforms on work requirements, verification updates, and cost-sharing rules for adults will begin on January 1, 2027, as well.
As for Medicare, new eligibility rules will start in January 2027. This date will directly impact future eligibility based on immigration status, but current enrollees can stay enrolled for 18 months after enactment.
With the Congressional Budget Office (CBO) estimating about a $1 trillion budget cut in Medicaid over the next decade, the cut estimate predicts about 7.8 million people losing coverage by 2034 due to OBBBA’s provisions.
Also included in the law are work requirements: recipients aged 19~64 with incomes between 100% and 138% of the federal poverty level must work at least 80 hours per month, with some exemptions (such as medical conditions or childcare). Those who fail to meet this requirement or fail to report their hours will risk losing benefits.
Additionally, individuals must submit official documentation as proof of citizenship and immigration status.