Here are the major provisions, why they matter, and when they go into effect.
| Semi-Annual Eligibility Verification |
| Community Engagement Requirements |
| Reduction of Medicaid Provider Taxes |
| Rural Hospital Fund |
The One Big Beautiful Bill Act contains changes to Medicaid that Republicans say will reduce fraud, waste, and abuse, making the program more sustainable for the future.
Democrats, however, have objected to the potential loss of coverage by several million enrollees, as forecast by the Congressional Budget Office (CBO), and the potential financial impact on small rural hospitals.
Both parties agree that Medicaid is a vital part of the country’s social safety net, providing health coverage for more than 72 million people, many of whom are children from low-income families, and elderly, or disabled people.
Yet the program costs more than $900 billion a year, more than two-thirds of which is paid by the federal government. And the cost has grown rapidly—more than 130 percent in 10 years.
Here is a summary of major changes to Medicaid authorized by what’s known as the One Big Beautiful Bill.
Semi-Annual Eligibility Verification
Medicaid is intended for low-income people, so annual income certification is currently required.
Under this bill, that would be done every six months, and includes providing proof of citizenship.
According to CBO data, some 1.4 million people who are not legal residents of the United States are currently enrolled in Medicaid.
“[The bill] requires citizenship verification and more frequent eligibility checks in order to ensure illegal immigrants and ineligible beneficiaries are not able to receive Medicaid,” Rep. Tom Cole (R-Okla.) said in a May 20 statement.
Others see additional administrative steps as a barrier to health coverage for people who qualify.
This provision takes effect in October 2027.
Community Engagement Requirements
In order to maintain eligibility, some Medicaid enrollees would be required to spend 20 hours per week in employment, educational activities, training, or community service.
This provision applies to adults who are not disabled and are not responsible for caring for children or other dependents.
About 90 percent of Republicans and more than half of Democrats favor these provisions in the bill, according to the health policy think tank KFF.
However, some say they do more harm than good.
“Work requirements impose administrative barriers and red tape that lead to coverage losses among both people who are working as well as people the policies purport to exempt,” according to Gideon Lukens and Elizabeth Zhang of the Center for Budget and Policy Priorities, a progressive think tank.
“They also lead to coverage losses for those who are between jobs,” Lukens and Zhang wrote.
This provision takes effect no sooner than January 2027.
