Medicaid and H.R. 1 Research Resources

Last Updated on January 20, 2026

Post passage of the 2025 budget reconciliation bill (H.R. 1), it is helpful for researchers, advocates and other stakeholders to have access to the latest research and data on the Medicaid program. This bibliography of resources pulls together current studies, reports and data analysis that examine: (1) the impact various H.R. 1 provisions will have on Medicaid access, coverage and financing; (2) guidance from the Centers for Medicare and Medicaid services concerning H.R. 1 implementation; and (3) the impact these policy changes will have on state budgets, the health care system and the populations served by the Medicaid program.

Additional resources related to Medicaid and H.R. 1 implementation can be found on Families USA’s Defending Medicaid page.

Resource Suggestions

Families USA will update this bibliography often as new resources are published. If you’d like to send us an additional resource to be published here, please email: healthpolicy@familiesusa.org.

Annotated Bibliography

Summary of H.R. 1's Medicaid Provisions & Implementation Dates Medicaid Eligibility & Enrollment (Sections 71101, 71102, 71103, 71104) Reduced Payment for Improper Payments (Section 71106) Six-Month Redeterminations for Medicaid Expansion Population (Section 71107) Nursing Home Staffing (Section 71111) Retroactive Coverage (Section 71112) Access to Reproductive Health Care (Section 71113) Provider Taxes (Sections 71115 & 71117) State Directed Payments (SDPs) (Section 71116) Medicaid Demonstration Projects Budget Neutrality (Section 71118) Work Reporting Requirements / Community Engagement (Section 71119) Home- and Community-Based Services, 1915(c) Waivers (Section 71121) Rural Health Transformation Grants (Section 71401) Impact of H.R. 1 on States and the Health Care System Impact of H.R. 1 on Various Populations

Summary

Federal Budget Reconciliation Law and Other Recent Medicaid Rule-Making Implementation Timeline
(Families USA, 11/17/25): This timeline examines H.R. 1 implementation and integrates implementation dates from several recent federal law and regulatory changes that impact Medicaid managed care into one place to help advocates better understand the evolving landscape.
Health Provisions in the 2025 Federal Budget Reconciliation Law
(KFF, 8/22/25): Detailed summary of H.R. 1’s health provisions.
Implementation Dates for 2025 Budget Reconciliation Law
(KFF, 2025): Timeline provides a brief overview of H.R. 1 provisions and their effective dates.
Webinar: What We Know and What Happens Next — OBBBA Overview and Implementation Timeline
(NHeLP, 8/14/25) Provides a high-level overview of H.R. 1 provisions and the timeline for federal and state implementation.
Budget Reconciliation Act Implementation Dates for Select Medicaid & Health Provisions
(NHeLP, 8/13/25): A chart outlining when major Medicaid and health provisions of the 2025 reconciliation law take effect.
Budget Reconciliation Act Implementation Dates, Funding, and Authorities for Medicaid & Select Health Provisions
(NHeLP, 8/13/25): Expands on implementation timelines by detailing funding sources and statutory authority for key Medicaid provisions.
H.R. 1— Provisions Related to Medicare, Medicaid & the Affordable Care Act
(Families USA, updated 8/12/25): A section-by-section overview of H.R. 1’s health care-related provisions.
Webinar: Budget Reconciliation (H.R. 1) Medicaid and Marketplace Provisions
(Georgetown Center for Children & Families, 7/29/25): Provides a recorded briefing on Medicaid and Marketplace provisions in H.R. 1, with implementation and advocacy implications.
Budget Reconciliation Implementation Roadmap
(State Health & Value Strategies, 7/24/25): Provides an integrated view of implementation dates for Medicaid, the Children’s Health Insurance Program, Marketplace, and Medicare provisions in H.R.1.
Changes to Medicaid in the Budget Reconciliation Law
(State Health & Value Strategies, 7/24/25): Expert webinar reviewing the final Medicaid provisions included in the law, associated timelines for implementation, and considerations for states.
Medicaid, CHIP, and Affordable Care Act Marketplace Cuts and Other Health Provisions in the Budget Reconciliation Law Explained
(Georgetown Center for Children & Families, 7/22/25): Offers a detailed, plain-language explanation of the law’s major health provisions and how they affect Medicaid, CHIP, and Marketplace coverage.
OBBB Implementation Dates & Details for Health Care Provisions
(Modern Medicaid Alliance, 7/22/25): A chart of key Medicaid implementation dates.
2025 Reconciliation Debate: Health Provisions—Senate
(Bipartisan Policy Center, 7/1/25): An updated explainer summarizing major health-care related policy changes in the Senate’s version of the One Big Beautiful Bill Act, including Medicaid provider tax caps, rural health transformation funding, and HCBS expansion, and noting coverage loss estimates.
With Budget Reconciliation Bill Enacted, Health Care Changes Loom
(Health Affairs, 7/11/25): This overview explains how the enacted reconciliation bill reshapes Medicaid, marketplace coverage, and federal health care spending.

Background Impact State Implementation

Eligibility and Enrollment Provisions in OBBBA
(NHeLP, 8/21/25): Summarizes how OBBBA changes Medicaid eligibility and enrollment rules in ways that increase administrative barriers and coverage losses.
State Landscape Detailing Eligibility & Enrollment Practices in Medicaid, SNAP, and TANF
(Center on Budget & Policy Priorities, 6/27/25): Provides a state-by-state overview of enrollment practices affecting access to Medicaid and other safety-net programs.
Lessons From Unwinding Offer Opportunities to Streamline Medicaid
(Center on Budget & Policy Priorities, 4/3/25): Draws lessons from post-PHE unwinding to improve renewal systems and reduce procedural terminations.

The Impact of H.R. 1 on Two Medicaid Eligibility Rules
(KFF, 9/22/25): Describes the impact of delaying key provisions from 2024 Biden Administration rules that made it easier for people to enroll in Medicaid programs. Identifies which provisions across both rules are not delayed and which are. Where available, it also indicates how many states have already implemented provisions that are now delayed.
Rolling Back Biden-Era Medicaid Rules Would Hurt Beneficiaries And Increase Costs
(Health Affairs, 6/24/25): This piece explains how rescinding recent Medicaid protections would increase churn and administrative burdens.
Medicaid Changes in House and Senate Reconciliation Bills Would Increase Costs for 1.3 Million Low-Income Medicare Beneficiaries
(KFF, 6/17/25): Describes how dual eligible beneficiaries would be disproportionately impacted by H.R. 1’s moratorium on two Biden era rules that aimed to streamline the enrollment process and make it easier for people to maintain Medicaid coverage by reducing administrative barriers.
House Budget Bill Would Impose Administrative Barriers for Kids, Families, Seniors, and People with Disabilities in Medicaid
(Georgetown Center for Children & Families, 5/19/25): Describes the implications of proposals to rescind Biden-era regulations that were intended to streamline enrollment and improve retention, especially for children, seniors, and people with disabilities.
Implications of Congress Eliminating Major Biden Era Regulations for Medicaid
(KFF, 2/9/25): Explains the impact of rescinding recent regulations that make it easier to enroll in Medicaid.

State Options to Implement Provisions of the Eligibility and Enrollment Final Rule Post-OBBBA
(NHeLP, 9/18/25): Explains which eligibility and enrollment protections states can still adopt despite OBBBA rollbacks.
Webinar: How Automated Eligibility Systems Can Harm or Help Applicants and Enrollees (SUPPORT)
(NHeLP, 9/11/25): Examines how automation can either improve access or exacerbate barriers in Medicaid and Marketplace enrollment.

Background Impact CMS Guidance State Implementation

Fraud and Abuse Against Medicaid: The Truth About the Budget Reconciliation Law
(Georgetown Center for Children & Families, 7/25/25): Explains why claims that Medicaid cuts are about fraud prevention are misleading and unsupported by evidence.
Streamline Eligibility to Connect People to Benefits, Improve Program Integrity, and Reduce Improper Payments
(Center on Budget & Policy Priorities, 3/11/25): Center on Budget & Policy Priorities’ testimony explains how simplifying enrollment improves accuracy while protecting coverage.
Understanding the Medicaid Payment Error Rate Measure
(Center on Budget & Policy Priorities, 2/21/25): Clarifies why PERM error rates largely reflect paperwork issues rather than fraud.

Republicans’ Claims of Fraud Are a Pretext for Unpopular and Drastic Medicaid Cuts
(Center on Budget & Policy Priorities, 4/16/25): Blog outlines the impact of exaggerated fraud claims being used to justify large Medicaid cuts rather than evidence-based reforms.

Families USA will include resources here as they become available.

Families USA will include resources here as they become available.

Background Impact CMS Guidance State Implementation

A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law
(KFF, 7/30/35): Examines impact of H.R. 1 on populations enrolled in the Medicaid expansion, including the requirement for redeterminations every six months.

Proposed Medicaid Eligibility Checks Mean More Bureaucracy, Less Coverage
(Modern Medicaid Alliance, 6/13/25): Outlines the impact increasing Medicaid redetermination frequency has on Medicaid-enrolled populations.
More Frequent Medicaid Redeterminations Would Reduce Health Insurance Coverage and Increase Administrative Costs
(Urban Institute, 5/21/25): Outlines the impact of increased redetermination requirements on enrollees, states, health plans, and providers.
More Frequent Medicaid Renewals Would Increase Errors and Lead Eligible People to Lose Health Coverage
(Center on Budget & Policy Priorities, 5/12/25): Details how the House proposal would cause many eligible people to drop off coverage simply due to paperwork burdens associated with more frequent renewals. Discusses the added costs to states and additional burdens of this proposal.
Thinking Frequent Medicaid Redeterminations Won’t Hurt Children’s Health Insurance? Take a look at What Happened in Texas.
(Georgetown Center for Children & Families, 5/2/25): Discusses the impacts monthly income checks to families have on children who are covered by Medicaid.

Families USA will include resources here as they become available.

Families USA will include resources here as they become available.

Background Impact CMS Guidance State Implementation

5 Key Facts About Nursing Facilities and Medicaid
(KFF, 5/28/25): This brief provides information on how Medicaid programs support nursing facilities and the people living in them.
Number of Hospitals and Nursing Facilities and Related Employment by County, 2023
(Georgetown Center for Children & Families, 2/25): Interactive map showing the number of hospitals and nursing homes/employment by county (if data for a county is available) in 2023, based on Bureau of Labor Statistics (BLS) data.
10 Things About Long-Term Services and Supports (LTSS)
(KFF, 7/8/24): Describes the importance of Medicaid for covering populations that need long-term care.

A Look at Nursing Facility Characteristics in 2025
(KFF, 12/17/25): Discusses the impact of the 2025 reconciliation law on nursing facilities and examines the characteristics of nursing facilities and the people living in them.
Cutting Medicaid Could Hurt Millions of Americans Who Need Long-term Care
(The 80 Million, 3/11/25): Explains the importance of Medicaid for people who need long-term care services.

Families USA will include resources here as they become available.

Families USA will include resources here as they become available.

Background Impact CMS Guidance State Implementation

Demonstrations to Limit Retroactive Eligibility in Medicaid Lack Evidence and Threaten Access to Care
(Commonwealth Fund, 10/21/21): Explains Medicaid retroactive eligibility, detailing how it promotes access by ensuring that providers can begin needed care immediately, regardless of the date of the patient’s application.
Section 1115 Waivers of Retroactive Medicaid Eligibility
(Urban Institute, 6/12/21): A study examining the effects of 1115 waivers for retroactive eligibility on coverage and care.

OBBBA Slashes Retroactive Coverage for Medicaid Beneficiaries
(NHeLP, 7/25/25): Describes how limits on retroactive coverage increase medical debt and coverage gaps for low-income enrollees.

Families USA will include resources here as they become available.

Families USA will include resources here as they become available.

Background Impact CMS Guidance State Implementation Litigation

State Variations in the Role of the Reproductive Health Safety Net for Contraceptive Care Among Medicaid Enrollees
(KFF, 12/1/25): Describes the importance of Medicaid as a major source of coverage for contraceptive care.
OBBBA’s Medicaid Abortion Provider “Defund”: An Overview
(NHeLP, 8/11/25): Report focused on the provision that targets abortion providers that serve Medicaid patients, which has colloquially been referred to as the abortion provider “defund” provision.

Recent Policy Proposals Could Weaken the Reproductive Health Safety Net as More People Become Uninsured
(KFF, 7/28/25): Explains the impact of H.R. 1 along with other policy changes that impact reproductive health care.
New Federal Medicaid Cuts Will Devastate Coverage for Reproductive Health Care
(Guttmacher Institute, 11/25): Report describing how over two million women could lose access to Medicaid as a result of H.R. 1, with potentially severe consequences for the sexual and reproductive health.
Planned Parenthood is Defunded: What does this mean, and where do we go from here?
(Planned Parenthood, n.d.): Discusses impact of H. R. 1 on Planned Parenthood clinics.
Planned Parenthood: Still Essential, Still Under Threat
(Families USA, 8/12/25): Blog breaks down why Planned Parenthood remains indispensable, how current threats are unfolding, and what you can do to help protect access in every community that their affiliates serve.

Families USA will include resources here as they become available.

Filling in the Gap in Federal Medicaid Funding to Planned Parenthood: State Responses
(KFF, 1/9/26): Brief reviews the status of state commitments to funding reproductive health care providers affected by Section 71113 to date.
State Action Needed to Maintain Access to Reproductive Health: What Advocates Can Do
(Families USA, 12/16/15): Discusses state responses to Planned Parenthood defunding.

Litigation Challenging the 2025 Budget Reconciliation Law’s Provision Blocking Federal Medicaid Payments to Planned Parenthood
(KFF, 12/5/25): Discusses legal challenges to prevent the implementation of Section 71113.

Background Impact CMS Guidance State Implementation

5 Key Facts About Medicaid and Provider Taxes
(KFF, 10/1/25): Issue brief uses data from KFF’s 2025-2026 survey of Medicaid directors to describe states’ current provider taxes, explore how the 2025 reconciliation law changed the federal rules governing provider taxes, and summarize potential impacts of the changes across states.
Senate Finance Committee Reconciliation Bill Would More Harshly Restrict State Use of Provider Taxes
(Georgetown Center for Children & Families, 6/18/25): Details proposed financing restrictions that disproportionately affect expansion states.
Paying the 2025 Tax Bill: Medicaid Provider Taxes
(Bipartisan Policy Center, 4/11/25): An explainer discussing how reforming Medicaid provider tax rules could offset costs of 2025 tax cut extensions and the trade-offs involved in such reforms.

How New Limits on State Provider Taxes Will Affect Medicaid Funding
(Commonwealth Fund, 12/19/25): Examines how the change in provider tax policy is likely to lead to coverage losses, lower provider payment rates, diminished access to care for Medicaid enrollees, and a weakened health coverage safety net.
OBBBA Provider Tax Provisions Impact on Medicaid Stakeholders
(Avalere Health, 7/22/25): Discusses the impact provider tax provisions will have on state Medicaid funding and plans and providers.
Which States Might have to Reduce Provider Taxes Under the Senate Reconciliation Bill?
(KFF, 6/18/25): Explains how states will be impacted by new cuts to Medicaid provider taxes.

Dear Colleague Letter: Section 71115 and 71117 of Working Families Tax Cuts Legislation on Provider Taxes
(Centers for Medicare & Medicaid Services, 11/14/25): In this guidance, CMS clarifies what constitutes an existing provider tax, provides details on how it intends to handle pending tax waivers and discusses the transition period for certain provider taxes.
CMS Issues New Guidance on H.R. 1’s Restrictions on State Use of Provider Taxes to Finance Medicaid
(Georgetown Center for Children & Families, 12/18/25): This post summarizes CMS’s November 2025 guidance on H.R. 1 provisions that constrain states’ longstanding use of provider taxes to finance Medicaid, detailing how the new restrictions and phasedown of permissible tax base could force states to cut coverage, reduce provider payments, or divert funds from other state priorities.
CMS’ Preliminary Provider Tax Guidance Is More Restrictive than H.R. 1 – What Advocates Should Know, and What They Can Do
(NHeLP/ Community Catalyst, 1/14/26): Describes how recent, preliminary CMS guidance goes even further than H.R. 1 language itself – for example, by invalidating new or increased provider taxes implemented just before H.R. 1 was enacted. Discusses what advocates can do engage on this issue.

State Roadmap for OBBBA Provider Tax Provisions
(Modern Medicaid Alliance, 10/16/25): Key implementation dates and considerations for state policymakers.

Background Impact of H.R. 1 CMS Implementation Guidance State Implementation

Directed Payments in Medicaid Managed Care
(MACPAC, 10/24): Issue brief discusses the history of directed payment policy, highlights changes made in the 2024 managed care rule and examines the use of directed payments based on MACPAC’s review of directed payments approved as of August 1, 2024.
State Policy Levers to Improve Medicaid Pediatric Provider Payment
(Cornell Health Policy Center, 9/25): Examines numerous strategies states employ to enhance pediatric provider payment, including through SDPs.
Value-Based State-Directed Payments in Medicaid Managed Care
(JAMA Health Forum, 6/25): Describes state use of SDPs to advance value-based purchasing models in Medicaid managed care.
Lifelines in Jeopardy: How Medicaid State Directed Payments Support Critical Health Care Providers
(Manatt/Commonwealth Fund, 5/25): Explains the reason states use State Directed Payments, and their importance for enhancing rates for hospitals and other providers to sustain operations, enhancing care quality, and supporting system-wide reforms.
State Directed Payments: Closing Medicaid Payment Gaps for Essential Hospitals
(America’s Essential Hospitals, 9/24): Issue brief on the use of state directed payments in Medicaid, examining how states are using this authority to improve access to care for Medicaid beneficiaries.
Hospital revenue is enhanced by state-directed Medicaid payments, health systems report
(HFMA, 8/24): Summarizes data on the use of state directed payments to improve hospital finances needed to sustain and improve healthcare access in Medicaid.
Improving Access in Medicaid Managed Care Using State Directed Payments
(Georgetown Center for Children & Families, 7/24): Explains 2024 Medicaid managed care regulations that update CMS policy on state directed payments.

OBBBA Harms People with Disabilities: Limits on State Directed Payments
(NHeLP, November 19, 2025): NHeLP explains how the bill limits State Directed Payments (SDPs), this brief discusses how these cuts will lead to slower and fewer services for disabled people and offer potential avenues for future advocacy.
Medicaid Financing after OBBBA: State Directed Payments and Provider Taxes
(NHeLP, 9/25): Explains how OBBBA constrains state financing tools, putting pressure on provider payments and access to care.
Reconciliation Language Could Lead To Cuts in Medicaid State-Directed Payments to Hospitals and Nursing Facilities
(KFF, 6/27/25): KFF analysis of states potentially affected by H.R. 1’s SDP limitations.
Hospitals Prepare for $149B Cut to Medicaid State-Directed Payments
(Healthcare Dive, 6/6/25): The article describes how hospitals are planning for major reductions in supplemental Medicaid payments.
Medicaid State Directed Payments and Provider Taxes are Critical for Children’s Hospitals
(Children’s Hospital Association, 4/25): Fact sheet outlining how 40 states use state directed payments to raise reimbursement rates for providers treating Medicaid patients, helping to mitigate these payment gaps.
Essential Hospitals Depend on State Directed Payments
(America’s Essential Hospitals, 4/25): Issue brief describing how state directed payments help to offset low Medicaid payment rates by requiring Medicaid managed care plans to pay providers according to specific rates that advance state quality and access goals.
How Medicaid State-Directed Payments Support Critical Health Care Providers
(Commonwealth Fund/Manatt Health, 4/3/25): Describes H.R. 1’s changes to SDPs and estimates the impact on total Medicaid payments to hospitals.

Section 71116 Dear Colleague Letter
(CMS, September 9, 2025): Offers preliminary implementation guidance for changes to state directed payments, primarily discussing how CMS intends to determine which SDPs are will be grandfathered under the law. CMS indicates a notice of proposed rulemaking is forthcoming.
What Recent CMS Changes To Medicaid State-Directed Payments Mean For The Future Of Medicaid
(Health Affairs, 12/24/25): Families USA analysis examining which SDPs are impacted by H.R. 1, which are eligible for the statute’s temporary “grandfathering” period, and what questions remain after preliminary implementation guidance from CMS.

State Roadmap for OBBBA SDP Provisions
(Modern Medicaid Alliance, 10/16/25): Key implementation dates and considerations for state policymakers.
Medicaid State Directed Payment for Primary Care and Behavioral Health Providers: Opportunities that Remain and Challenges Ahead
(Families USA, 1/16/25): Outlines the ongoing use of state directed payments to support primary care and behavioral health services in Medicaid.

Background Impact CMS Guidance State Implementation

Medicaid Demonstrations: Action Needed to Address New Cost Concerns
(Government Accountability Office, 9/16/25): Discusses recommendations from GAO concerning budget neutrality for Medicaid demonstration waivers.
Medicaid Section 1115 Waivers: The Basics
(KFF, 1/24/25): Brief explains what Section 1115 waivers are and how they are used, and summarizes key waiver requirements, including budget neutrality.
Budget Neutrality for Section 1115(a) Medicaid Demonstrations
(Centers for Medicare & Medicaid Services, 6/24): Slide deck discusses certain updates to CMS’s approach to determining budget neutrality that CMS has applied when approving Medicaid section 1115 demonstrations beginning in September 2022.
Recent Updates to Section 1115 Waiver Budget Neutrality Policy: Overview and Implications for States
(State Health & Value Strategies, 12/2/22): Describes prior changes to Section 1115 Medicaid demonstrations and budget neutrality that preceded H. R. 1.

Families USA will include resources here as they become available.

Families USA will include resources here as they become available.

Families USA will include resources here as they become available.

Background Impact CMS Guidance State Implementation Litigation

Tracking Implementation of the 2025 Reconciliation Law: Medicaid Work Requirements
(KFF, 12/8/25): Provides an overview of new work reporting requirements, along with a list of outstanding implementation questions.
Work Requirements for Medicaid Enrollees
(Commonwealth Fund, 9/30/25): Backgrounder on Medicaid work requirements.
Mandatory Medicaid Work Reporting: Implementation Requirements and Decision Points
(State Health & Value Strategies, 9/15/25): This toolkit details the federal requirements for various features of the mandatory work reporting requirements, outlines state policy and operational options, and provides key considerations related to maximizing efficiencies and mitigating coverage losses.
A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law
(KFF, 7/30/25): Issue brief provides an overview of the Medicaid work requirement provisions.
Understanding the Intersection of Medicaid and Work: An Update
(KFF, 5/30/25): This brief updates an earlier analysis of work status and characteristics of Medicaid enrollees to show that in 2023, nearly two-thirds of adults ages 19-64 covered by Medicaid were working and nearly three in ten were not working because of caregiving responsibilities, illness or disability, or due to school attendance, reasons that counted as qualifying exemptions from the work requirements under previous policies.
Implementing Work Requirements on a National Scale: What We Know from State Waiver Experience
(KFF, 5/20/25): Discusses implications of budget reconciliation bill work requirement proposal, based on prior state experiences implementing similar programs within their jurisdictions.

CMS’s Georgia Waiver Extension Underscores the Failure of Medicaid Work Requirements
(Georgetown Center for Children & Families, 10/30/25): Uses Georgia’s Pathways waiver to demonstrate how work requirements fail to expand coverage while creating costly administrative hurdles.
A Look at the Potential Impact of the High Unemployment Hardship Exception to Medicaid Work Requirements
(KFF, 9/29/25): Issue brief describes the hardship exception for individuals living in counties with high unemployment, and using the most recent available county-level unemployment data from the Bureau of Labor Statistics (BLS) and county-level Medicaid expansion enrollment data, estimates the number of counties that could meet the criteria for this exception and the number of expansion enrollees living in those counties who could be exempt from the work requirements.
The Impact of Proposed Federal Medicaid Work Requirements on Hospital Revenues and Financial Margins
(Commonwealth Fund, 9/18/25): Analysis estimating coverage losses as a result of H.R. 1 and the financial impact on acute-care hospitals.
Medicaid Work Requirements Will Take Away Coverage From Millions State and Nationwide
(Center on Budget & Policy Priorities, 7/22/25): Shows that work requirements lead to large coverage losses due to paperwork and reporting barriers rather than failure to work.
Implications of Medicaid Work and Reporting Requirements for Adults with Mental Health or Substance Use Disorders
(KFF, 6/23/25): This brief describes key challenges that Medicaid work requirements may pose for adults with mental health or substance use disorders.
Millions of Working People Could Lose Medicaid Under Proposed Work Requirements
(Robert Wood Johnson Foundation, 6/18/25): The analysis shows how work reporting rules would disproportionately affect employed beneficiaries.
Workers in a Broad Range of Occupations at Risk of Having Their Coverage Taken Away
(Center on Budget & Policy Priorities, 6/12/25): Demonstrates that workers across sectors such as retail, food service, caregiving, and construction would be disproportionately harmed by Medicaid work mandates.
Conditional Care: The Real Cost of Medicaid Work Requirements
(NHeLP, 6/12/25): Details how work requirements lead to coverage loss, administrative churn, and harm to medically vulnerable populations.
Many Working People Would Be Shut Out of Medicaid under Proposed Work Requirements
(Urban Institute, 6/11/25): Findings from the Survey of Income and Program Participation.
New Resources on the Impact of Medicaid Work Requirements
(Geiger Gibson, 6/10/25): Compiles new modeling tools and analyses estimating coverage, access, and financial impacts of Medicaid work requirements on states and health centers.
Medicaid Work Requirements Will Harm Low-Paid Workers
(Center on Budget & Policy Priorities, 6/6/25): Explains that most Medicaid enrollees already work or face barriers to work, and that work requirements primarily take coverage away from low-paid workers without increasing employment.
Most Older Medicaid Enrollees Face Significant Health Barriers to Work
(Center on Budget & Policy Priorities, 6/6/25): Explains why older adults on Medicaid are especially vulnerable to work requirement policies.
Nearly 5.6 Million Community Health Center Patients Could Lose Medicaid Coverage Under New Work Requirements, with Revenue Losses Up to $32 Billion
(Commonwealth Fund, 5/30/25): Examines how proposed Medicaid work requirements could impact community health centers (CHC) across the country. Report estimates that nearly 5.6 million CHC Medicaid patients who live in states that have expanded Medicaid to low-income working-age adults (i.e., 40 states and the District of Columbia, as of May 2025), could lose coverage; CHC revenue losses would be nearly $32 billion.
How Do We Know Congress’s Work Requirements in Medicaid Will Fail? They Already Have.
(Georgetown Center for Children & Families, 5/13/25): Dissects past state-level efforts to implement Medicaid work requirements.
More Than 100,000 Michigan Residents Nearly Lost Medicaid Coverage Under Work Requirements
(Commonwealth Fund, 5/12/25): Explores Michigan’s experience in attempting to adopt work reporting requirements.
New Reports on Medicaid Work Requirements
(Geiger Gibson, 5/5/25): Highlights recent national and state-level studies projecting large Medicaid coverage losses and economic harm resulting from work reporting mandates.
How National Medicaid Work Requirements Would Lead to Large-Scale Job Losses, Harm State Economies, and Strain Budgets
(Commonwealth Fund, 5/1/25): Report uses economic modeling to outline the impacts of a 20 hour/week federal work reporting requirement.
Medicaid Work Requirements: Implications for Low Income Women’s Coverage
(KFF, 4/30/25): Analysis documents differences by sex in the work status of adult Medicaid enrollees ages 19-64 who were not receiving Supplemental Security Income (SSI) and were not dually eligible for Medicare in 2023, and highlights differences by parent status.
New Evidence Confirms Arkansas’s Medicaid Work Requirement Did Not Boost Employment
(Urban Institute, 4/23/2025): Study builds evidence base on the effects of Medicaid work requirements by reexamining experiences in Arkansas using national survey data.
Expanding Federal Work Requirements to Age 64 Would Increase Medicaid Coverage Losses
(Robert Wood Johnson Foundation, 4/18/25): This brief focuses on coverage losses among older adults nearing Medicare eligibility.
Work Requirements Threaten Health and Increase Costs
(Robert Wood Johnson Foundation, 4/10/25): Readers will learn how work requirements raise administrative costs while worsening health outcomes.
How Many Expansion Adults Could Lose Medicaid Under Federal Work Requirements
(Robert Wood Johnson Foundation, 3/28/25): This analysis quantifies potential coverage losses among expansion populations.
36 Million People at Risk of Having Health Coverage Taken Away by Medicaid Work Requirements
(Center on Budget & Policy Priorities, 3/3/25): Provides a detailed breakdown of populations exposed to work requirements, including people with disabilities and caregiving responsibilities.
Who is Harmed by Medicaid Work Requirements?
(NHeLP, 1/6/25): Presents the lived experience of populations who have been subject to Medicaid work requirements.

CMCS Informational Bulletin — Section 71119 of the “Working Families Tax Cut” Legislation, Public Law 119-21: Requirements for States to Establish Medicaid Community Engagement Requirements for Certain Individuals
(CMS, 12/8/25): Provides an overview of the Medicaid “community engagement” requirement mandated by H.R. 1, with initial implementation guidance to states.
Federal Officials Have Spoken, and Now it’s the States’ Turn: “Lookback Period” for Medicaid Work Reporting Requirements
(Families USA, 12/19/25): Blog discussing preliminary guidance from CMS on Medicaid work reporting requirements and flexibilities offered by the law to help states maximize the number of working people who can retain access to Medicaid.
CMS Issues Initial Guidance on Work Reporting Requirements
(State Health and Value Strategies, 12/11/25): Compares the guidance with what CMS verbally shared at NAMD conference and raises question on whether look-back periods at application and renewal apply to the medical frailty exemption.
CMS Guidance on Medicaid Work Requirements Leaves States Hanging
(Georgetown Center for Children & Families, 12/11/25) Analyzes CMS guidance showing states still lack clarity on how to implement federally mandated work reporting requirements.

A Technical Guide for States to Reduce Procedural Terminations from Medicaid’s Work Reporting Requirements
(Center on Budget & Policy Priorities, 1/12/26): In this guide, the Benefits Tech Advocacy Hub (a joint effort of NHeLP, TechTonic Justice, and Upturn) offers recommendations for minimizing procedural terminations connected with OBBBA’s work requirements.
Engaging Enrollees in Medicaid Work Reporting Requirements Implementation
(State Health & Value Strategies, 12/19/25): Toolkit provides practical strategies for engaging Medicaid enrollees in implementation decisions, including general guidelines, suggested opportunities for engagement, and sample questions and activities to support meaningful enrollee participation.
Designing Effective Verification Pathways for Exempt Populations at Heightened Risk of Coverage Loss Under Mandatory Work Reporting Requirements
(State Health & Value Strategies, 12/12/25): This toolkit offers a high-level roadmap for how states can plan to identify and protect three populations exempt from work reporting requirements.
How Medical Frailty Exemption Policies Can Offer a Lifeline to People with Disabilities and Chronic Illnesses When Medicaid Work Requirements Are Implemented
(Commonwealth Fund, 12/18/25): Examines the concept of medical frailty and its application to work reporting requirements.
Checking All the Boxes: A Survey of Medical Frailty Definitions in Alternative Benefit Plans and Section 1115 Work Requirements Demonstrations
(NHeLP, 12/3/25): This survey provides information on the use of medical frailty in the past by summarizing medically frail designations in the context of Alternative Benefit Plans (ABPs) and state-level efforts to incorporate work requirements into their Medicaid programs outside of the context of H.R. 1.
Medicaid Work Requirements: Mitigating Harm through Implementation
(NHeLP, 12/1/25): This piece provides an overview of the structure of the new Medicaid work requirement and recommends how states can choose policies that lessen the negative effects of this new requirement.
Got Your (Work) Number: The Intersection of Medicaid Eligibility Data Sources and Work Requirements
(NHeLP, 11/20/25): This resource provides a brief overview of existing ex parte verification requirements and common sources used for ex parte verification and emphasizes that those sources should be used with care to minimize coverage loss.
Operationalizing the Medical Frailty Exemption: A Step-by-Step Implementation Toolkit for States
(State Health & Value Strategies, 11/14/25): Toolkit provides a step-by-step guide for how states can tackle the operationalization of medical frailty exemptions, while reducing burden on individuals and state administration and making accurate eligibility determinations.
Medicaid Work Reporting Requirements: Verifying Compliance and Exemptions
(State Health & Value Strategies, 11/5/25): This toolkit lays out the federal statutory definitions for qualifying activities and mandatory exemptions, describes whether the criteria can be verified via an ex parte review using data sources that are currently available or would require new state builds and whether a state needs to add a new question to its single streamlined application.
Challenges with Implementing Work Requirements: Findings from a Survey of State Medicaid Programs
(KFF, 10/31/25): Discusses state-reported challenges to implementing work reporting requirements by the end of 2026.
Human-Centered Principles for States Evaluating Vendor Solutions to Implement H.R.1 Work Reporting Requirements
(State Health & Value Strategies, 10/28/25): Examines key principles states should consider as they evaluate vendor solutions to support work reporting requirements implementation.
Leveraging Managed Care Plans to Support Implementation of Medicaid Work Reporting Requirements
(State Health & Value Strategies, 10/24/25): Describes Managed Care plan partnership strategies to support the implementation of work reporting requirements to promote continuity of coverage and minimize procedural disenrollment risks.
Work Reporting Requirements: State Considerations When Defining Medical Frailty
(State Health & Value Strategies, 10/23/25): Provides a description of the factors such as increased risk of unemployment for reasons beyond an individual’s control, such as stigma and discriminatory hiring practices, that states may want to consider as they define the term for purposes of each of the key sub populations identified in H.R.1.
State Roadmap for OBBBA Work Requirements
(Modern Medicaid Alliance, 10/16/25): Graphic of key implementation dates related to Medicaid work reporting requirements along with key actions for states to implement these programs by 2027.
Strategic Verification Hierarchy for Medicaid Work Reporting Requirements
(State Health & Value Strategies, 10/6/25): This toolkit lays out a potential step-by-step strategic verification hierarchy for identifying compliance with or exemption from work reporting requirements at application. States should use this toolkit as a jumping off point as they assess their own state-specific eligibility systems’ capabilities and available data sources.
Recommendations for Mitigating Harms to People with Disabilities, Older Adults, and Caregivers from Medicaid Work Requirements
(NHeLP, 10/3/25): This co-branded brief from Justice in Aging, the Bazelon Center for Mental Health Law, and the National Health Law Program offers implementation strategies to minimize wrongful coverage loss and protect people’s access to care due to these new policies.
How Will States Implement Medicaid Work Requirements?
(KFF, 9/11/25): Webinar discussion with experts on how states will go about implementing the new Medicaid work requirements.
Webinar: How to Prepare for Medicaid Work Requirements
(NHeLP, 9/8/25): Discusses expected federal approval pathways and strategies for responding to Medicaid work requirements.
How Will We Know if States Are Ready to Implement H.R. 1 and Work Reporting Requirements?
(Georgetown Center for Children & Families, 9/4/25): Performance metrics to track whether states are prepared to implement work reporting without harming eligible enrollees.
Tracking State Readiness to Implement H.R. 1
(Georgetown Center for Children & Families, 8/28/25): Georgetown Center for Children & Families’ tracking tool documenting state actions, timelines, and risks as H.R. 1 implementation begins.
States Pursuing Medicaid Work Requirement Waivers Must Make Changes: How the OBBB Changed the Landscape
(Georgetown Center for Children & Families, 7/23/25): Explains how the new federal law reshapes waiver options and raises new legal and operational challenges for states.
Implementation Strategies for Work and Community Engagement Requirements in Means-Tested Programs
(Bipartisan Policy Center, 5/30/25): A policy brief reviewing historical work requirements across programs like TANF, SNAP, and Medicaid and outlining best practices for implementing new requirements to minimize disruption.

Chief Justice Roberts’ 2012 Ruling Should Undermine Work Requirements
(Millbank Memorial Fund, 8/26/25): Opinion piece describing how the legal analysis in the 2012 US Supreme Court decision regarding the Affordable Care Act (ACA) may undermine current efforts to institute work requirements in the Medicaid program.

Background Impact CMS Guidance State Implementation

Medicaid Home Care (HCBS) in 2025
(KFF, 1/5/16): Provides an overview of what Medicaid home care (also known as “home- and community-based services” or HCBS) is, who is covered, and what services were available in 2025.
States’ Management of Medicaid Home Care Spending Ahead of H.R. 1 Effects
(KFF, 11/20/25): Using data from the 23rd KFF survey of officials administering Medicaid home care programs, this issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.
Medicaid makes community living possible for people with intellectual, developmental disabilities
(Manatt/Fierce Healthcare, 5/9/25): Article on the benefits of Medicaid Home and Community Based Services (HCBS) and how the continuation of such programs can help people with intellectual and developmental disabilities (I/DD) live and fully participate in community life.

Payment Rates for Medicaid Home Care Ahead of the 2025 Reconciliation Law
(KFF, 1/5/26): Issue brief describes states’ ongoing efforts to respond to shortages of home care workers and impact of Medicaid cuts on this important workforce.
History Repeats? Faced With Medicaid Cuts, States Reduced Support For Older Adults And Disabled People
(Health Affairs, 4/16/25): Describes the importance of Home and Community Based Services (HCBS) offered through Medicaid and the impact of proposed cuts to these important services for seniors and people with disabilities.

Families USA will include resources here as they become available.

How States Can Mitigate the Harm of HCBS Cuts
(Health Affairs, 6/10/25): This article outlines policy tools states can use to protect home- and community-based services.

Background Impact CMS Guidance and Grant Awards State Implementation

How States Can Access New Federal Funds to Improve Care in Rural Communities
(Commonwealth Fund, 10/7/25): Describes the Rural Health Transformation Program, timeline for its implementation and impact on rural health care.
How Can the Rural Health Transformation Fund Help Make Maternal Health Great Again?
(Georgetown Center for Children & Families, 10/9/25): Explores whether rural funding can realistically address maternity care deserts amid Medicaid cuts.
Unpacking the Rural Health Transformation Fund
(Georgetown Center for Children & Families, 9/19/25): Explains the structure, limits, and tradeoffs of the Rural Health Transformation Fund.
Rural Hospitals and the Rural Health Transformation Program: What Comes Next
(Bipartisan Policy Center, 6/25/25): This article explains how the One Big Beautiful Bill’s Rural Health Transformation Program could support rural hospitals facing financial pressures and outlines priority areas for investment.

Rural Health Fund Will Do Little to Offset Harm to Rural Providers in Republican Megabill
(Center on Budget & Policy Priorities, 9/26/25): Explains why limited rural funding cannot compensate for deep Medicaid cuts.
Untangling the Debate Around Federal Medicaid Cuts and Rural Health Funding
(Georgetown Center for Children & Families, 9/2/25): Clarifies why temporary rural funds cannot replace stable Medicaid financing.
House Republican Reconciliation Bill Would Harm Rural Households, Communities, and Economies
(Center on Budget & Policy Priorities, 6/9/25): Shows how Medicaid cuts destabilize rural hospitals and local economies.

CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
(CMS, 12/29/25)
First-Year Rural Health Fund Awards Range From Less Than $100 Per Rural Resident in Ten States to More Than $500 in Eight
(KFF, 1/6/26): Examines rural health grant awards issued by CMS, by state.
Key Takeaways from CMS’s Rural Health Funding Announcement
(KFF, 9/23/25): This brief describes five key takeaways from the rural health fund Notice of Funding Opportunity, including information about how CMS intends to review state applications and distribute funds and ongoing questions about the impact on rural hospitals, the distribution of funds across rural hospitals and states, and issues related to oversight and transparency.

A $50 Billion Band-Aid?: States Considering Rural Health Funding Should Proceed With Caution
(NHeLP, 10/15/25): Warns that new rural health funding does not offset the scale of Medicaid cuts imposed by OBBBA.
Innovating and Investing in Rural Health: How States Propose Spending the $50 Billion Rural Health Transformation Fund
(State Health & Value Strategies, 10/12/25): Examines the various approaches states are taking to utilizing rural health transformation fund dollars.
States Should Use Rural Transformation Fund to Focus on Children and Families
(Georgetown Center for Children & Families, 9/26/25): Argues states should prioritize primary care and family health rather than short-term hospital relief.
Tracking State Preparation for the Rural Health Transformation Program
(State Health & Value Strategies, 9/18/25): Highlights state action to create a transformation plan and prepare to apply for the rural health fund.

Congressional Budget Office Analyses Impact of H.R. 1, In General Health Care System State Budgets Medicaid Benefits Medicaid Expansion States Medicaid Managed Care Impact on Medical Debt Workforce State-by-State Analyses Public Opinion

Distributional Effects of Public Law 119-21
(Congressional Budget Office, 8/11/25)
Estimated Budgetary Effects of Public Law 119-21, to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Relative to the Budget Enforcement Baseline for Consideration in the Senate
(Congressional Budget Office, 7/21/25)
New CBO Health Coverage Estimates of Budget Reconciliation Law
(Georgetown Center for Children & Families, 8/14/25): Summarizes updated CBO estimates showing significant national coverage losses driven largely by Medicaid and ACA policy changes.
Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States: Enacted Reconciliation Package
(KFF, 7/23/25): Analysis allocates the CBO’s estimated reduction in federal spending across states based on KFF’s state-level data and where possible, prior modeling work; and shows the federal spending reductions relative to KFF’s projections of federal spending by state under current law.
Congressional Budget Office Confirms Senate Republican Reconciliation Bill’s Medicaid Cuts Are More Draconian Than the House-Passed Bill
(Georgetown Center for Children & Families, 6/29/25): Highlights CBO findings showing the Senate bill would deepen Medicaid cuts and increase coverage losses beyond the House version.

By the Numbers: Harmful Republican Megabill Will Take Health Coverage Away From Millions and Raise Families’ Costs
(Center on Budget & Policy Priorities, 8/27/25): Center on Budget & Policy Priorities policy brief that quantifies coverage losses and cost increases driven by proposed Medicaid and ACA cuts.
H.R. 1: The Many Harmful Impacts of Trump’s Health Care Cuts on Coverage, Costs, and Care
(Families USA, updated 8/12/25): An overview of the major health provisions of the law, and their impact.
Proposed changes to Medicaid, other health programs could lead to over 51,000 preventable deaths, researchers warn
(Yale School of Public Health, 6/3/25): Researchers estimate that 42,500 lives could be lost each year from disenrollments in Medicaid and Marketplace coverage and the rollback of nursing home staffing rules. An additional 8,811 deaths are projected from the expiration of the enhanced Affordable Care Act (ACA) Premium Tax Credits, bringing the total to more than 51,000.

The Impact of Proposed Federal Medicaid Work Requirements on Hospital Revenues and Financial Margins
(Commonwealth Fund, 9/18/25): Analysis estimating coverage losses as a result of H.R. 1 and the financial impact on acute-care hospitals.
What are the Implications of the 2025 Budget Reconciliation Bill for Hospitals?
(KFF, 6/12/25): Discusses the implications of H.R. 1 for hospitals and explains how some hospitals (such as rural hospitals as well as urban hospitals that serve a large share of Medicaid patients) may be less well positioned than others (such as hospitals that serve a large share of commercial patients) to absorb revenue losses given their current financial status.
Estimated Effects of H.R.1 on Hospital Uncompensated Care Costs
(America’s Essential Hospitals, 6/25): Examines current rates of uncompensated care and the impact of the House bill on these costs going forward.
Nearly 5.6 Million Community Health Center Patients Could Lose Medicaid Coverage Under New Work Requirements, with Revenue Losses Up to $32 Billion
(Geiger Gibson, 5/30/25): Estimates that Medicaid work requirements in H.R.1 could result in 5.6 million community health center patients losing coverage and up to $32 billion in lost revenue over five years.
The Big, ‘Beautiful’ Bill’s Health Care Cuts Would Drive Up Uncompensated Care and Threaten Vulnerable Hospitals
(Center for American Progress, 5/23/25): A new analysis from the Center for American Progress projects that if 13.7 million people lose their insurance because of House Republicans’ cuts—which should be considered a minimum and conservative estimate of coverage losses given the last-minute changes to the House bill passed on May 22—uncompensated care costs will surge by $48 billion annually by 2034, straining vulnerable providers that anchor care in rural and underserved communities.
Medicaid Coverage for Over Nine Million Community Health Center Patients Is At Risk Under a Federal Work Mandate
(Geiger Gibson, 2/3/25): Finds that over nine million community health center patients could be at risk of losing Medicaid coverage under a nationwide work requirement policy.

The Medicaid Puzzle: Piecing Together Policies for a Balanced Budget
(National Conference of State Legislatures, 1/13/25): Discusses state options for navigating Medicaid budget shortfalls.
State Medicaid Officials Project Flat Enrollment Post Unwinding but Increased Spending and Budget Pressures, as States Prepare for Impact of Federal Medicaid Policy Changes
(KFF, 11/13/25): Details the budget challenges facing states post H.R. 1.
States Are Planning Their Responses to H.R. 1 Cuts in Medicaid Funding — Will Enrollees Lose Benefits?
(Commonwealth Fund, 10/14/25): Examines how states are beginning to respond to Medicaid budget cuts and anticipated budget shortfalls.
Timeline Charts of Changes to Medi-Cal and Covered California Under OBBBA and the California Budget
(NHeLP, 9/17/25): Visual timelines showing how federal and state policy changes affect Medi-Cal and Covered California coverage.
What to Expect from States When They’re Expecting Big Changes Due to H.R. 1
(Georgetown Center for Children & Families, 8/8/25) Outlines likely state responses to federal cuts, including benefit reductions and eligibility tightening.
Reconciliation Bill Effects on States’ Health Care Spending and Uncompensated Care
(Robert Wood Johnson Foundation, 6/17/25): This report estimates how Medicaid cuts would raise state costs and uncompensated care.
Responding to Federal Medicaid Reductions: Which States Are Most at Risk?
(KFF, 5/2/25): States’ ability to respond to federal spending reductions and how they will be affected by any cuts is complicated and depends on an array of factors. An analysis examining a range of factors to identify states that may have greater difficulty responding to federal Medicaid spending reductions.
Governors and State Agencies Estimate Impact of Potential Federal Medicaid Cuts on State Budgets
(Georgetown Center for Children & Families, 4/28/25): Examines state analyses of how reduced federal Medicaid funding to states impacts state budgets and programs.
Reducing Federal Support for Medicaid Expansion Would Shift Costs to States and Likely Result in Coverage Losses
(Robert Wood Johnson Foundation, 2/14/25): This brief outlines fiscal strain and enrollment losses tied to reduced expansion funding.
Maryland Community Health Centers: The Role of Medicaid (PDF)
(Geiger Gibson, 1/2025): Details Medicaid’s role in financing Maryland community health centers and the potential impact of federal Medicaid cuts on access to care.

How State Budget Shortfalls Could Put Medicaid Dental Coverage at Risk
(Commonwealth Fund, 6/12/25): Examines optional benefits under Medicaid and potential loss of important health care services (including dental) as a result of Medicaid cuts.
Federal Medicaid Cuts Would Force States To Eliminate Services for Disabled Adults, Older Adults, and Children
(Center for American Progress, 5/16/25): Describes Medicaid benefits that the federal government categorizes as optional for states and that could therefore be at risk if federal funding for Medicaid is cut.

The Future of ACA’s Medicaid Expansion: What Do Changes in HR1 Mean?
(Georgetown Center for Children & Families, 11/10/25): In this analysis, the Georgetown Center for Children & Families discusses the impacts of H.R. 1 on Medicaid expansion decisions, including new financing barriers and restrictions that could deter states from expanding Medicaid despite the permanent 90% federal match, while also highlighting evidence of positive outcomes associated with expansion.
How OBBBA Punishes Medicaid Expansion States
(NHeLP, 8/13/25): Analyzes how OBBBA disproportionately penalizes states that expanded Medicaid coverage.
Quick Reference on OBBBA Cuts: Medicaid Expansion vs. Non-Expansion States
(NHeLP, 7/30/25): A side-by-side comparison of how OBBBA cuts affect expansion and non-expansion states differently.
Senate Finance Language Would Further Cut Federal Spending for Medicaid Expansion States
(KFF, 6/20/25): Discusses the provisions of H.R. 1 that impact Medicaid expansion states.
Eliminating Medicaid Expansion in Ohio in Response to Reduced Federal Funding
(Urban Institute, 5/29/25): Research findings on the potential impact of H.R.1 on Ohio’s state Medicaid budget and decisions regarding Medicaid expansion due to financial implications.
2.4 Million Parents Would Lose Medicaid if States Eliminate the ACA Expansion
(Urban Institute, 5/9/25): Fact sheet with national and state projections for 2026.
5.7 Million Women of Reproductive Age Would Lose Medicaid if States Eliminate the ACA Expansion
(Urban Institute, 5/9/25): Fact sheet with national and state projections for 2026.
House Republicans Won’t Let Go of Repealing ACA; Decimating Its Medicaid Expansion Would Harm Millions of Parents, Children, Disabled People
(Center on Budget & Policy Priorities, 5/1/25): Explains how repeated repeal efforts would dismantle Medicaid expansion, leading to large coverage losses among low-income parents, children, and people with disabilities.
How Work Requirements Would Affect Medicaid Coverage in Each Expansion State
(RWJF, 4/14/25): State-by-state estimates of Medicaid expansion coverage losses under a federal work requirement.

Medicaid Managed Care in 2025: The Year That Was
(Georgetown Center for Children & Families, 12/18/25): This retrospective piece reviews how 2025 unfolded for Medicaid managed care against the backdrop of H.R. 1, describing how federal policy changes have reshaped coverage, financing, and provider dynamics, with implications for states and plans as they navigate cuts and new administrative requirements.
Impact of H.R. 1 on Managed Care
(Academy of Managed Care Pharmacy, 7/1/25): Discusses some of the key impacts of the new law on Medicaid managed care.
Medicaid Managed Care Headwinds for the Big Five in the Budget Reconciliation Law
(Georgetown Center for Children & Families, 7/18/25): Discusses implications of H.R. 1 on the biggest MCO plans.
Where Interests Conflict: Medicaid Managed Care Meets Work Reporting Requirements
(Georgetown Center for Children & Families, 7/25/25): Examines how work reporting requirements create misaligned incentives between managed care plans, states, and enrollees.
Medicaid Managed Care Work Reporting Requirements in the One Big Beautiful Bill Act
(Georgetown Center for Children & Families, 6/18/25): Details how work reporting requirements embedded in the OBBB increase administrative complexity and risk of coverage loss.

How States Can Help Curb the Rising Medical Debt Related to Federal Coverage Cuts
(Commonwealth Fund, 9/10/25): Discusses impact of H.R. 1 on medical debt and tools states can use to protect patients.

How States Can Lead the Way for Workers: A State Playbook
(The Century Foundation, 10/10/25): Discusses impact of H.R. 1 and how states can find opportunities to create wins for workers in their state and set an example for the rest of the country.
Medicaid Is a Critical Insurer for Small Business
(Georgetown Center for Children & Families, 6/26/25): Explains how Medicaid supports small businesses by covering workers and their families.
Webinar: Medicaid Is a Critical Health Insurer for Small Businesses
(Georgetown Center for Children & Families, 6/26/25): Provides data and examples illustrating Medicaid’s role in the small-business economy.

Medicaid Cuts Kick In Quickly and Quietly in Idaho
(Georgetown Center for Children & Families, 9/17/25): Shows how Medicaid cuts translate rapidly into state-level service and coverage reductions.
How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State?
(KFF, 8/20/25): The Congressional Budget Office (CBO) estimates that, relative to its estimates of insurance coverage prior to the law being enacted, the law will increase the number of people without health insurance in 2034 by 10 million, because of changes to Medicaid (7.5 million), the ACA Marketplaces (2.1 million), and other policies and interactions among different provisions (0.4 million). This analysis apportions the increase in the number of uninsured across the 50 states and the District of Columbia and shows that number as a percentage of each state’s population.
New Resource on State-by-State Impacts of Budget Reconciliation Law
(Georgetown Center for Children & Families, 8/15/25): Introduces a state-by-state resource detailing how Medicaid and ACA cuts will affect coverage, budgets, and health systems across states.
Medicaid Cuts and the States: Tracking State-Specific Estimates of the Impacts of Proposed Changes
(State Health & Value Strategies, 7/11/25): Expenditure and enrollment estimates across all 50 states.
Senate-Passed H.R. 1: Updated Estimates on Impact to State Medicaid Coverage and Expenditures, Hospital Expenditures, Including Impacts by Congressional District
(State Health & Value Strategies, 7/1/25): Written analysis and an accompanying Excel workbook examining state-by-state estimates of Medicaid coverage and expenditure impacts.
House Budget Bill Medicaid Proposals: State-by-State Estimates of Impacts on Expenditures and Enrollment
(State Health and Value Strategies/Manatt Health, 6/2/25): Estimates the state-by-state impact over the next 10 years of most of the major provisions in the House bill. The estimates take into account the interactions across the provisions.
House Republicans’ Extreme Budget Plan Fails Families, Children, and Communities
(Center on Budget & Policy Priorities, 5/29/25): State-by-state fact sheets on impact of the House bill.
How Will the 2025 Reconciliation Bill Affect the Uninsured Rate in Each State?: Allocating CBO’s Partial Estimates of Coverage Loss (KFF, 5/20/25): Analysis apportions the increase in the number of uninsured across the 50 states and DC and shows that number as a percentage of each state’s population.

KFF Health Tracking Poll: The Public’s Views of Funding Reductions to Medicaid
(KFF, 6/6/25): KFF Health Tracking Poll examines the views and experiences of the groups that could be most impacted by H.R. 1.

Rural Americans Older Adults People with Disabilities Maternal Health Young Adults Children Low-Income Families Behavioral Health and Substance Use Disorders Veteran and Military Families American Indians and Alaska Natives Immigrants People Experiencing Homelessness Educational Attainment Gun Violence SNAP and Medicaid Cuts Justice-Involved Individuals

How Might Federal Medicaid Cuts in the Enacted Reconciliation Package Affect Rural Areas?
(KFF, 7/24/25): Explains the impact H.R. 1 will have on rural communities.
5 Key Facts About Medicaid Coverage for People Living in Rural Areas
(KFF, 6/26/25): Explains the importance of Medicaid for rural Americans and the potential impact of H.R. 1 on these communities.
Critical Condition: How Medicaid Cuts Would Reshape Rural Health Care Landscapes
(National Rural Health Association, 4/8/25): Describes the impact of Medicaid funding cuts on raising uninsurance rates across the US, with a higher impact in vulnerable rural areas.
Medicaid Work Requirements Undermine Rural Healthcare
(NHeLP, 4/7/25): Describes the impact of work reporting requirements on the rural health care system.
Medicaid’s Role in Small Towns and Rural Areas
(Georgetown Center for Children & Families, 1/15/25): Describes importance of Medicaid to rural communities. Includes county-specific data on Medicaid coverage rates of children, non-elderly adults and seniors. Also includes interactive maps.
Why Medicaid is Important for Rural Health
(NHeLP, 1/15/25): Outlines the critical importance of Medicaid for rural communities.

What Could the Health-Related Provisions in the Reconciliation Law Mean for Older Adults?
(KFF, 9/17/25): Describes how H.R. 1 could affect the 22 million people ages 50 and older with coverage under the Medicaid program by reducing the number of people with Medicaid and reducing access to health and long-term care services for people who remain enrolled in the program.
What Does the 2025 Reconciliation Law (H.R. 1) Mean for Older Adults and People with Disabilities on Medicare?
(Commonwealth Fund, 7/21/25): Examines the implications H.R. 1 will have for older adults and people with disabilities on Medicare.
Medicaid Changes in House and Senate Reconciliation Bills Would Increase Costs for 1.3 Million Low-Income Medicare Beneficiaries
(KFF, 6/17/25): Describes how dual eligible beneficiaries would be disproportionately impacted by H.R. 1’s moratorium on two Biden era rules that aimed to streamline the enrollment process and make it easier for people to maintain Medicaid coverage by reducing administrative barriers.
The Big Republican Cost-Shift: Massive Cuts To Medicaid And The ACA Will Increase Costs For Older Adults And Medicare
(Health Affairs, 5/30/25): Impacts of the House bill on older adults who access both Medicare and Medicare (dual eligibles).
History Repeats? Faced With Medicaid Cuts, States Reduced Support For Older Adults And Disabled People
(Health Affairs, 4/16/25): Describes the importance of Home and Community Based Services (HCBS) offered through Medicaid and the impact of proposed cuts to these important services for seniors and people with disabilities.
Medicaid and Its Role for Older Adults: 51 State Fact Sheets
(AARP, 4/11/25): State-by-state fact sheets focused on the importance of Medicaid for adults aged 50 and older.
Medicaid is Vital for Seniors and Americans with Complex Medical Needs
(Modern Medicaid Alliance, 4/9/25): Fact sheet on the coverage Medicaid provides to seniors and people with disabilities.
A Cut to Medicaid is a Cut to Medicare
(Justice in Aging, 3/4/25): Fact sheet and issue brief outlining how, given that nearly 30% of all Medicaid dollars directly support Medicare enrollees, any proposed cuts to Medicaid are in effect, cuts to Medicare.
Medicaid and Its Role for Older Adults
(AARP, 3/25): Describes the critical safety net Medicaid provides for people ages 50 and older.
Trump’s Plan to Slash Medicaid will Harm Older Women–And the Economy
(National Partnership of Women & Families, 2/25): Presents data on the impact of Medicaid cuts on older women.
Aging at Risk: The Impact of Medicaid Cuts on Older Adults
(Milbank Memorial Fund, 2/20/25): Issue brief on how proposed Medicaid cuts impact the almost 9 million older adults aged 65 and up rely on Medicaid.
5 Key Facts about Medicaid Eligibility for Seniors and People with Disabilities
(KFF, 2/7/25): Describes the importance of Medicaid for seniors and people with disabilities.
Work Requirements Would Cut Medicaid for Older Adults
(Justice in Aging, 2/4/25): Examines the impact work reporting requirements would have on older adults.

Webinar – The Impact of OBBBA on People with Disabilities
(NHeLP, 10/30/25): This webinar discusses the impact of OBBBA on people with disabilities, including work requirement exemptions and compliance, new authority related to home- and community-based services waivers, higher out of pocket costs, and changes to home equity limits for long term care.
The Disability Gap in Medicaid: Implications for the Federal Work Requirement Proposal
(State Health & Value Strategies, 6/20/25): Analysis shows that more than two-thirds of Medicaid enrollees who self-identify as having a disability are not enrolled through the program’s disability eligibility pathway.
2025 Budget Impacts: House Bill Would Cut Assistance and Raise Costs for People With Disabilities
(Center on Budget & Policy Priorities, 6/9/25): Policy brief on coverage and service disruptions for people with disabilities due to harmful impacts of administrative changes being attempted under the Trump Administration.
Answers to FAQ on Medicaid and Budget Reconciliation Proposals
(Consortium for Constituents with Disabilities, 5/25): Overview of proposals to cut Medicaid and impact on people with disabilities.
History Repeats? Faced With Medicaid Cuts, States Reduced Support For Older Adults And Disabled People
(Health Affairs, 4/16/25): Describes the importance of Home and Community Based Services (HCBS) offered through Medicaid and the impact of proposed cuts to these important services for seniors and people with disabilities.
Beyond Health: What Cutting Medicaid Means for Disabled People, Including in Maine
(The Century Foundation, 4/2/25): Outlines how funding cuts to Medicaid would impact care for people with disabilities, including the 4.5 million people with home- and community-based services (HCBS).
5 Key Facts about Medicaid Coverage for People with Disabilities (KFF, 2/7/25): Describes the impact of lower Medicaid spending on the unique needs of people with disabilities
How Medicaid Work Requirements Hurt People with Disabilities
(NHeLP, 12/16/24): Examines impact of Medicaid work requirements for people with disabilities; discussion of how Medicaid services can help people with disabilities stay in the workforce.

Federal Threats to Maternal and Infant Health Highlighted in Health Affairs
(Georgetown Center for Children & Families, 9/5/25): Summarizes research showing how federal policy changes threaten maternal and infant health outcomes.
How the Republican Megabill Impacts Black Maternal Health
(The Century Foundation, 8/5/25): webinar in collaboration with the Black Maternal Health Federal Policy Collective on the changes to Medicaid and the ACA on Black maternal health.
Medicaid Cuts Threaten Pregnancy and Postpartum Coverage, Access to Care, and Health
(Health Affairs, 5/29/25): Readers will learn how coverage reductions undermine maternal health outcomes.
Medicaid Expansion Reduces Maternal Mortality: Medicaid Cuts Would Be Deadly for Mothers and Babies
(Families USA, 5/20/25): analysis comparing maternal mortality rates between states that expanded Medicaid and those that have not. The findings reveal that, between 2019 and 2023, maternal mortality rates in non-expansion states were 35% higher than in expansion states.
Medicaid Cuts Could Increase Maternal Mortality and Jeopardize Women’s Health
(Commonwealth Fund, 5/20/25): Describes how Medicaid supports maternal health and how Medicaid expansion programs have expanded access to health coverage for women of all ages.
5 Key Facts About Medicaid and Pregnancy
(KFF, 5/29/25): This brief examines Medicaid’s pregnancy and postpartum coverage and its support for strengthening and improving maternal health outcomes.
5 Key Facts About Medicaid and Family Planning
(KFF, 5/29/25): Explainer on Medicaid’s role in supporting family planning.
Medicaid Plays A Key Role for Maternal and Infant Health in Rural Communities
(Georgetown Center for Children & Families, 5/15/25): Examines the role of Medicaid in covering women of childbearing age (19 through 44 years old) living in small towns and rural areas.

Medicaid Cuts in the One Big Beautiful Bill Act Leave 3 in 10 Young Adults Vulnerable to Losing Health Care Access
(Urban Institute, 8/7/25): Examines the role of Medicaid in covering young adults age (18-24) with low and moderate incomes.

Child Uninsurance Rate Hits Highest Level in Almost a Decade
(Georgetown Center for Children & Families, 10/6/25): Uses Census data to show rising child uninsurance and highlights state policy choices driving losses.
Who Cares for Our Nation’s Children?
(Georgetown Center for Children & Families, 9/11/25): Connects Medicaid cuts to instability in the childcare workforce and harms to young families.
U.S. Uninsured Rate Stays Level in 2024 for Adults and Kids—Storm Clouds Lie Ahead
(Georgetown Center for Children & Families, 9/9/25): Explains why stable uninsured rates mask looming coverage losses tied to Medicaid and ACA changes.
Worth Repeating: Pregnant Women, Infants, Young Children Are Not Protected in Proposed Medicaid Cuts
(Georgetown Center for Children & Families, 7/1/25): Clarifies that proposed Medicaid cuts fail to meaningfully shield pregnant people and young children.
New Blog: Medicaid Cuts Put One in Five Enrolled Children at Risk
(Geiger Gibson, 5/7/25): Warns that proposed Medicaid cuts could place one in five currently enrolled children at risk of losing coverage by eliminating optional eligibility pathways.
No Place to Hide: Children Will Be Hurt by Medicaid Cuts
(Manatt, 5/6/25): National and state-by-state estimates on the potential impact of key Medicaid cuts under consideration by Congress on children and youth.
Deep Medicaid Spending Cuts Put Health Care Coverage at Risk for One of Five Enrolled Children
(Commonwealth Fund, 5/5/25): Discusses state Medicaid coverage for children and how proposals can directly or indirectly jeopardize access to care for young Medicaid recipients.
Thinking Frequent Medicaid Redeterminations Won’t Hurt Children’s Health Insurance? Take a look at What Happened in Texas.
(Georgetown Center for Children & Families, 5/2/25): Discusses the impacts monthly income checks to families have on children who are covered by Medicaid.
Medicaid Cuts Would Weaken Early Intervention for Infants and Toddlers with Disabilities and Developmental Delays
(Georgetown Center for Children & Families, 4/11/25): Brief explainer on how Part C of the Individuals with Disabilities Act (IDEA), or early intervention, relies on Medicaid in most states to help pay for an array of therapies, treatments and services for eligible infants and toddlers with disabilities or developmental delays.
Beyond Health: Threats to Medicaid Funding Would Endanger Child Care Too
(The Century Foundation, 3/5/25): Discusses the many potential harms of up to $880 billion in potential Medicaid cuts, including impact to the childcare sector.
Issue Brief: What Proposed Federal Budget Cuts and Policy Changes Will Cost Children
(First Focus, 2/25): Outlines the immense return by investing in children through programs like Medicaid; describes impact of proposed Medicaid cuts on children and places this in context with other proposed cuts (to nutrition assistance or social services).

House Reconciliation Bill Will Hit Lowest-Income Families the Hardest
(Urban Institute, 6/13/25): Examines key aspects of the bill related to Medicaid, SNAP, and federal income taxes and credits.

How Will States Implement the Behavioral Health Exemption to Medicaid Work Requirements?
(Commonwealth Fund, 11/21/25): Examines critical issues in how H.R. 1’s work requirements will impact people with substance use or disabling mental disorder.
Medicaid Unwinding: Association With New and Ending Buprenorphine Treatment Episodes
(Journal of Addiction Medicine, 10/25): Discusses the impact the Medicaid unwinding, and subsequent coverage loss, had on access to buprenorphine treatment for opioid use disorder.
Proposed Medicaid Policy Changes Threaten Behavioral Health Care Access at Community Health Centers
(Commonwealth Fund, 7/2/25): Examines how emerging Medicaid policy proposals, including work requirements and more frequent redeterminations, risk destabilizing community health centers.
Implications of Medicaid Work and Reporting Requirements for Adults with Mental Health or Substance Use Disorders
(KFF, 6/23/25): This brief describes key challenges that Medicaid work requirements may pose for adults with mental health or substance use disorders.
Implications of Potential Federal Medicaid Reductions for Addressing the Opioid Epidemic
(KFF, 5/14/25): Discusses the importance of Medicaid for expanding access to treatment for substance use disorders and the potential impact of Medicaid spending cuts on these critical programs and services.
Cuts to Medicaid Expansion Harm People with Mental Health Disabilities
(NHeLP, 4/16/25): Describes how Medicaid expansion cuts undermine access to mental health treatment and continuity of care.
Medicaid State Fact Sheets
(NAMI, 4/25): State-specific statistics on Medicaid and mental health.
Medicaid Work Reporting Requirements – Even with Exemptions – Will Have Significant Consequences for People with Substance Use Disorders
(Georgetown Center for Children & Families, 4/29/25): Examines the impact work reporting requirements would have on people with substance use disorders (2 in 5 nonelderly Medicaid enrollees).
Medicaid Cuts Kick Down on People Caught in the Opioid Epidemic
(Scientific American, 3/18/25): Reviews Medicaid’s role in treating opioid use disorder and the lessons learned from the impact of Medicaid expansion on the treatment of substance use disorder in the U.S.
Medicaid’s Role in Child, Youth and Adult Mental Health
(Georgetown Center for Children & Families, 2/25): Outlines the role of Medicaid as the single largest payer of mental health services in the United States.
How Medicaid Helps People with Substance Use Disorders
(Georgetown Center for Children & Families, 2/25): Describes the importance of Medicaid in combating the opioid crisis.

5 Key Facts About Medicaid and Veterans
(KFF, 6/20/25): Presents key facts about veterans enrolled in Medicaid and examines how Medicaid changes could affect their coverage and access to care.
2025 Budget Impacts: House Bill Would Cut Assistance and Raise Costs for Veterans
(Center on Budget & Policy Priorities, 6/9/25): Shows how Medicaid supplements VA coverage and fills gaps for low-income veterans.
Medicaid Cuts Threaten Veterans’ Health Care
(Modern Medicaid Alliance, 4/10/25): Describes the importance of Medicaid for filling the gaps in coverage for Veterans.
TOP 8 WAYS Medicaid Helps America’s Veterans
(Modern Medicaid Alliance, 2/19): Fact sheet on importance of Medicaid for Veterans.
Medicaid: Important for Military Families & Future Readiness
(Georgetown Center for Children & Families, 1/27/25): A report detailing how Medicaid serves as a critical safety net to families of active-duty service members and veterans.

An Overview of the Impact of Medicaid on Health Care of American Indians and Alaska Natives
(The National Council of Urban Indian Health, 6/12/23): Highlights data and statistics on AI/AN Medicaid coverage and enrollment and the impact of Medicaid funding on Indian healthcare providers.

1.4 Million Lawfully Present Immigrants are Expected to Lose Health Coverage due to the 2025 Tax and Budget Law
(KFF, 9/25/25): Outlines the groups of lawfully present immigrants that will lose access to federally funded health coverage due to the 2025 tax and budget law and the Congressional Budget Office’s (CBO’s) estimates of the increases in the number of uninsured and federal savings and revenue changes due to these provisions.
Potential Impacts of 2025 Budget Reconciliation on Health Coverage for Immigrant Families
(KFF, 6/17/25): Discusses key provisions in the new law that are aimed at limiting health coverage for immigrant families.
The Proposed One Big Beautiful Bill Act Would Mean Dramatic Change for Immigrant Health Coverage
(State Health & Value Strategies, 6/6/25): Expert perspective analyzes the combined impact of the bill’s provisions on non-citizen coverage across the Marketplace and Medicaid.
The Truth About Medicaid Coverage for Immigrants – and the Looming Threats
(Georgetown Center for Children & Families, 5/21/25): Explains the term “qualified immigrants” and the pathways such immigrants may have to health insurance coverage, along with an examination of what proposed changes to Medicaid policy may mean for immigrant populations.

Medicaid Cuts Will Undermine Essential Care for Community Health Center Patients Experiencing Homelessness
(Geiger Gibson, 7/31/25): A data note showing that Medicaid cuts under H.R. 1/OBBBA will disproportionately harm patients experiencing homelessness by reducing access to primary and preventive care and destabilizing safety-net providers.

Beyond Health: Potential Impact on K–12 Students of $880 Billion in Medicaid Cuts
(The Century Foundation, 3/26/25): Discusses the ripple effects of proposed Medicaid cuts on school-based health services for K–12 students.
Beyond Health: Medicaid Cuts Could Put College Dreams on Life Support
(The Century Foundation, 3/26/25): Discusses the ripple effects of proposed Medicaid cuts on higher education.
How Medicaid Cuts Will Harm Students & Schools
(Healthy Schools Campaign, 3/25): Report on the importance of school-based health services and the connection between Medicaid and school health funding.

Beyond Health: Medicaid Cuts Will Further Exacerbate the Epidemic of Gun Violence
(The Century Foundation, 4/2/25): Describes the importance of Medicaid for public safety, as the people who need Medicaid the most are also the same people that are more likely to be victims of gun violence.

Comparing Medicaid and Supplemental Nutrition Assistance Program Work Reporting Requirements Exemptions
(State Health & Value Strategies, 10/6/25): This tool lays out mandatory and optional exemptions from Medicaid work reporting requirements in H.R.1, identifies whether SNAP has a corresponding exemption, and describes whether information in the state’s public benefit system can be leveraged to exempt individuals from Medicaid’s new requirements.
About 12 Million Households Receive Both Medicaid and SNAP. The Reconciliation Bill Puts Them At Risk.
(Urban Institute, 7/28/25): Analysis using 2019–23 five-year American Community Survey (ACS) data showing that most households reporting SNAP benefit receipt also report at least one person with Medicaid or CHIP; one-third of households receiving Medicaid or CHIP report being SNAP recipients.
Using Administrative Advocacy to Improve Access to Medicaid, SNAP, TANF, and WIC
(Center on Budget & Policy Priorities, 6/30/25) A toolkit developed by Center on Budget & Policy Priorities on administrative advocacy.
The Implications of Federal SNAP Spending Cuts on Individuals with Medicaid, Medicare and Other Health Coverage
(KFF, 6/26/25): Examines how SNAP cuts will impact people on Medicaid and other health coverage.
New Data Note and Issue Brief Analyzing Loss of Post-ACA Gains and Medicaid and SNAP Cuts
(Geiger Gibson, 6/25/25): Shows that Medicaid and SNAP cuts would reverse coverage and economic gains achieved since the ACA, particularly in low-income communities.
How Medicaid and SNAP Cutbacks in the “One Big Beautiful Bill” Would Trigger Big and Bigger Job Losses Across States
(Commonwealth Fund, 6/23/25): Analysis of federal funding reductions for Medicaid and SNAP programs in each state using Congressional Budget Office estimates, along with recent Medicaid and SNAP data.

Medicaid Cuts Will Harm Justice-Involved Individuals Transitioning Out of Incarceration
(NHeLP, 9/12/25): Explains how reduced Medicaid access worsens reentry outcomes and public health for formerly incarcerated individuals.