Timeline of Trump’s New Health Care Law: What You Need to Know

Earlier this month, Republicans in Congress passed, and President Trump signed, their “One Big Beautiful Bill,” which includes the largest health care cuts in history: more than $1 trillion over 10 years, primarily impacting Medicaid and ACA Marketplace enrollees. Last week, the nonpartisan Congressional Budget Office estimated that as a direct result of Republicans’ new health care law, 10 million people will be forced off of their health insurance. Another 5 million people will lose coverage because Republicans chose not to extend enhanced ACA premium tax credits in the bill, which expire at the end of the year.

Today, Families USA published a comprehensive timeline of when different provisions of the law that will impact Medicaid, Medicare, and ACA enrollees take effect. This implementation period is critical for advocates across the country as we work to mitigate the harm of these new bureaucratic burdens and document the damage that these severe cuts to our health care will cause.

Here are some of the key implementation dates for provisions in the law that are expected to severely reduce health insurance coverage:

Medicaid Work Reporting Requirements

The most extreme coverage losses under the bill will come from a new Medicaid work reporting requirement, which goes into effect on January 1, 2027. Under the law, adults enrolled in the ACA Medicaid expansion (which 40 states and DC have adopted) are at risk of losing Medicaid coverage if they do not regularly report work, school, or “community engagement” activities of at least 80 hours a month. Those who fail to complete this paperwork at least once every six months – or more frequently at state discretion – will not just lose Medicaid coverage, but will also be locked out from obtaining tax credits for private insurance in the ACA marketplace. If coverage loss is similar to the experience in states that have previously attempted work reporting requirements, more than 7 million people could lose Medicaid coverage — not because they do not meet eligibility requirements or exemptions offered under the law, but because of red tape and paperwork burdens.

Under the law, by June 2026, the HHS Secretary must promulgate interim final rules to implement these new work reporting requirements. From there, states will have seven months to design, test and implement their program. States can apply for a waiver to the HHS Secretary for a delayed implementation, but only if they can demonstrate a good faith effort to comply with the requirements. At most, states can push their implementation timeline to January 2029.

New Red Tape in Medicaid

Effective January 1, 2027, states will be required to redetermine Medicaid eligibility every six months for people who access Medicaid through the ACA expansion (previously, redetermination happened just once per year). While some enrollees may have a change in eligibility circumstances (for example, increased income or moving out of state), previous redetermination data shows that up to 70% of Medicaid disenrollments happen for procedural reasons — for example, lost paperwork or an incorrect mailing address. More frequent redetermination creates more paperwork and more room for error, leaving eligible people without access to Medicaid. CMS will issue guidance to expansion states at the end of this year on how they must conduct more frequent eligibility determinations.

In addition, the law makes it more difficult for new Medicaid enrollees to access the services and care they need to stay healthy and out of medical debt. Currently, when an individual newly signs up for coverage, Medicaid will pay for medical expenses up to three months prior to their official Medicaid enrollment date. This “retroactive coverage” is a critical safeguard for new enrollees who need ongoing care while they await a Medicaid determination, for example, newly pregnant women or people who apply for Medicaid during a sudden health decline.

Starting January 1, 2027, the new Republican health care law limits retroactive coverage to just one month for people covered through Medicaid expansion and two months for all other eligibility groups.

“Defunding” Planned Parenthood

Federal law already prohibits Medicaid dollars from covering abortion services, but the Republican health care law now prohibits all Medicaid reimbursement to a health center that offers abortion services, even if other services offered are otherwise covered under the Medicaid program (such as cancer screening and prenatal care for mothers). The restriction applies to any clinic that received more than $800,000 in Medicaid funding in 2024, designed to target Planned Parenthood clinics but potentially impacting other groups of providers as well.

This provision is set to expire in July 2026 but is currently being challenged in court. If it is allowed to move forward, entire communities will be severely impacted and millions of women will lose access to vital reproductive care and maternal health care as clinics are forced to close.

New Restrictions on Health Coverage for Legal Immigrants

The Republican health care law significantly limits Medicaid, Medicare and ACA marketplace coverage for lawfully present immigrants. In October 2026, the law restricts Medicaid eligibility to lawful permanent residents, Cuban and Haitians entrants, and residents of the Federated States of Micronesia and the Republic of the Marshall Islands. This means many types of legal immigrants are no longer eligible for Medicaid, including refugees and victims of trafficking, domestic violence and other crimes. In addition, starting January 1, 2026, lawfully present immigrants earning less than 100% of the federal poverty level are no longer allowed to sign up for marketplace plans. Then, on January 1, 2027, many lawfully present immigrants will no longer be able to access tax credits that help them afford health coverage, further jeopardizing access to health care. With more limited Medicaid access and without access to ACA marketplace plans or tax credits to afford them, many low-income legal immigrants will not have any option for affordable health coverage. At the same time, states that have expanded Medicaid will receive a lower federal Medicaid matching rate for emergency services provided to immigrants who would otherwise qualify for Medicaid expansion except for their immigration status.

In the months ahead, Families USA will work with our partners and advocates across the country to protect health care for Americans, and hold those who voted to rip health care away accountable for their votes. If you have a story to share about the impact of the Republican health care law, reach out to our team at stories@familiesusa.org. To join our mailing list and learn more about our ongoing campaigns, click here.