On Medicaid? Here’s What You Need to Know About the Big Beautiful Bill

You’ve certainly heard of it, though you may not have read it. There are literally hundreds of provisions in the One Big Beautiful Bill Act (often shortened to "Big Beautiful Bill"), which, as of Independence Day, is law. The entirety of the text is more than 250 pages long.

That’s a lot of fine print for Americans — and even legislators — to get caught up in. Much of the bill is about taxes, imposing new cuts for certain groups of Americans. But to make up for that loss in governmental income, the bill also introduces "historic cuts to the nation’s safety net program," reports CNN — "particularly Medicaid and food stamps."

It will also have impacts across other areas of American health care, too — let’s take a look.

How does the Big Beautiful Bill affect Medicaid?

If you’re covered by Medicaid, here are a few of the most important things to understand about how — and when — the Big Beautiful Bill might affect your health care.

Work requirements

One of the most profound changes under the Big Beautiful Bill is the requirement for applicants and enrollees ages 19 to 64 to work (or participate in other qualifying activities) at least 80 hours per month as a condition of Medicaid eligibility. (Before the bill was passed, this kind of condition was prohibited by law.)

Some adults, including parents of dependents ages 13 and under and those who are medically frail, are exempt from these requirements — but those denied Medicaid coverage, or disenrolled due to the work requirement, will also be ineligible for subsidized Marketplace coverage.

Urban Institute reports that this change could cause millions of Medicaid recipients to lose their coverage — even if they’re working enough to meet the requirements. Confusion around how to properly report those working hours and navigate the systems to do so have caused coverage losses in states that have implemented similar requirements before.

These changes will go into effect by Dec. 31, 2026 at the latest, though individual states may opt to implement them earlier.

Increases to cost sharing

While Medicaid-covered services are already often subject to cost sharing, the Big Beautiful Bill specifically requires states to impose cost sharing of up to $35 per service on adults who qualify for Medicaid under the expansion program.

There are, again, exemptions to this clause — including services provided by federally qualified health centers, behavioral health clinics and rural health clinics — but this still may increase out-of-pocket costs for many enrollees.

This change will be effective as of Oct. 1, 2028.

Tighter eligibility requirements

The Big Beautiful Bill will also make it more difficult for many applicants to qualify for — and keep — their Medicaid coverage. Along with stricter guidelines meant to box out fully undocumented immigrants (and reduce availability even for those with legally permanent status), the Big Beautiful Bill will require states to review eligibility requirements every six months rather than every 12 months for those covered under the expansion program.

These changes are slated to go into effect no later than Dec. 31, 2026.

What about other parts of U.S. health care?

What’s listed above is just a small sliver of how the Big Beautiful Bill will impact Medicaid enrollees. (KFF offers an excellent tracking tool, which breaks down changes across the Medicaid program as well as Medicare, HSAs and Obamacare.)

But the shortest version of the story is that sweeping cuts were made — and plenty of Americans can probably expect to see rising out-of-pocket costs and, in some cases, coverage losses. (The average Silver-level Marketplace plan costs about $621 per month.)

If you’re enrolled in Medicaid (or planning to be soon), calling your state Medicaid office is a good first step toward understanding what you can expect out of your coverage moving forward — and learning what steps you’ll need to take to protect your enrollment.

And if you’re on a Marketplace plan and receiving a premium tax credit, be sure your reported income information is correct — under the Big Beautiful Bill, you’ll be required to pay back any overages beyond what you’re found to be eligible for, no matter your income at the time of that determination.