Key Updates in Medicaid and Medi-Cal Under the One Big Beautiful Bill Act
The recently enacted One Big Beautiful Bill Act (HR 1) introduces significant modifications to Medicaid and Medi-Cal programs, impacting millions of Americans reliant on these public health insurance systems.
Key adjustments include the introduction of work requirements for some adults aged 19 to 64 without dependent children, necessitating 80 hours of approved activities monthly to maintain coverage, with specified exemptions. This change aligns with more frequent eligibility renewals every six months, likely increasing administrative responsibilities for both enrollees and state agencies. Additionally, states gain authority to impose co-pays up to $35 on certain services excluding primary and emergency care, potentially altering out-of-pocket expense structures for beneficiaries depending on income criteria.
Long-term care financial assistance calculations undergo revision; the asset exemption for home equity is capped at $1 million, affecting eligibility for those with higher-value properties, which may particularly resonate in high-cost markets such as California. The legislation also reshapes Medi-Cal access for non-citizens, including restrictions on full Medi-Cal enrollment for adults lacking eligible immigration status starting in 2026, altered dental coverage provisions, and a $30 monthly premium requirement from 2027 for undocumented adults 19 to 59. Emergency Medi-Cal coverage remains intact irrespective of immigration status.
Moreover, for individuals who do not qualify for Medicaid or fall above income thresholds, state-run insurance marketplaces like Covered California and Nevada Health Link continue to offer marketplace plans with available financial subsidies. However, the enhanced subsidies established during the COVID-19 public health emergency are expected to diminish after 2025, increasing cost-sharing for some consumers.
These changes collectively reflect a tightening of eligibility and an emphasis on work-related criteria and modified cost-sharing frameworks within state-managed Medicaid programs. Insurance professionals, policy administrators, and providers should anticipate operational adjustments due to increased renewal frequencies and administrative scrutiny. Meanwhile, health organizations such as Barton Health underscore their commitment to accessible, patient-centered care amid evolving coverage landscapes.