House Passes Bill Proposing Key Medicaid and SNAP Changes

The House of Representatives narrowly passed the "Big Beautiful Bill Act" (H.R. 1) with a 215-214 vote. This reconciliation bill proposes significant changes to Medicaid, the Affordable Care Act, food nutrition programs, and the national debt limit. Although it is unlikely the Senate will pass the bill, its provisions have notable implications for state health programs and funding structures if enacted.

Key Medicaid-related changes include a mandate for states to implement work requirements by December 31, 2026, obliging able-bodied adults aged 19-64 to engage in work or qualifying community activities for at least 80 hours a month. Exemptions would apply for certain groups, such as pregnant women, individuals with serious medical conditions, and tribal members. These requirements could lead to cost savings mainly through administrative processes that potentially reduce Medicaid enrollment.

The bill also seeks to adjust Medicaid expansion financing by lowering the federal match rate from 90% to 80% for states providing financial assistance to undocumented immigrants, excluding children and pregnant women. Additionally, states would be required to conduct Medicaid eligibility determinations more frequently—every six months for expansion populations.

Restrictions on state provider taxes are also included, prohibiting new provider taxes and freezing existing ones at current rates. This could affect state funding mechanisms, particularly in states like Arizona where hospital assessments contribute significant matching funds for Medicaid coverage.

The legislation incorporates provisions impacting reproductive health funding by barring federal funds to specific abortion providers. Meanwhile, Supplemental Nutrition Assistance Program rules are tightened with work requirements for able-bodied adults without dependents and the introduction of state cost-sharing responsibilities that escalate based on error rates. This poses potential financial impacts on state budgets, exemplified by anticipated effects on Arizona's general fund starting in 2028.

Overall, while the bill faces uncertainty in the Senate, its multifaceted changes highlight evolving federal-state dynamics in Medicaid and nutrition assistance programs, signaling potential compliance, funding, and operational shifts for state health agencies and providers.