There has been a lot of confusion about how last year’s Congressional budget bill, coined the One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, will affect Medicaid this year (see The 2025 Federal Budget Reconciliation Bill (House Resolution 1 – One Big Beautiful Bill Act)). And for good reason, there are 12 very significant provisions in the bill affecting Medicaid—each with a different impact on Medicaid policy, regulations, and funding.

A recent analysis—State-Level Impacts Of Key Medicaid Provisions In The One Big Beautiful Bill Act—projected the likely impact on the field. At the macroeconomic level, state Medicaid budgets are expected to be cut by $664 billion over the 2025–2034 period—this is approximately…