On July 3, the U.S. House of Representatives enacted the president’s massive tax cuts and federal cost-cutting bill known as the One Big Beautiful Bill, and the president signed it into law on July 4.  The following are some of the health care changes included in that legislation.

Cost Sharing: Requires states to impose cost sharing on the expansion population of up to 35 dollars per service. (Mississippi is not an expansion state.)

Redeterminations: Starting in 2027, states must conduct Medicaid eligibility redeterminations every six months for the expansion population, rather than annually under prior law. The Secretary must issue guidance within 180 days of enactment.

Community Engagement/Reporting Requirements: Starting January 1, 2027, states will be required to implement work requirements for beneficiaries aged 19-64. Medicaid eligibility for applicable beneficiaries will be conditioned on completing 80 hours of community engagement per month. Beneficiaries are exempt if they are pregnant, disabled or medically frail, and/or have a dependent aged 13 years or younger.

Retroactive Coverage: Retroactive coverage will be reduced from 90 days to 30 days for the expansion population and 60 days for the non-expansion population. (Medicaid eligibility for nursing home care will be limited to 60 days prior to the month of application.)

Coverage for Immigrants: On October 1, 2026, Medicaid and CHIP funding will no longer cover medical assistance provided to individuals unless they are U.S. citizens, lawful permanent residents, Cuban/Haitian, or lawful residents under a Compact of Free Association, and a resident of a U.S. state, D.C., or territory.

: The federal Health & Human Services agency is prohibited from implementing this rule that was implemented during the Biden administration to require certain minimum staffing in nursing homes.

Home Equity Limits for Long Term Care: Changes the maximum home equity limit to 1 million dollars. (This is the value of a home that will not count as a resource for Medicaid nursing home eligibility.)

Rural Health Transformation Program: Establishes a 50 billion dollar rural health fund for states (to help rural hospitals in trouble).

Affordable Care Act Enrollment Verification: The first month of coverage begins once the plan confirms the enrollee’s income, immigration status, insurance eligibility, address, family size, and other required information.

ACA Premium Tax Credits: Only US Citizens, lawful permanent residents, certain Cuban immigrants and Citizens of the Federated States of Micronesia lawfully residing in the US are eligible for premium tax credits. Premium tax credits cannot be used to assist lawfully present migrants who have incomes at or below 100 percent of the federal poverty level.

ABLE Accounts: Extends increased contribution limit, enhanced savers credit, and qualified tuition program rollovers for ABLE account contributions.

Source: Healthsperien