CounterPunch Exclusives

CounterPunch Exclusives

States Face Massive Medicaid Issues Thanks to the One Big Beautiful Bill Act

The changes to Medicaid outlined in Trump’s One Big Beautiful Bill Act (OBBBA) are still coming into view – and so are the policy adjustments that states can make to maintain enrollment.

The Congressional Budget Office (CBO) estimates that the federal government will save $911 billion over 10 years from enacting these changes to Medicaid and that 10 million people will lose health insurance as a result.

As I wrote last week, the OBBBA requires able-bodied Medicaid beneficiaries with incomes currently above the poverty line but under different thresholds by family size — $22,025 for an individual or $45,360 for a family of four — to navigate a maze of red tape and reporting requirements twice a year to remain enrolled. Disabled people on Medicaid will have to provide documentation that they are too disabled to work in order to waive the work requirement and remain on Medicaid. These reporting requirements are expected to remove people who meet Medicaid’s eligibility requirements from the Medicaid rolls.

States can hire navigators (as they did for the Affordable Care Act exchanges) to help able-bodied people navigate the work reporting requirements. They can assist those who are disabled and unable to work in gathering and providing documentation that they are medically fragile and thus not required to meet the work requirements. Navigators also educate the community about changes in Medicaid and other safety net programs that affect them and help with obtaining these benefits.

The advantages to states are clear. When states spend money on Medicaid, the federal government must reimburse the state by providing its share of matching funds. Medicaid is the largest overall source of federal funding for nearly all states. As eligible people lose Medicaid because they have difficulty meeting administrative requirements, this will reduce federal spending on the program, creating pressure on state budgets. If navigators assist eligible people and keep them from being dropped, the federal government will have to pay its share of health care costs for these individuals and the holes in the budgets of states and hospitals/providers that treat Medicaid patients will be much smaller.

There is already evidence of policy movements in this direction. Crain’s New........

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