H.R.1 Resources for States

On July 4, 2025, the federal budget reconciliation bill, H.R.1, was signed into law, enacting major structural reforms to Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act Marketplaces. These changes, including a $911 billion reduction in federal Medicaid spending over the next 10 years, significantly reshape the operational and financial landscape of the health coverage system, with far-reaching implications for program enrollment, expenditures, and administration, immediately and in the years ahead. SHVS has created this resource page as a centralized, accessible hub of information to support states with implementation of H.R.1.

Communications & Outreach

Resources to support states as they communicate to help enrollees maintain coverage and access care.

Marketplace Provisions

H.R.1 and federal regulations will significantly reshape Affordable Care Act Marketplace programs and affordability. These resources support states with implementation.

Medicaid Work Reporting Requirements

H.R.1 establishes work reporting requirements as a new condition of Medicaid eligibility. These resources are designed to support state planning and implementation with the goal of preserving coverage for eligible individuals.

Non-Citizen Coverage Eligibility Changes

H.R.1 is estimated to leave 1.3 million more immigrants uninsured. These resources describe the changes to eligibility for Medicaid and Marketplace programs for non-citizens.

Reporting & Evaluation

These resources support states in documenting how the policy changes in H.R.1 impact affordability, access, and coverage stability in their states.

Rural Health Transformation Program

H.R.1 includes $50 billion for a Rural Health Transformation Program (RHTP). These resources include tracking of state activity related to RHTP.

Overview of the Budget Reconciliation Law & Modeling

Leading up to the passage of H.R.1, SHVS published estimates produced by Manatt Health using its Medicaid Financing model of the various iterations of committee and bill language.