Budget Reconciliation Implementation Roadmap

Manatt Health

Since early 2025, the new administration and Congress have moved swiftly to advance a series of legislative, regulatory, and executive actions aimed at fundamentally restructuring the Medicaid and Affordable Care Act Marketplace programs. Central to these efforts is budget reconciliation legislation (H.R.1), which was signed into law by the President on July 4, 2025, and makes sweeping changes to Medicaid and the Marketplaces that are projected by the Congressional Budget Office to lead to over $1 trillion in federal funding cuts and 10 million more individuals without health insurance over the next 10 years.

This Excel tool provides an integrated view of implementation dates for Medicaid, the Children’s Health Insurance Program, Marketplace, and Medicare provisions in H.R.1. Because of interdependencies with the budget reconciliation provisions, policies in the Marketplace Integrity and Affordability final rule of June 25, 2025, are also included in this timeline. This tool is intended to support states in (1) planning for timely implementation of reconciliation-driven health policy changes, and (2) effectively communicating potential impacts to communities and key stakeholders.

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