The federal policy changes included in the budget reconciliation bill, as well as the recently finalized 2025 Marketplace Integrity and Affordability Rule, will significantly impact many essential State-Based Marketplace (SBM) functions and result in significant coverage losses. As the federal policy bills were being considered, SHADAC tracked states’ estimates of the impacts of the federal policy changes and the expiration of the enhanced premium tax credits on SBM consumers. The estimates collected in this expert perspective illustrate how states worked to assess the likely effects of major federal changes to their SBMs.

The budget reconciliation bill (H.R. 1), signed into law on July 4, 2025, includes major overhauls to the Medicaid program. As the federal budget bills were being considered, many individual state agencies publicly released their own estimates seeking to quantify the potential impacts of federal policy changes on their respective state Medicaid programs. This expert perspective compiles those estimates which reflect an important snapshot in time, highlighting how states sought to understand the potential impact of sweeping federal Medicaid reforms.

July 9, 2025 marks the effective date of new federal requirements that states engage people with lived experience of the Medicaid program through the creation of Beneficiary Advisory Councils (BACs). This expert perspective highlights examples of how states have been preparing for implementation of BACs—including raising awareness about the BAC, recruiting and selecting members, and establishing policies for their meetings.

State updates as of July 11, 2025.

State updates as of July 3, 2025.

State updates as of June 27, 2025.

The mandatory federal work requirement proposal for the adult expansion population in the federal budget reconciliation bill includes an exemption for people with disabilities. However, the work requirement proposal relies on the Supplemental Security Income (also known as SSI) definition of disability. This expert perspective offers an analysis of 2023 American Community Survey data to illustrate that this narrow definition of disability excludes many Medicaid enrollees who self-report having a disability. The disconnect between how enrollees experience disability and how it is formally defined, suggests that many individuals with self-reported disabilities would not be exempt from the work requirement proposal. 

State updates as of June 20, 2025.

On June 16, the Senate Finance Committee released its budget reconciliation legislation. Overall, the Senate bill’s health policy provisions hue closely to and build on the policies included in the House-passed budget reconciliation bill—H.R. 1, the “One Big Beautiful Bill Act”—with changes that make even deeper Medicaid cuts. This expert perspective summarizes the healthcare provisions in the legislation.

To mitigate duplicate Medicaid enrollment and payment, Medicaid statute and regulation require states to conduct data matching through the Public Assistance Reporting Information System (PARIS). This expert perspective lays out the current challenges with using PARIS data matching and provides recommendations on how to improve identification of concurrent Medicaid enrollment.