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.
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.
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.
On July 1, the Senate passed Republicans’ budget reconciliation bill, H.R.1. Using its Medicaid Financing model, Manatt Health has prepared updated estimates on the Senate-passed bill, including state-by-state estimates of Medicaid coverage and expenditure impacts, hospital expenditure impacts, and new Congressional District-level coverage and hospital expenditure impacts.
On June 27, the Senate Budget Committee (SBC) released its version of the One Big Beautiful Bill Act (OBBBA) and on Saturday, June 28, the Senate approved a motion to proceed with debate over the Senate bill language. The Senate version of the OBBBA, which may still undergo further revisions through the amendment process, is expected to come up for a final vote in the Senate as early as Monday, June 30. Using its Medicaid Financing model, Manatt Health (Manatt) has prepared new state-by-state estimates [including the District of Columbia (D.C.) and excluding Tennessee due to data limitations] on the impact of the Medicaid provisions included in the Senate version of the OBBBA.
On June 16, the Senate Finance Committee (SFC) released its budget reconciliation legislation. Several new policies in the SFC bill language would yield deeper Medicaid cuts than House-passed legislation, H.R.1, the One Big Beautiful Bill Act. Using its Medicaid Financing model, Manatt Health has prepared estimates on the impact of the Medicaid provisions included in SFC budget reconciliation legislative language.
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.
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.
On Thursday, May 22, the U.S. House of Representatives passed its reconciliation legislation, the “One Big Beautiful Bill Act.” If enacted in its current form, the bill would significantly increase rates of uninsurance for immigrants—including many non-citizens who are lawfully present in the country. This expert perspective analyzes the combined impact of the bill’s provisions on non-citizen coverage across the Marketplace and Medicaid.
On Thursday, May 22, the House passed its “One Big Beautiful Bill Act” through the budget reconciliation process. As the Senate moves to take up the legislation, Manatt Health—with support and input from State Health and Value Strategies—has updated its toolkit for states, estimating the state-by-state impact over the next 10 years of most of the major provisions in the bill. The estimates take into account the interactions across the provisions included in the Manatt model.
On Thursday, May 29, State Health and Value Strategies hosted the second in a two-part webinar series. During the webinar, experts reviewed proposed changes to policies governing the Affordable Care Act Marketplace and what they might mean for health insurance Marketplace and Division of Insurance officials.
On Thursday, May 22, State Health and Value Strategies hosted the first in a two-part webinar series. During the webinar, experts from Manatt Health reviewed changes proposed in the House reconciliation bill to Medicaid eligibility, payment and financing, and coverage.
On May 14, the House Energy and Commerce Committee (E&C) voted to advance its legislative proposals to meet the budget reconciliation instructions. The committee’s proposals largely target cuts at the Medicaid expansion group created by the Affordable Care Act, including by establishing a state mandate to impose a work requirement on this population. This expert perspective provides an analysis of the E&C proposal to establish work requirements for Medicaid expansion and certain other low-income adults.
The budget reconciliation process is continuing to move forward in Congress and includes developing proposals in the House to identify $880 billion in federal savings over the next ten years, the vast majority of which will need to come from Medicaid. To support states in informing and validating their own fiscal and program impact estimates of federal policy changes, Manatt Health has developed, with support and input from State Health and Value Strategies, a new toolkit providing national and state-by-state data on the potential impact of key cuts under consideration in Congress. This expert perspective provides an executive summary of the toolkit and has been updated to include estimates of state-by-state impacts of making work requirements a condition of Medicaid eligibility.
Congress is considering significant cuts to Medicaid as part of the legislative process—called “budget reconciliation”—being used to advance President Trump’s key legislative priorities. To support states in informing and validating their own fiscal and program impact estimates of federal policy changes, Manatt Health has developed, with support and input from State Health and Value Strategies, a new toolkit providing national and state-by-state data on the potential impact of key cuts under consideration in Congress. The toolkit is designed to help state officials prepare or review their own estimates and to offer estimates to states not undertaking their own analyses.
On Thursday, May 1, State Health and Value Strategies hosted a webinar to discuss significant cuts to Medicaid under consideration by Congress as part of the budget reconciliation process. Manatt Health has developed, with support and input from SHVS, a new toolkit providing national and state-by-state modeling on the potential impacts of proposals. Key proposals discussed include those to reduce the federal medical assistance percentage rate, establish a per-capita cap financial approach for enrolled Medicaid populations, and make work reporting requirements a condition of Medicaid eligibility. During the webinar, experts from Manatt Health reviewed the new toolkit, including proposal-specific modeling data sources and assumptions, and national and state model findings.
A range of policy proposals to cut federal Medicaid funding under consideration by Congress could profoundly reshape the Medicaid program. Although the specific details of these proposals have not yet been defined, many entities are actively analyzing the possible effects on state Medicaid enrollment and spending. This expert perspective highlights the national 50-state analyses of Medicaid cuts that have been released. SHVS will continue to regularly monitor published estimates and update this expert perspective.
On Wednesday, February 26, State Health and Value Strategies hosted a webinar discussing the Medicaid and Marketplace reforms under consideration by the new administration and the 119th Congress, including adjustments to program financing, eligibility, and other policy requirements, with potential broad implications for state Medicaid and Marketplace programs. During the webinar, experts from Manatt Health provided an overview of potential federal policy changes to Medicaid and Marketplace coverage programs, vehicles for advancing and anticipated timing of such changes, and implications for states.