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 produced the following resources to support states as they communicate to help enrollees maintain coverage and access care.
H.R.1 makes significant changes to how individuals enroll and stay enrolled in the Affordable Care Act Marketplaces, with two of those changes taking effect for plan year (PY) 2028—the end of both auto-reenrollment and advanced premium tax credits during pending verification. In advance of these changes, State-Based Marketplaces (SBMs) can leverage the upcoming open enrollment period beginning in fall 2026 to build capacity, test approaches, and identify what works before the stakes rise for PY 2028, to help ensure eligible enrollees remain covered without disruptions to care. This expert perspective highlights preparatory actions that SBMs can take, including operational and communications pilots.
On Thursday, February 19, State Health and Value Strategies hosted a webinar on communicating the new work reporting requirements under H.R.1. A robust communications and outreach strategy can help states protect coverage for eligible enrollees and support broader operations as they roll out these new requirements. During the webinar, experts from GMMB provided an overview of key H.R.1 provisions related to communications and walked through a communications workplan to support outreach on the new reporting requirements. Experts from Health Equity Solutions also shared recommendations from the toolkit Engaging Enrollees in Medicaid Work Reporting Requirements Implementation and highlighted ways states can involve people enrolled in Medicaid in communications planning and message development.
Work reporting requirements marks a major shift in how Medicaid operates and how consumers access and maintain their coverage. This workplan is designed for state Medicaid and health and human services communications staff responsible for planning and executing outreach related to new work reporting requirements. States can use it to inform the creation of communications efforts or to cross-reference existing plans, ensuring key tactics are considered, gaps are identified, and strategies are aligned around maintaining coverage for eligible people enrolled in Medicaid.
Managed care plans (MCPs) are well-positioned to support state Medicaid agencies as they develop their policy, operational and information technology (IT) system plans to implement federally mandated work reporting requirements. While MCPs cannot make determinations of work reporting compliance or exemptions under H.R.1, they can provide states with data analysis, evidence, and recommendations which states can use to make determinations. This expert perspective describes MCP partnership strategies to support the implementation of work reporting requirements to promote continuity of coverage and minimize procedural disenrollment risks.
As the open enrollment period for plan year 2026 approaches, health insurance Marketplaces face a rapidly shifting policy environment. These changes will influence the way Marketplaces engage with enrollees, community partners, and stakeholders. This toolkit is designed to help State-Based Marketplaces maintain trust with enrollees and stakeholders; communicate clearly and effectively; prepare enrollees for upcoming changes; and help enrollees maintain coverage and access care. The toolkit includes content that states can customize to reflect their voice and policy context.
On Thursday, July 10, State Health and Value Strategies hosted a webinar for State-Based Marketplace and Division of Insurance officials. On July 4, the president signed the reconciliation budget bill into law, starting the clock on a number of changes to Marketplace coverage and premium tax credit eligibility. Just two weeks earlier, the Centers for Medicare & Medicaid Services finalized its Program Integrity rule that also creates new requirements for Marketplaces. During the webinar, SHVS’ experts discussed the immediate changes that states are facing and what steps to take in the coming days and weeks.