What's in the Big Beautiful Bill: 15 Sections impacting Medicaid
- Ask Medicaid Florida
- Jul 3, 2025
- 7 min read
Updated: Nov 9, 2025
How does the One Big Beautiful Bill Act effect Medicaid recipients? In this article I'll outline sections directly from the Bill. The purpose of this article is to educate Medicaid recipients across the country on potential policy changes and state requirements.
Subtitle D - Health
Part 1- Medicaid
Subpart A--Reducing Fraud and Improving Enrollment Processes
(Sec. 44103)
This section requires the Centers for Medicare & Medicaid Services (CMS) to establish a centralized system for states to check whether enrollees are simultaneously enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states.
Beginning no later than 2027, states must regularly obtain the addresses of Medicaid and CHIP enrollees from specified authorized sources. Beginning no later than FY2030, states must report on at least a monthly basis the Social Security numbers of enrollees to the CMS' newly established system. The CMS must notify states on at least a monthly basis of individuals who are enrolled in multiple states so that states may take appropriate action.
The section provides funds for FY2026 and FY2029 for the CMS to establish and maintain the new system, respectively.
(Sec. 44104)
This section requires state Medicaid programs to check, beginning in 2028, the Social Security Administration's Death Master File on at least a quarterly basis to determine whether Medicaid enrollees are deceased.
(Sec. 44105)
This section requires state Medicaid programs to check, beginning in 2028, as part of the provider enrollment and reenrollment process, whether providers were terminated from participating in the Medicare program, any other state Medicaid program, or CHIP using certain databases (e.g., the Data EXchange system). The section requires states to continue to check these databases on at least a monthly basis after providers are enrolled.
(Sec. 44106)
This section provides statutory authority for the requirement that state Medicaid programs check, as part of the provider enrollment and reenrollment process, whether providers are deceased through the Social Security Administration's Death Master File. Beginning in 2028, the section requires states to continue to check this database on at least a quarterly basis after providers are enrolled.
(Sec. 44108)
This section requires state Medicaid programs to redetermine every six months, beginning on December 31, 2026, the eligibility of individuals who are enrolled in Medicaid as part of the Medicaid expansion population under the Patient Protection and Affordable Care Act. (The act allows states to extend Medicaid coverage to all adults under the age of 65 with incomes of up to 138% of the federal poverty level, including able-bodied adults without dependent children.)
(Sec. 44111)
This section reduces by 10%, beginning in FY2028, the enhanced federal matching rate for the Medicaid expansion population in states that provide comprehensive health benefits or financial assistance for purchasing health benefits to individuals (other than children or pregnant women) who are not lawfully residing in the United States, regardless of the source of the benefits or financial assistance.
Subpart B--Preventing Wasteful Spending
(Sec. 44123)
This section provides funds through FY2033 for the CMS to survey retail and non-retail pharmacies (e.g., mail-order pharmacies) to determine average prices of covered outpatient drugs under Medicaid. Pharmacies that fail to participate in the surveys are subject to civil penalties.
The section additionally provides funds for FY2026 for the Office of the Inspector General of the Department of Health and Human Services (OIG) to study the results of the survey and report accordingly to Congress.
(Sec. 44124)
This section requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with pharmacy benefit managers (PBMs) under Medicaid.
(Sec. 44125)
This section prohibits federal payment under Medicaid or CHIP for specified gender transition procedures. The section defines these procedures to mean those that are intended to change the body of an individual to no longer correspond to the individual's biological sex (male or female), including specified surgeries, implants, and medications (e.g., hormones).
The section excludes procedures that are provided to an individual under the age of 18 with the consent of a parent or legal guardian and that are intended to (1) rectify early puberty, genetic disorders, or chromosomal abnormalities; (2) reverse prior gender transition procedures; or (3) prevent imminent death or impairment of a major bodily function.
(Sec. 44126)
This section prohibits federal Medicaid payment for 10 years to nonprofit health care providers that serve predominantly low-income, medically underserved individuals (i.e., essential community providers) if the provider (1) primarily furnishes family planning services, reproductive health, and related care; (2) offers abortions in cases other than that of rape, incest, or life-threatening conditions for the woman; and (3) in FY2024, received federal and state Medicaid payments totaling more than $1 million.
Subpart C--Stopping Abusive Financing Practices
(Sec. 44131)
This section requires states that had not chosen to expand Medicaid pursuant to the Patient Protection and Affordable Care Act prior to March 11, 2021, to do so by January 1, 2026, in order to receive the corresponding enhanced federal matching rate.
(Sec. 44132)
This section generally precludes states from instituting new or otherwise increasing Medicaid provider taxes. Specifically, the section precludes the revenue from any Medicaid provider tax that is newly imposed or increased by a state from qualifying for federal matching payments.
(Sec. 44133)
This section provides funds through FY2033 for the CMS to revise regulations so as to limit state-directed payments for inpatient hospital services, outpatient hospital services, nursing facility services, or qualified practitioner services at an academic medical center under Medicaid managed care contracts to the payment rate for services under Medicare, rather than the average commercial rate. For states that cover the Medicaid expansion population, payment is limited to 100% of the Medicare rate; for other states, payment is limited to 110% of the Medicare rate.
Subpart D--Increasing Personal Accountability
(Sec. 44141)
This section requires, beginning not later than December 31, 2026 (or earlier, at the option of the state), individuals who are eligible for Medicaid as part of the Medicaid expansion population to engage in community service, work, or other activities in order to qualify for Medicaid.
Specifically, the section requires these individuals to, on a monthly basis, (1) work at least 80 hours, (2) complete at least 80 hours of community service, (3) participate in a work program for at least 80 hours, (4) be enrolled at least half-time in an educational program, or (5) engage in any combination thereof for a total of at least 80 hours. Individuals may also qualify if they have a monthly income that is at least as much as the equivalent of minimum wage multiplied by 80 hours.
Individuals who are applying for Medicaid must demonstrate compliance with these requirements for one month or more (as determined by the state) consecutively and immediately prior to filing an application; individuals who are already enrolled in Medicaid must demonstrate compliance for one month or more (as determined by the state), whether or not consecutive, during the period between the individual’s last eligibility determination and the next scheduled eligibility determination.
States must verify an individual’s compliance upon a determination or redetermination of eligibility but may also choose to verify compliance more frequently. States may not waive the new requirements. However, states may choose to provide an exception for individuals experiencing short-term hardships (e.g., hospitalization).
The section excludes certain individuals from these requirements, including those with serious medical conditions or dependent children.
The section provides funds for FY2026 for states and the CMS to implement these requirements.
(Sec. 44142)
This section requires, beginning in FY2029, states to institute cost-sharing requirements for individuals who are eligible for Medicaid as part of the Medicaid expansion population and whose family income exceeds the federal poverty line. Cost sharing may not exceed $35 for an item or service; total cost sharing for all individuals in a family may not exceed 5% of the family’s income.
The requirements do not apply to services for which cost sharing is already prohibited (e.g., emergency services) or to primary care, mental health, or substance use disorder services. States may allow providers to condition the provision of services upon the payment of any required cost sharing.
Conclusion
President Trump’s “One Big Beautiful Bill Act” (OBBBA) represents a sweeping fusion of permanent tax cuts and aggressive spending reductions. While its supporters tout enhanced take‑home pay, business incentives, and bolstered defense and border security, opponents warn of devastating impacts on social-safety programs—potentially stripping healthcare and food aid from millions—and deepening the national debt by trillions. As the bill faces final congressional scrutiny, its passage signals a pivotal test for the GOP: whether the economic benefits to some outweigh the hardships imposed on many, and whether the public’s judgment will redefine the future of Trump’s legacy.
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As a Florida Medicaid recipient, the Big Beautiful Bill gives me hope for better coverage and access. It could simplify paperwork, expand benefits, and help families like mine get essential care without constant stress. I just hope it’s implemented fairly and actually reaches the people who need it most.