Here Are the Big Medicaid Changes Coming Under HR-1
5 min read
Medicaid, the nation's largest health insurance program covering over 80 million Americans, faces significant changes under the newly passed One Big Beautiful Bill Act (HR-1). These modifications will affect everything from how often you need to renew your coverage to how much you'll pay for doctor visits.
The changes primarily make Medicaid coverage less stable and more expensive to maintain, with more frequent eligibility checks, new work requirements, and co-payments for services that used to be free. For millions of low-income Americans, seniors, and people with disabilities who rely on Medicaid, these changes could mean greater risk of losing coverage and paying more for care.
Here's what every Medicaid recipient needs to know about the changes taking effect over the next few years.
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1. You'll Need to Prove You're Eligible More Often
The most significant change affects how often you'll need to prove your eligibility for Medicaid. The One Big Beautiful Bill Act requires that, starting at the end of 2026, states must check eligibility for Medicaid expansion population enrollees every six months instead of the current annual review.
This change dramatically increases the risk of losing coverage because:
More opportunities for administrative errors: twice as many renewal periods mean twice as many chances for paperwork problems
Income fluctuations become problematic: temporary income spikes that might average out over a year could now trigger coverage loss
Increased paperwork burden: you'll need to submit documentation and respond to renewal notices twice as often
Shorter response times: missing a renewal deadline means losing coverage more quickly
Also, states must now check the Death Master File quarterly and promptly disenroll deceased individuals. While this reduces improper payments, it also increases administrative oversight and the potential for errors affecting living beneficiaries who may be mistakenly flagged.
2. Many Adults Will Need to Work to Keep Coverage
One of the biggest changes introduces work requirements for many Medicaid recipients. Starting in 2025, childless adults and parents of children older than 13 must work, volunteer, or attend school for 80 hours a month to keep their Medicaid coverage.
Who this affects:
Adults without children
Parents whose youngest child is 14 or older
People between jobs or working part-time
Exemptions include:
People with disabilities
Pregnant women
Parents of children 13 and under
Full-time students
People in substance abuse treatment
What this means: If you don't meet the 80-hour monthly work requirement and don't qualify for an exemption, you could lose your Medicaid coverage entirely. States like Alaska and Hawaii can apply for waivers to bypass these requirements.
3. You'll Start Paying Co-Payments for Medical Services
For the first time, many Medicaid recipients will have to pay co-payments when they visit the doctor or get medical services. States will be required to charge co-payments of up to $35 for medical services that used to be completely free.
What this covers:
Doctor visits
Specialist appointments
Some medical procedures
Other healthcare services (specifics vary by state)
Impact on your budget: While $35 might not sound like much, these costs can add up quickly if you have ongoing health conditions that require regular care. For families already struggling financially, these new costs could force difficult choices about seeking medical care.
4. Home Value Limits Are Frozen, Affecting Long-Term Care
HR-1 makes it harder for families to get help paying for long-term care by freezing limits on home value at $1 million. Right now, families can qualify for Medicaid to help cover nursing home or other long-term care costs if their home is worth between $730,000 and $1,097,000 (as of 2025), and these limits go up each year as home prices rise.
Under the new rules, that limit stays stuck at $1 million forever, no matter how much home prices increase. This means that over time, more and more middle-class families will be shut out of getting help.
A home that costs $1 million today might be pretty average in 10 or 15 years because of inflation, but families living in those homes still won't qualify for Medicaid assistance. They'll have to use up their savings or sell their house to pay for care that Medicaid used to help cover.
5. Coverage Restrictions for Immigrants
The law restricts Medicaid eligibility for immigrants, limiting coverage to green card holders and certain other specific categories rather than all people who are "lawfully present" in the U.S. This means a lot of benefits for immigrants could soon disappear; particularly, some immigrants who currently have Medicaid coverage may lose it.
The law also reduces how much the federal government pays for emergency medical care for undocumented immigrants, which could affect the availability of emergency services in some communities.
6. Retroactive Coverage Gets Cut
Currently, if you qualify for Medicaid, the program can cover medical bills you incurred up to three months before you applied. HR-1 cuts this to just one month, meaning you'll have less protection for medical expenses that happened before you got enrolled.
7. Nursing Home Care Improvements Delayed
In a significant setback for nursing home residents, HR-1 blocks implementation of new minimum staffing requirements until 2035. The Centers for Medicare & Medicaid Services had implemented these rules in 2024 to address chronic understaffing in nursing homes, but the new law delays these improvements by more than a decade.
What this means:
Nursing homes can continue operating with current staffing levels
Quality of care improvements are delayed
Residents may face continued risks associated with understaffing
Family members should continue advocating for adequate care
8. States Lose Flexibility in Funding Programs
States lose important flexibility in how they fund their Medicaid programs. The law introduces new restrictions on provider taxes, which states have used to help fund their Medicaid programs and draw down federal matching funds.
Impact: Reduced state flexibility may lead to:
Program cuts to stay within budget
Reduced provider payments (which could mean fewer doctors accept Medicaid)
Fewer optional services
Longer wait times for care
Changes to waivers: Medicaid waivers, which allow states to modify their programs to serve specific populations better, now face new restrictions. This makes it much harder for states to get approval for innovative programs that might provide better care.
9. Planned Parenthood Funding Blocked
For one year, Planned Parenthood and similar organizations will be prevented from receiving Medicaid payments, which could affect access to reproductive health services for Medicaid recipients.
What These Changes Mean for You
How these changes affect you depends entirely on your particular situation.
If You Have Medicaid Expansion Coverage
Starting in late 2026, you'll need to renew your Medicaid coverage every six months instead of annually. This means:
More frequent paperwork: You'll receive renewal notices twice as often and need to respond promptly to maintain coverage
Higher risk of coverage gaps: Missing a renewal deadline or having incomplete paperwork could result in losing coverage more quickly
Income reporting becomes critical: Temporary income increases that might not affect annual eligibility could now trigger coverage loss during six-month reviews
If You're Subject to Work Requirements
If you're a childless adult or parent of children 14 and older, you'll need to:
Track your work hours: Keep detailed records of work, volunteer, or school hours
Report changes quickly: Notify your state Medicaid office if your work situation changes
Understand exemptions: Know if you qualify for any exemptions from the work requirements
Have a backup plan: Understand what happens if you temporarily can't meet the requirements
If You Need Regular Medical Care
With new co-payments, you'll need to:
Budget for medical costs: Plan for up to $35 in co-payments for medical visits
Consider the total cost: Multiple appointments could mean significant out-of-pocket expenses
Understand your state's rules: Different states may implement co-payments differently
If You Need Long-Term Care
The frozen home equity cap may affect your family's long-term care planning:
Current seniors: If you're already receiving long-term care services, this change doesn't immediately affect you
Future planning: Families planning for long-term care should consider that the $1 million home equity limit will become more restrictive over time as property values rise
Estate planning: Consider consulting with an elder law attorney to understand how these changes might affect your long-term care options
What You Should Do Now
Update Your Information Immediately
Contact your state Medicaid office to ensure they have your current:
Address and phone number
Email address (if you have one)
Income information
Household composition
Work status and hours
Prepare for More Frequent Renewals
Set up reminders: Mark your calendar for renewal periods and set up reminders to watch for renewal notices
Keep documents ready: Maintain organized files with proof of income, residence, work hours, and other eligibility documents
Respond quickly: Don't wait until the last minute to complete renewal paperwork
Understand Your Coverage Type
Determine if you're in the Medicaid expansion population that will face six-month renewals:
Adults aged 19-64 with incomes up to 138% of the federal poverty level
Adults who gained coverage through ACA Medicaid expansion
Check with your state Medicaid office if you're unsure
Plan for New Costs
Budget for co-payments: Set aside money for potential $35 co-payments for medical services
Prioritize care: Understand which services are most important if budget becomes tight
Know your options: Ask providers about payment plans or sliding scale fees if available
Plan for Potential Coverage Gaps
Know your options: Understand what happens if you lose Medicaid coverage temporarily and how to reapply
Consider marketplace plans: Familiarize yourself with healthcare marketplace options in case you need temporary coverage
Maintain provider relationships: Keep in touch with your healthcare providers about potential coverage changes
Timeline of Changes
2025: Work requirements, co-payments, immigration restrictions, and most administrative changes take effect
December 31, 2026: Six-month eligibility reviews begin for Medicaid expansion populations
2035: Nursing home staffing requirements finally take effect (delayed from 2024)
Getting Help
As these changes roll out, contact your state Medicaid office if you have questions about:
Your renewal schedule and requirements
Work requirement exemptions
Required documentation for eligibility reviews
Appeal processes if coverage is denied
Long-term care planning and asset limits
Many states also have Medicaid advocacy organizations that can provide assistance with renewals, appeals, and understanding the new requirements.
State-by-State Variations
Remember that Medicaid is administered by states, so implementation of these changes may vary:
Some states may implement changes more quickly than others
States may have different procedures for renewals, work requirements, and appeals
Your state's Medicaid website will have specific information about how these changes affect your coverage
States like Alaska and Hawaii have received special consideration for certain requirements
The Bottom Line
The changes to Medicaid under HR-1 represent a significant shift toward less stable, more expensive coverage with reduced state flexibility. While the law aims to reduce program costs and improve oversight, it will make healthcare coverage less secure and more costly for millions of Americans. Understanding these changes and preparing accordingly will be crucial for maintaining access to this vital healthcare program.
The key is staying informed, keeping your information updated, and being proactive about meeting new requirements. Don't wait until the last minute to understand how these changes affect your specific situation.