Medicaid – Cuts & Changes – The Big Ugly Bill – Part I

Part I of a series on all the cuts and changes to Medicaid. Share with everyone. This is what Congress did to all of us - ALL OF US!

The Medicaid Changes and cuts were enacted on July 4, 2025. There are many different roll out dates for different parts of these changes. The real impacts will not really be felt by anyone until after the Midterms in 2026 in the hopes that the “R’s” will get re-elected before anyone finds out exactly what they did. Well, I am here to tell you what they did and when each part of it is going to begin.

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The Medicaid portion of the budget takes up more than 100 pages, so in order to cover it all without causing your brain to overload, I will be preparing the information in a multi-part series. Part I covers what is NOT going to be implemented and enforced, the Federal government’s requirement to collect social security and address data from all 50 States and DC, eligibility requirements, and redetermination requirements. There is a lot of information here and I have listed all the referenced documents in the Research section at the end.

Medicaid – By State – What is it called?

I want to start by giving everyone a list of the names of the Medicaid programs in each State so that you understand if you are actually receiving your health care through your State Medicaid program.

https://www.axios.com/2025/07/08/medicaid-cuts-states

Overview

“Though beneficiaries will get warnings ahead of time, able-bodied recipients ages 19 to 64 wouldn't actually be dropped from program rolls for failure to meet or properly report the required 80 hours a month until after November 2026.”

“The bill also increases the frequency of Medicaid eligibility checks to every six months, starting on [the first quarter after] Dec. 31, 2026. People in the Medicaid expansion population who retain coverage under the new system could have to pay up to $35 in cost-sharing per service starting in October 2028.” https://www.axios.com/2025/07/07/medicaid-impacts-tax-bill-delayed

Beginning in 2028, the matching funds that go to States to help pay for their Medicaid programs will drop significantly at which time States will have to make decisions on how to administer their form of Medicaid to people in need in their States or drop people off the program.

The Affordable Care Act (Obamacare) may not be an option if you cannot get Medicaid as the premiums subsidies expire at the end of 2025 and this MAGA infested Congress has no plan to extend them to continue to help anyone. They hate Obamacare and have been trying to get rid of it since 2010 when it was enacted. Over 44 million people are enrolled in the ACA (Obamacare). I am one of them; at least until I reach the age of 65 when Medicare, also on the chopping block, takes over. When the subsidies expire…

“Obamacare premiums would increase by more than 75% on average for enrollees next year without the enhanced subsidies.”

“Medicaid funding of Planned Parenthood will also be cut off for next year under the bill — a change the family planning organization said could result in the closure of nearly 200 clinics.” (Note that this is currently in the Courts and a temporary restraining order has been placed on the cutting of funding to Planned Parenthood. More to come on this case as it works its way through the judicial system).

“Restrictions on which lawfully residing immigrants can access Medicaid will go into effect on Oct. 1, 2026, just before the primaries.” https://www.axios.com/2025/07/07/medicaid-impacts-tax-bill-delayed

The Good News!

Remember that nothing is permanent. Legislation can be altered or repealed. So while they cut Medicaid benefits, a change in administration could restore these sections at any time. Keep pounding on Congress at your displeasure at what they have done and how it will impact you or someone in your family, or even someone you may know.

In order to make these posts a little less confusing, I will cover what is going to be changed, cut, or implemented by date in each section.

2025! – What’s Happening This Year

The Law that was signed cutting Medicaid was enacted on July 4, 2025.

Premium subsidies for Obamacare will expire on December 31, 2025.

Beginning immediately, the following sections of the “Medicaid Programs: Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” (89 Fed. Reg. 22780) title 42, Code of Federal Regulations will be paused until October 1, 2034.

(1) Part 431.--

(A) Section 431.213(d).

“(d) The beneficiary's whereabouts are unknown, and the post office returns mail directed to him indicating no forwarding address (see § 435.919(f)(4) of this chapter for procedures if the beneficiary's whereabouts become known);”

(2) Part 435.--

(A) Section 435.222.

“Optional eligibility for reasonable classifications of individuals under age 21 with income below a MAGI-equivalent standard in specified eligibility categories.”

(B) Section 435.407.

“(7) Verification with a State vital statistics agency documenting a record of birth. (8) A data match with the Department of Homeland Security (DHS) Systematic Alien Verification for Entitlements (SAVE) Program or any other process established by DHS to verify that an individual is a citizen.”

(C) Section 435.907.

“(4) Any MAGI-exempt applications and supplemental forms must be accepted through all modalities described at paragraph (a) of this section.

(d) Requesting information from applicants. (1) If the agency needs to request additional information from the applicant to determine and verify eligibility in accordance with § 435.911, the agency must—

(i) Provide applicants with a reasonable period of time of no less than 15 calendar days, measured from the date the agency sends the request, to respond and provide any necessary information;

(ii) Allow applicants to provide requested information through any of the modes of submission specified in paragraph (a) of this section; and

(iii) If the applicant subsequently submits the additional information within 90 calendar days after the date of denial, or a longer period elected by the agency, treat the additional information as a new application and reconsider eligibility in accordance with the application time standards at § 435.912(c)(3) without requiring a new application; and

(2) The agency may not require an in-person interview as part of the application process.”

(D) Section 435.911(c).

“Determination of eligibility.

(c) For each individual who has submitted an application described in § 435.907, whose eligibility is being renewed in accordance with § 435.916, or whose eligibility is being redetermined in accordance with § 435.919 and who meets the non-financial requirements for eligibility (or for whom the agency is providing a reasonable opportunity to verify citizenship or immigration status in accordance with § 435.956(b)), the State Medicaid agency must comply with the following—"

(E) Section 435.912.

Timely determination and redetermination of eligibility.

{Note: This is really long, so check it out at this link: https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health and search for that section.}

(F) Section 435.916.

Regularly scheduled renewals of Medicaid eligibility.

{Note: This is really long, so check it out at this link: https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health and search for that section.}

(G) Section 435.919.

Changes in circumstances.

{Note: This is really long, so check it out at this link: https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health and search for that section.}

Section 435.1200(b)(3)(i)-(v).

Medicaid agency responsibilities for a coordinated eligibility and enrollment process with other insurance affordability programs.

* * * * *

(b) General requirements. * * *

(1) Fulfill the responsibilities set forth in paragraphs (c) through (h) of this section.

* * * * *

(3) Enter into and, upon request, provide to the Secretary one or more agreements with the Exchange, Exchange appeals entity and the agencies administering other insurance affordability programs as are necessary to fulfill the requirements of this section, including a clear delineation of the responsibilities of each program to—

(i) Minimize burden on individuals seeking to obtain or renew eligibility or to appeal a determination of eligibility for enrollment in a QHP or for one or more insurance affordability programs;

(ii) Ensure compliance with paragraphs (c) through (h) of this section;

(iii) Ensure prompt determinations of eligibility and enrollment in the appropriate program without undue delay, consistent with timeliness standards established under § 435.912, based on the date the application is submitted to any insurance affordability program;

(iv) Provide for a combined eligibility notice and opportunity to submit a joint fair hearing request, consistent with paragraphs (g) and (h) of this section;

(v) If the agency has delegated authority to conduct fair hearings to the Exchange or Exchange appeals entity under § 431.10(c)(1)(ii) of this chapter, provide for a combined appeals decision by the Exchange or Exchange appeals entity for individuals who requested an appeal of an Exchange-related determination in accordance with 45 CFR part 155, subpart F, and a fair hearing of a denial of Medicaid eligibility which is conducted by the Exchange or Exchange appeals entity; and

(I) Section 435.1200(e )(1)(ii).

* * * * *

(e) * * *

(1) Individuals determined not eligible for Medicaid. For each individual who submits an application to the agency which includes sufficient information to determine Medicaid eligibility or whose eligibility is being renewed in accordance with § 435.916 (regarding regularly-scheduled renewals of eligibility) or § 435.919 (regarding changes in circumstances) and whom the agency determines is ineligible for Medicaid, and for each individual determined ineligible for Medicaid in accordance with a fair hearing under subpart E of part 431 of this chapter, the agency must promptly and without undue delay, consistent with timeliness standards established under § 435.912:

(i) Determine eligibility for a separate CHIP if operated in the State, and if eligible, transfer the individual's electronic account, via secure electronic interface, to the separate CHIP agency and ensure that the individual receives a combined eligibility notice as defined at § 435.4; and

(ii) If not eligible for CHIP, determine potential eligibility for BHP (if offered by the State) and coverage available through the Exchange, and if potentially eligible, transfer the individual's electronic account, via secure electronic interface, to the program for which the individual is potentially eligible.

(J) Section 435.1200(h)(1).

(h)

(1) Include in the agreement into which the agency has entered under paragraph (b)(3) of this section that a combined eligibility notice, as defined in § 435.4, will be provided:

(i) To an individual, by either the agency or a separate CHIP, when a determination of Medicaid eligibility is completed for such individual by the State agency administering a separate CHIP in accordance with paragraph (b)(4) of this section, or a determination of CHIP eligibility is completed by the Medicaid agency in accordance with paragraph (e)(1)(i) of this section; and

(ii) To the maximum extent feasible to an individual who is not described in paragraph (h)(1)(i) of this section but who is transferred between the agency and another insurance affordability program by the agency, Exchange, or other insurance affordability program, as well as to multiple members of the same household included on the same application or renewal form.

(3) Part 447.--Section 447.56(a)(1)(v).

Limitations on premiums and cost sharing.

(a)

(1)

(v) At State option, individuals under age 19, 20 or age 21, eligible under § 435.222 or § 435.223 of this chapter.

(4) Part 457.--

(A) Section 457.344.

Changes in circumstances.

{Note: This is really long, so check it out at this link: https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health and search for that section.}

(B) Section 457.960. – This section was removed.

(C) Section 457.1140(d)(4).

Program specific review process: Core elements of review.

(d)

(4) Receive continued enrollment and benefits in accordance with § 457.1170.

(D) Section 457.1170.

Program specific review process: Continuation of enrollment.

A State must ensure the opportunity for continuation of enrollment and benefits pending the completion of review of the following:

(a) A suspension or termination of enrollment, including a decision to disenroll for failure to pay cost sharing; and

(b) A failure to make a timely determination of eligibility at application and renewal.

(E) Section 457.1180.

Program specific review process: Notice.

A State must provide enrollees and applicants timely written notice of any determinations required to be subject to review under § 457.1130 that includes the reasons for the determination, an explanation of applicable rights to review of that determination, the standard and expedited time frames for review, the manner in which a review can be requested, and the circumstances under which enrollment and benefits may continue pending review”

https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health

***This is the end of the section of items that are on pause until October, 1, 2034.

Amendments to Social Security Act (42 U.S.C. 1396a)

I have included this full document in the Research section at the end if you wish to read it.

October 1, 2026 - $10 Billion dollars will be made available for creating the State to Fed reporting system gathering data on anyone enrolled in any State Medicaid program.

January 1, 2027 – Feds are going to collect address information for everyone enrolling in a State Medicaid program. Just recently, several States have declined to share Medicaid information with the Federal government agencies like DHS. However, once the federal government has the data, even though they have said they will maintain privacy, they can share it within any way they want to. So there will be no privacy once it hits the Federal Government computer servers. It may not even be protected, since “doge” has access to everything and everything “doge” has access to is being used to teach Artificial Intelligence. Do not assume that the Federal government will protect this data.

October 1, 2028 – An additional $20 Billion will be available to maintain these reporting systems until it is paid out to zero.

October 1, 2029 – States must submit data once a month and during determination of eligibility or redetermination of eligibility to the Federal government all social security numbers for all individuals enrolled in a State Medicaid program. All individuals who are enrolled will be required to have a social security number.

The Federal government maintains they will use this information to eliminate the possibility of duplicate enrollment in multiple States.

States will be required to have in place a system to report the required data to the Federal government. The system must work both ways as the States are to send data to the Federal Government and the Federal government will send information back to the States regarding any person simultaneously enrolled in Medicaid in more than one State. Again, the Federal government promises to protect this data and not use it for anything else. (I do not believe them.)

Obtaining Address Information

The Federal government wants the address information for each person enrolled in a State Medicaid program and a continuous verification process if that address changes. The verifications can be from the Postal Service, The National Change of Address database (I did not know there was one of these), a managed care entity, prepaid inpatient health plan, or prepaid ambulatory health plan. The point is that the address change verification will come from a verifiable source and not the person. (Of course, they do not trust us.)

January 1, 2027 – If a State has a managed care entity, the address information on any enrolled individual will be sent directly from the managed care entity.

October 1, 2029 – The HHS secretary gets to determine if a State is not required to have this address verification system in place.

All of these rules apply to CHIP enrollees as well.

Deceased Individuals

January 1, 2027 - To ensure that no deceased individuals are still receiving Medicaid benefits, every quarter each State will have to review the Death Master File and make sure that anyone on this list is disenrolled and all benefits have ceased.

If they make a mistake, once the person who is really alive is determined to be alive, they will be re-enrolled retroactive back to the date they were taken off the plan. No mention was made regarding what proof would be required to prove you are still alive, but I am guessing that it will be determined by each State.

January 1, 2028 – To ensure that no providers (doctors) receive any Medicaid payments after they have died, every quarter States will check the Death Master File. No mention is specified regarding clawing back any payments to doctors after they have died, but I presume that will be the case.

Error Rates For Erroneous Payments

October 1, 2029 – The current matching funds to States are based on error rates and beginning in FY 2030, there are going to be changes to the State matching funds based on an error rate of 0.03 (which I presume is 3%). Each State may have a separate dollar amount that matches this percentage.

Note that as matching funds from the Federal government decrease, States will either have to make it up in State funding, or people will be removed from Medicaid and lose their coverage. The impact of fewer people on Medicaid will mean any of the following: People will cease to seek medical attention unless they become so ill or are hurt so bad that they have to go to an emergency room putting off care until it is critical or life-threatening. Emergency rooms will become the defacto medical care for people with no insurance as by law they cannot turn anyone away on ability to pay. This was the state of medical care before the enactment of the Affordable Care Act.

Fewer payments to medical facilities will result in them shutting down including but not limited to hospitals, clinics, nursing homes, imaging, specialties, outpatient surgical services, radiology, doctors, nurses, anesthesiologist, radiologists, specialists, mental health care, and more. As facilities and providers close, a larger burden is put on the providers and facilities that remain open with less income to support a larger population. People will die.

Eligibility Redetermination – Begins After Midterms (of course)

October 1, 2026 - $75 million dollars has been budgeted for redetermination.

March 1, 2027 – or there abouts, and every 6 months afterward, enrollees will need to have their eligibility redetermined for the following individuals:

From the Big Ugly Bill:

``(I) Individuals enrolled under

subsection (a)(10)(A)(i)(VIII).

``(II) Individuals described in

such subsection who are otherwise

enrolled under a waiver of such plan

that provides coverage that is

equivalent to minimum essential

coverage (as described in section

5000A(f)(1)(A) of the Internal Revenue

Code of 1986 and determined in

accordance with standards prescribed by

the Secretary in regulations) to all

individuals described in subsection

(a)(10)(A)(i)(VIII).

``(ii) Exemption.--The requirements

described in clause (i) shall not apply to any

individual described in subsection

(xx)(9)(A)(ii)(II).”

Internal Revenue Code of 1986 – Amended - From Section 5000A(f)(1)(A)

“(f)Minimum essential coverage For purposes of this section—

(1)In general The term “minimum essential coverage” means any of the following:

(A)Government sponsored programs Coverage under—

(i)

the Medicare program under part A of title XVIII of the Social Security Act,

(ii)

the Medicaid program under title XIX of the Social Security Act,

(iii)

the CHIP program under title XXI of the Social Security Act or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act),

(iv)

medical coverage under chapter 55 of title 10, United States Code, including coverage under the TRICARE program; [2]

(v)

a health care program under chapter 17 or 18 of title 38, United States Code, as determined by the Secretary of Veterans Affairs, in coordination with the Secretary of Health and Human Services and the Secretary,

(vi)

a health plan under section 2504(e) of title 22, United States Code (relating to Peace Corps volunteers); ² or

(vii)

the Nonappropriated Fund Health Benefits Program of the Department of Defense, established under section 349 of the National Defense Authorization Act for Fiscal Year 1995 (Public Law 103–337; 10 U.S.C. 1587 note).” https://www.law.cornell.edu/uscode/text/26/5000A

Analysis of the Big Ugly Bill will continue in Part II tomorrow!

From the Kaiser Family Foundation

“States would be required to renew eligibility for expansion enrollees at least two times per year and impose new cost sharing requirements.”

“New requirements added under the Biden administration for states to streamline Medicaid eligibility and enrollment would be delayed until January 1, 2035, which would increase barriers to enroll in and renew Medicaid coverage, especially for older adults and people with disabilities.”

“The bill would create new requirements for verifying addresses, cross-checking eligibility and data against other sources, and would reduce retroactive coverage from three months to one month.”

“The bill would eliminate the reasonable opportunity period for verification of immigrant status in all states, during which people receive coverage.” https://www.kff.org/policy-watch/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/

Changes to the Affordable Care Act (Obamacare)

There are quite a few changes you should know about that are specific to the ACA. Please read them all in this bulletin from the Kaiser Family Foundation: https://www.kff.org/policy-watch/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/

Able-Bodied People Taking Advantage of Medicaid Can Replace Migrant Farm Workers

🤣🤣🤣🤣🤣🤣

Just to give you a laugh at how stupid the MAGAs are, the Secretary of Agriculture said that with 34 million people on Medicaid, and the fact that deportations of migrant farm workers would continue, there would be enough workers to refill the farm positions from people cut from Medicaid – What absolute morons.

This is NOT feasible and it is NOT going to happen. People are NOT going to move to agricultural States and pick fruits and vegetables for a pittance wage out in the hot sun with no breaks, long hours, no bathrooms, no nothing. Drumpf and his dogies are dreaming if they believe otherwise.

They can destroy every social safety net there is, but they cannot make anyone work in the fields picking crops. What about grandma and grandpa in the nursing home? Or little Timmy in the wheelchair who is now over 14 and mom has to work, but he needs 24/7 care? What about John who works 20 hours per week, but got laid off and is looking for other work to help feed his wife and children? What about Aunt Hilda who is 63 and cannot work but cannot get a medical waiver? There are too many what abouts here and none of the people are going to work on Big Agri farms. Trump's agriculture head expects '34M able-bodied on Medicaid' to do farm work - https://www.rawstory.com/brooke-rollins-medicaid-farm-workers/

Research & Additional Reading:

The Big Ugly Bill - https://www.congress.gov/bill/119th-congress/house-bill/1/text

Medicaid Program; Streamlining the Medicaid, Children's Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes - A Rule by the Centers for Medicare & Medicaid Services on 04/02/2024 - https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health

42 U.S.C. 1396a - State plans for medical assistance - https://www.govinfo.gov/content/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap7-subchapXIX-sec1396a.pdf

TITLE 42—THE PUBLIC HEALTH AND WELFARE - https://www.govinfo.gov/content/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap7-subchapXIX-sec1396a.pdf

26 U.S. Code § 5000A - Requirement to maintain minimum essential coverage - https://www.law.cornell.edu/uscode/text/26/5000A

How Will the One Big Beautiful Bill Act Affect the ACA, Medicaid, and the Uninsured Rate? - https://www.kff.org/policy-watch/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/

Trump's spending bill cuts Medicaid: Here's what it's called in your state - https://www.axios.com/2025/07/08/medicaid-cuts-states

Trump bill's health effects won't be felt until after midterms - https://www.axios.com/2025/07/07/medicaid-impacts-tax-bill-delayed

Articles By Bluesmurf! How Our Government Works, Your Rights, Medicare, Social Security, the Big Ugly Bill, and More!

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Note: All commentary on my pages are from research and/or my opinion or interpretation of what I read. The opinions of the writers of the articles are their own. I work to find reliable and highly factual content with a “central” bias. Happy researching and reading! Have a Wonderful Rest of Your Day!!!