Federal Medicaid Advocacy Opportunity From the National Council
Big Beautiful Bill
House Passes Big Beautiful Bill: Major Cuts to Medicaid to Impact Millions
Today, the House voted and passed HR 1 by a margin of 218–214, to advance the bill known as the “Big Beautiful Bill,” which now moves to the White House to Trump’s desk to be signed into law in time to beat a self-imposed July 4 deadline.
The final version cuts about $1 trillion from Medicaid, the federal health insurance program for low-income individuals and people with disabilities, and other health care programs. It reduces spending on anti-hunger programs, including SNAP, the Supplemental Nutrition Assistance Program formerly known as food stamps, by $185 billion.
The Pennsylvania Congressional Delegation all voted on party lines, with the exception of Representative Brian Fitzpatrick, who was one of only two Republicans to join all Democrats in voting against the measure. RCPA thanks Congressman Brian Fitzpatrick for meeting with RCPA last week and for voting against this bill. We are grateful for the Congressman’s support in protecting the most vulnerable populations that rely on Medicaid.
Main Points Relating to Medicaid Include
About 71 million Americans are enrolled in Medicaid, according to the government’s most recent data. According to a Congressional Budget Office report published this week, the changes to Medicaid and the Affordable Care Act in the current version would result in an increase of nearly 12 million more uninsured people by 2034. It is estimated that nearly 600,000 Pennsylvanians could lose Medicaid coverage.
Work Requirements
The bill outlines new work requirements for the popular entitlement program that provides government-sponsored health care for low-income Americans and people with disabilities. They require adults to work, volunteer, or study 80 hours a month to qualify for enrollment, unless they have an exception. The bill also requires parents of children over the age of 14 to work, as well as those receiving SNAP benefits.
Reporting Requirements
The bill also requires Medicaid recipients to prove their eligibility twice a year, instead of annually.
From our Partners at the National Council on Mental Wellbeing
The scale of the funding reductions and new administrative burdens is immense. But it is also important to recognize that some last-minute changes made to the bill in the past week provide an opening for further advocacy efforts that could potentially mitigate some of the impacts. Most relevant provisions of the bill will not take effect immediately, and in some cases, the effects will be phased in gradually over the course of several years. In addition, several provisions require agency rulemaking for full implementation, and there will likely be opportunities for you to engage through the notice and comment process.
RCPA will continue to review the final bill language and will follow up with a detailed analysis on the impacts of the bill; and through ongoing advocacy channels we will engage in with our national and state partners.
Senate Votes to Pass “Big Beautiful Bill” — Potential Healthcare Cuts for Millions of Americans
The Senate today approved the “Big Beautiful Bill” with the collateral impact of taking away health care from hundreds of thousands of Pennsylvanians. The bill will now return to the House for a final vote before it goes to the President’s desk for signature and approval. The House is expected to act quickly.
The Senate bill makes even more drastic cuts to health coverage than the House version, totaling over $1 trillion, including Medicaid. Millions of Americans will lose access to health care; specifically, these cuts will take away health care from more than 600,000 Pennsylvanians and could double health insurance premiums for many more. In addition, the bill adds trillions to the growing Federal deficit by way of sizable tax cuts.
This will deeply impact our most vulnerable individuals and families that our members serve in the Commonwealth. We must act now to save access to health care. Find your legislator and their contact information here to let them know that you do not support the passage of the “Big Beautiful Bill.”
RCPA Shares Medicaid and Federal Updates
The Trump Administration’s “Big Beautiful Bill” was passed by House Republicans on May 22 and contains significant Medicaid cuts that could leave millions of Americans without coverage as well as severely reduce access to care. The proposed bill also includes cuts to Medicare funding, new restrictions on federal loans for medical students, and provisions to create a permanent, inflation-based mechanism for annual updates to Medicare physician payments. The legislation now heads to the Senate, where it will face further debate by lawmakers.
The proposed legislation seeks to accomplish the following:
Medicaid:
- The bill introduces a two-year acceleration of Medicaid work requirements for able-bodied adults ages 18 to 64, which is slated to take effect no later than December 31, 2026, instead of 2029. States have the ability to implement these requirements earlier to secure quicker savings.
- Beginning October 21, 2027, states will be mandated to determine Medicaid eligibility every six months for people in the expansion population.
- Medicaid and CHIP federal financial participation is prohibited under the bill revisions for people who fail to verify immigration status, citizenship, or nationality in the designated “reasonable opportunity” window.
- States will also be required to cross-check their Death Master File quarterly to confirm deceased individuals are disenrolled. Should errors occur, there will be reinstatement provisions.
- The Social Security Act is amended to cut retroactive Medicaid coverage from three months to one month before the application date.
- Federal Medicaid and CHIP funding is prohibited for “specific gender transition procedures” provided to people under 18 years of age.
- Eligibility for increased federal medical assistance percentage for states that are newly expanding Medicaid will be wound down. To qualify, states must start expansion by January 1, 2026, to restrict late expansion states from receiving an elevated match rate.
- New rules for waiving the uniform tax requirement for Medicaid provider taxes will be imposed, which tightens conditions for states to use the financial tools.
Medicare:
- A proposed staffing mandate is halted under the bill for long-term care facilities that receive Medicaid and Medicare funds.
- The bill promotes the use of artificial intelligence to recover and reduce improper Medicare payments.
- A May 20 report from the nonpartisan Congressional Budget Office found that the bill could cut nearly $500 billion over the next decade in Medicare funding.
- The budget bill includes provisions to increase Medicare physician payments by an estimated 2.25% in 2026. This would be achieved by tying payments to 75% of the Medicare Economic Index. Starting in 2027, annual payments would be adjusted by 10% of the index, establishing a permanent, inflation-based update mechanism.
- Under current law, physician pay is set to increase by just 0.25% in 2026 and 2.5% by 2035. The proposed changes would boost payments to 4.3% by 2035 instead. Physician groups, including the American Medical Association, strongly support the provision, calling it a critical step toward restoring stability after years of payment cuts.
- The bill also adjusts the Medicare Physician Fee Schedule’s conversion factor, a key formula used to calculate final physician reimbursement. While the legislation introduces inflation-based updates, changes to the conversion factor could offset those increases and slow long-term payment growth. Physician groups have welcomed the update mechanism as a step in the right direction, though they say further reforms are needed to ensure physician payments fully reflect inflation and keep pace with rising practice costs over time.
CMS:
Outside of Congress, the Center for Medicaid Services (CMS) has also made announcements that could threaten access to healthcare:
- On May 27, CMS announced increased federal oversight to prevent states from using federal Medicaid dollars to cover healthcare for undocumented immigrants for anything beyond emergency services, which violates federal law.
- CMS outlined plans to increase audits of state Medicaid spending, eligibility systems, and financial controls, with recoupment of funds if misuse is found.
Please contact Emma Sharp with any questions.