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- The ‘One Big Beautiful Bill Act’ proposes national work requirements for able-bodied Medicaid recipients.
- Critics argue this could lead to significant coverage losses due to bureaucratic hurdles.
- Exemptions apply to pregnant and postpartum women, children, seniors, and people with disabilities.
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Essential Context
The ‘One Big Beautiful Bill Act,’ passed by the U.S. House of Representatives on May 22, 2025, includes sweeping changes to Medicaid. A key provision is the imposition of national work requirements for able-bodied adults aged 19 to 64 without dependents to receive Medicaid.
Core Players
- U.S. House of Representatives – Passed the ‘One Big Beautiful Bill Act’
- U.S. Senate – Currently debating the legislation
- Republican Rep. Gus Bilirakis – Spokesperson supports exemptions for vulnerable groups
- Democratic Rep. Kathy Castor – Criticizes new work requirements as bureaucratic red tape
Key Numbers
- 18,000+ – Number of people who lost Medicaid coverage in Arkansas due to work requirements in 2018.
- May 22, 2025 – Date the ‘One Big Beautiful Bill Act’ passed the U.S. House of Representatives.
- 2027 – Year by which states must feed Social Security numbers into CMS’s new central database monthly.
- FY 2030 – Deadline for quarterly death-master file reviews by state Medicaid offices.
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The Catalyst
The ‘One Big Beautiful Bill Act’ aims to reduce what supporters call “waste, fraud, and abuse” in Medicaid by introducing work requirements. However, critics argue this approach could disproportionately affect vulnerable populations.
“And that’s where people will lose coverage, because you will be subjected to all sorts of new bureaucratic red tape requirements to justify the fact that you are or are not working,” said Democratic Rep. Kathy Castor.
Inside Forces
The bill’s provisions include centralized checks for dual enrollment to prevent duplicate coverage and monthly reporting of Social Security numbers to ensure accurate enrollment. These measures are intended to streamline the system but may add administrative burdens.
Nonpartisan government watchdog groups warn that these administrative changes could lead to coverage losses, similar to what happened in Arkansas in 2018 when over 18,000 people lost Medicaid due to not reporting their work status or providing necessary documentation.
Power Dynamics
The introduction of work requirements gives significant power to state and federal administrators to enforce these new rules. This could lead to a shift in how Medicaid is managed, with more emphasis on compliance and less on accessibility.
Supporters, like Republican Rep. Gus Bilirakis’s spokesperson, argue that exemptions for pregnant and postpartum women, children, seniors, and people with disabilities protect the most vulnerable groups.
Outside Impact
The broader implications include potential coverage losses for millions of Americans who may struggle to meet the new work requirements or navigate the increased paperwork. Health policy experts, such as Jennifer Tolbert from the KFF, highlight that these requirements could affect people with disabilities, chronic conditions, and those caring for children or elderly parents.
Consumer advocacy groups and health experts express concerns about the impact on public health and the social safety net.
Future Forces
The future of Medicaid under this bill hinges on the Senate’s decision. If passed, the bill will introduce significant changes by 2027 and beyond, including the implementation of a centralized database and quarterly death-master file reviews.
Key areas to watch include the administrative capacity of states to manage these changes and the impact on Medicaid enrollment and coverage rates.
Data Points
- 2018: Arkansas introduced work requirements, resulting in over 18,000 people losing Medicaid coverage.
- May 22, 2025: The ‘One Big Beautiful Bill Act’ passed the U.S. House of Representatives.
- 2027: States must start feeding Social Security numbers into CMS’s new central database monthly.
- FY 2030: State Medicaid offices must conduct quarterly death-master file reviews.
The ‘One Big Beautiful Bill Act’ represents a significant shift in how Medicaid is administered, with potential far-reaching consequences for millions of Americans. As the bill moves through the Senate, it remains to be seen how these changes will impact the healthcare landscape and the lives of those dependent on Medicaid.
