The One Big Beautiful Bill Act - What changes are being made to SNAP and Medicaid?

H.R.1 - 119th Congress (2025-2026): One Big Beautiful Bill Act | Congress.gov | Library of Congress

Attached is the bill itself. Feel free to check it out for yourselves and make up your own mind. I am going to outline SNAP benefits and Medicaid as they have been scrutinized the most. Some of you may have heard some chatter from some politicians in DC and maybe even locally that folks were going to lose these benefits. That they were simply being taken away from eligible people. I will share what I discovered in reading the bill for myself.

"(Sec. 10102) This section increases the work requirements for certain SNAP recipients who are able-bodied adults.
As background, SNAP recipients who are able-bodied adults without dependents (ABAWDs) currently have work-related requirements in addition to the general SNAP work registration and employment and training requirements. SNAP law limits benefits to ABAWDs to 3 months out of a 36-month period, unless the participant meets the additional work-related requirements.
This section raises the age for those who must meet these additional work requirements to include adults who are 65 years old and younger, whereas these requirements currently apply to adults who are 55 years old and younger.
This section requires parents and household members to meet the additional work requirements (similar to someone who does not have a dependent child) if the child is age 14 and older. Currently, those with a child under the age of 18 are exempt from the requirements.
This section excludes from the additional work requirements SNAP recipients who are Indians, Urban Indians, or California Indians (as these terms are defined by the Indian Health Care Improvement Act).
In addition, the section generally requires homeless individuals, veterans, and certain foster care individuals to meet these work requirements. Foster care individuals are those who are 24 years old or younger and were in foster care on the date of attaining 18 years of age or a higher age. Specifically, this section eliminates the current exclusion from the additional work requirements for these individuals based on this status.
Finally, this section limits the ability of a state to temporarily suspend the three-month time limit for SNAP benefits for ABAWDS in areas with high unemployment or an insufficient number of jobs. Under current law, the ABAWD waiver program allows states to request a temporary waiver of the three-month SNAP benefit limit. States may receive a waiver based on an area having an unemployment rate of over 10% or an insufficient number of jobs."

Basically, what this is saying is self-explanatory. The program for native Americans is unchanged, within 3 months citizens receiving benefits that are deemed abled bodied are being asked to meet a work requirement to keep the benefit they have. The age for the work requirement was also changed to 65 and under and since most folks work up to age 65 or older these days, they are considered able bodied for the basis of keeping the benefit. It also states that in areas where unemployment is over 10% or has an insufficient number of jobs available that the work requirement can be waived. So, nobody is simply having the benefit removed. The government is simply asking folks to contribute by working.

"(Sec. 10103) This section generally eliminates the ability of a household to use participation in certain energy assistance programs to determine SNAP income eligibility unless the household includes an elderly or disabled member.

As background, a household may deduct a portion of their housing and utility costs from their income (i.e., the excess shelter expense deduction) when determining SNAP benefits. Under current law, a household that receives a certain level of energy assistance through the Low Income Home Energy Assistance Program (LIHEAP) or a similar energy assistance program may deduct a set allowance. This set allowance (i.e., Standard Utility Allowance or SUA) represents low-income household utility costs in the state or local area. Using this allowance makes qualifying for an excess shelter deduction more likely. This section eliminates the use of the set allowance for households without elderly or disabled members, which may decrease the availability of the excess shelter deduction and reduce the SNAP benefits for these households."

Basically, this provision no longer allows energy assistance participation to help determine SNAP eligibility unless a senior lives in the home. For homes without a senior living there it eliminates the set allowance for utility costs and could potentially reduce the SNAP benefit.

"(Sec. 10104) This section prohibits a household from using any internet connection service fees as part of their housing and utility costs for the purposes of determining the size of household SNAP benefits, thus potentially reducing the SNAP benefits for these households.
As background, a household may deduct a portion of their housing and utility costs from their income (i.e., the excess shelter expense deduction) when determining SNAP benefits. Under current law, household expenses may include internet connection service fees."

Realistically an internet connection is not truly a utility though many homes do count on having one. This is most likely why this was removed and could potentially reduce a benefit.

"(Sec. 10105) This section establishes state-matching fund requirements for the cost of SNAP program allotments beginning in FY2028. The state contribution ranges from 0% to 15% for the cost of SNAP program allotments and is based on the state’s SNAP payment error rate. Currently, the state match is 0%.
For FY2028, a state may elect either the FY2025 or FY2026 payment error rate to calculate its state-matching fund requirement. For FY2029 and each fiscal year thereafter, the state match is calculated using the payment error rate for the third fiscal year preceding the fiscal year for which the state share is being calculated.
Any state that has a payment error rate that is less than 6% will have a state match of 0% (i.e., the state does not have to contribute).
A state with a payment error rate that is

• at least 6% but less than 8% must contribute 5%,
• at least 8% but less than 10% must contribute 10%, and
• 10% or greater must contribute 15%.

In general, the effective date for the state-matching fund requirements is the beginning of FY2028. However, any state that has an error rate above a certain level will have implementation delayed until FY2029 or FY2030. Specifically, the implementation date is delayed for states where the state's error rate multiplied by 1.5 equals or exceeds 20% in FY2025 or FY2026. For such states, the implementation date is delayed until FY2029 if the specified error rate occurs in FY2025 and until FY2030 if the error rate occurs in FY2026."

This provision calls for a state contribution based on calculation errors in total benefits issued. Those who have a margin of error would contribute a percentage based on that percentage of the margin of error.

"(Sec. 10106) This section reduces the amount that USDA may pay a state agency for administrative costs for the operation of SNAP to 25% of all administrative costs beginning in FY2027 and for each fiscal year thereafter. Currently, USDA must pay 50% of all administrative costs, thus this section increases the state share of administrative costs from 50% to 75%."

This section refers to the percentage of administrative costs between the individual states and the USDA for SNAP benefits. This most likely would not affect any benefits, just how the cost to operate is allocated.

"(Sec. 10107) This section eliminates funding for the SNAP Nutrition Education and Obesity Prevention Grant Program (SNAP-ED). SNAP state and local agencies administer this federal grant program. SNAP-Ed uses evidence-based, public health projects and interventions with the goal to implement a nutrition education and obesity prevention program for eligible individuals that promotes healthy food choices and physical activity consistent with the most recent Dietary Guidelines for Americans."

This section eliminates the SNAP-ED fund. Many localities have lunch and breakfast programs for those in need which is most likely the reason for this change.

"(Sec. 10108) This section eliminates SNAP eligibility for certain individuals who are classified as an alien under federal law and legally present in the United States, including those who have qualified for conditional entry under the asylum and refugee laws or based on urgent humanitarian reasons (e.g., a survivor of domestic violence or human trafficking).
The section maintains SNAP eligibility for individuals who reside in the United States and are (1) U.S. citizens or U.S. nationals; (2) lawful permanent residents, with exceptions; (3) aliens who are Cuban or Haitian entrants; or (4) individuals who are lawfully residing in the United States in accordance with the Compacts of Free Association between the United States and Micronesia, the Marshall Islands, and Palau."

This section eliminates SNAP for those who do not have legal residency in the United States and outlines the eligibility for those who can receive these benefits. Basically, while in some cases there are folks removed there are very specific reasons for that. Most eligible folks will be allowed to continue to receive benefits based on the criteria in the sections I have quoted.

Next, I will share the provisions of Medicaid as there is also chatter going around in DC of people being removed from Medicaid. Here is the Medicaid sections from the Bill.

"Subchapter A--Reducing Fraud and Improving Enrollment Processes

(Sec. 71101) This section delays until FY2035 implementation of certain provisions of the rule titled Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment, which was issued by the Centers for Medicare & Medicaid Services (CMS) on September 21, 2023.
Specifically, the section delays provisions of the rule that (1) specify that individuals who must pay a premium to enroll in Medicare hospital services, reside in a group payer state, and enroll during a general enrollment period may qualify for Medicare Savings Programs (MSPs) as early as the month of their entitlement to Medicare hospital services; (2) require states to use certain data from the Social Security Administration (SSA) to facilitate the enrollment of qualifying individuals in both MSPs and the Low-Income Subsidy (LIS) program under the Medicare prescription drug benefit; and (3) align the definition of family size under MSPs with the definition under the LIS program.
(MSPs allow individuals to receive Medicare cost-sharing and premium assistance from state Medicaid programs if they meet certain income and resource criteria. The LIS program, also known as the Extra Help program, provides similar assistance with respect to cost-sharing for covered drugs under the Medicare prescription drug benefit.)
The section provides $1 million for FY2026 for the CMS to implement this section and Sec. 71102 of this act."

Basically, this section delays a provision that would have called for a premium to be paid to enroll in Medicare hospital services, allowed the state to use data from SSA to qualify for MSP's and LIS programs taking away the option to choose one on your own when the time comes. It would also align the family size under MSP's with LIS in determining eligibility for Medicaid programs and low cost drug benefits.

"(Sec. 71102) This section delays until FY2035 implementation of certain provisions of the rule titled Medicaid Program; Streamlining the Medicaid, Children's Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes, which was issued by the CMS on April 2, 2024.
Specifically, the section delays provisions of the rule that, among other changes, (1) allow state Medicaid programs to verify an individual’s U.S. citizenship and identity through certain systems without additional proof of identity; (2) align certain Medicaid enrollment processes for those whose eligibility is not based on income with those that are based on income; and (3) establish additional timelines for Medicaid eligibility terminations, including when there is a change in an individual’s circumstances."

This section by delaying these provisions ensures that state Medicaid programs would need to still gain proof of identity to establish citizenship for eligibility for benefits. It also delays aligning enrollment eligibility of those who are based or not based on income. It also delays timelines for eligibility terminations including when someone's situation changes. Basically, the bill is maintaining the current standards for eligibility and ensuring at least until FY35 current and potential candidates enrolling in Medicaid will have the same level of service.

"(Sec. 71103) This section requires the 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 $10 million for FY2026 and $20 million for FY2029 for the CMS to establish and maintain the new system, respectively."

This section is to ensure states are aware of folks receiving benefits in that state and another state so that the state can take action. Most likely getting the employee removed from the previous state.

"(Sec. 71104) This section requires state Medicaid programs to check, beginning in 2028, the SSA's Death Master File on at least a quarterly basis to determine whether Medicaid enrollees are deceased."

This is being done to eliminate potential fraud and to ensure only those who are living and eligible receiver a state benefit.

"(Sec. 71105) 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 SSA'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."

This section gives the authority for the states to do this quarterly check.

"(Sec. 71106) This section includes Medicaid payments to individuals for whom there is insufficient information as to their eligibility as erroneous excess payments that may ultimately reduce a state’s federal matching funds. These changes apply beginning in FY2030."

This section makes the individual states responsible for ensuring sufficient evidence is included in Medicaid payments. If there are individuals receiving payments erroneously this could reduce the matching federal fund they receive.

"(Sec. 71107) This section requires state Medicaid programs to redetermine every six months, beginning with the first quarter after 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. (That 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.)
The section provides $75 million for FY2026 for the CMS to implement these provisions."

This program currently has a yearly review. This section makes this a twice per year review most likely so review for changes in income and potential eligibility.

"(Sec. 71108) This section caps home equity limits for Medicaid nursing facility or other long-term care services beginning in 2028.
Currently, in order to qualify for such services, an individual’s home equity may not exceed certain limits, as set by states in accordance with federal standards and adjusted annually for inflation. For 2025, home equity limits set by states must be between $730,000 and $1,097,000.
The section caps the maximum home equity limit to $1 million, regardless of inflation. This limit does not apply to homes located on agricultural lots."

This section puts a cap on home equity for qualifying for services. Currently states can go as high as nearly 1.1 million. This section caps this at 1 million.

"(Sec. 71109) This section generally restricts, beginning in FY2027, federal payment for Medicaid and CHIP to services for individuals who are U.S. residents and are either U.S. citizens, lawful permanent residents, Cuban-Haitian entrants, or Compact of Free Association migrants lawfully residing in the United States. The restrictions do not apply to certain mandatory emergency services provided to individuals who are not lawfully residing in the United States or to optional services provided to certain lawfully residing children and pregnant women.
Current law authorizes federal payment with respect to additional categories of individuals, including refugees; noncitizens granted parole for at least one year, asylum, or related relief; and Violence Against Women Act (VAWA) self-petitioners. The section excludes these individuals from eligibility.
The section provides $15 million for FY2026 for the CMS to implement these provisions."

This section basically restricts coverage for non-citizens except for those defined above.

"(Sec. 71110) This section reduces the Medicaid federal matching rate for emergency services provided to individuals who are not lawfully residing in the United States but who would otherwise qualify for Medicaid as part of the Medicaid expansion population in states that have expanded Medicaid. Specifically, the section limits, beginning in FY2027, the Medicaid federal matching rate for emergency services provided to individuals who are not lawfully residing in the United States to the same matching rate as would otherwise apply for such services (rather than the enhanced federal matching rate for states that have expanded Medicaid).

The section provides $1 million for FY2026 for the CMS to implement these provisions."

This section refers to reduced federal matching for emergency services for unlawful residents.

"Subchapter B--Preventing Wasteful Spending

(Sec. 71111) This section delays until FY2035 implementation of certain provisions of the rule titled Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting, which was issued by the CMS on May 10, 2024.
Specifically, the section delays provisions of the rule that, among other changes, (1) establish minimum staffing standards for nurses in Medicare and Medicaid long-term care facilities, including requiring a nurse to be onsite 24/7 and requiring a minimum of 3.48 total nurse staffing hours per resident per day; and (2) require state Medicaid programs to report on payments to direct care workers and support staff of nursing facilities and intermediate care facilities for individuals with intellectual disabilities."

This section delays implementation of a change to the minimum staffing standards for those in long term facilities that count on adequate staffing. Many of these facilities have their own minimum standard or follow state regulations.

"(Sec. 71112) This section shortens the window for retroactive Medicaid coverage. Specifically, the section specifies that, beginning with the first quarter after December 31, 2026, Medicaid coverage may begin retroactively (1) for individuals in the Medicaid expansion population, one month prior to the application filing date; and (2) for all other individuals, two months prior to the application filing date. Additionally, CHIP coverage may retroactively begin two months prior to the application filing date. (Currently, coverage may begin three months prior to the application filing date.)

The section provides $10 million for FY2026 for the CMS to implement these provisions."

This section refers to the reduction of the retroactive coverage of Medicaid from 3 months to 1 to 2 months depending on the category.

"(Sec. 71113) This section prohibits federal Medicaid payment for one year 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 FY2023, received federal and state Medicaid payments totaling more than $800,000.
The section provides $1 million for FY2026 for the CMS to implement these provisions."

This basically prohibits federal Medicaid payments for non-profits who for the most part offer family planning services for one year and received payments in FY2023 totaling more than $800,00.

"Subchapter C--Stopping Abusive Financing Practices

(Sec. 71114) 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."

This section refers to states who have not expanded Medicaid as of 2021 and are encouraged to do so by 1/2026 in order to receive the enhanced matching grant.

"(Sec. 71115) This section generally limits Medicaid provider taxes beginning in FY2027.
Under current law, states may impose a provider tax of up to 6% of net patient service revenues to potentially receive additional federal matching funds. The section precludes states that have not expanded Medicaid from increasing the rate of a provider tax beyond that currently in effect in order to qualify for federal matching funds. For states that have expanded Medicaid, a provider tax may not exceed the current rate or a specified rate, whichever is lower; the maximum rate gradually decreases from FY2028-FY2032, with a maximum rate of 3.5% beginning in FY2032 (these limits do not apply to nursing and intermediate care facilities, which are instead limited to current rates). The section additionally precludes states from imposing a new provider tax if there is not already one in effect.
The section provides $20 million for FY2026 for the CMS to implement these provisions.
(Sec. 71116) This section provides $7 million per fiscal year for FY2026-FY2033 for the CMS to revise regulations so as to limit state-directed payments for inpatient hospital services, outpatient hospital services, nursing facility services, and 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."

This section refers to the federal matching funds outlined in the previous section and how they would be allocated.

"Subchapter D--Increasing Personal Accountability

(Sec. 71119) This section requires, beginning not later than the first quarter after 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 (or, for seasonal workers, an average monthly income over six months) 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 to three months (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 with dependent children aged 13 or younger.
Upon request, the CMS may exempt a state from fully implementing these requirements until December 31, 2028. States requesting an exemption must demonstrate good faith efforts to comply with the requirements and provide a detailed timeline for implementation.
The section provides $200 million to states and $200 million to the CMS for FY2026 to implement these requirements."

This section is the work, community service or education requirement 80 hours per month to receive the Medicaid expanded population coverage. This would be for those deemed abled bodied and is outlined above.

"(Sec. 71120) 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 (1) services for which cost sharing is already prohibited (e.g., emergency services); (2) primary care, mental health, or substance use disorder services; or (3) services provided by federally qualified health centers, certified community behavioral health clinics, or rural health clinics. States may allow providers to condition the provision of services upon the payment of any required cost sharing.
The section provides $15 million for FY2026 for the CMS to implement these provisions."

This section refers to cost sharing for states who have individuals who are eligible for the expansion population option but has income that exceeds the family poverty line.

"Subchapter E--Expanding Access to Care

(Sec. 71121) This section authorizes additional home and community-based services (HCBS) waivers (also known as Section 1915(c) waivers) for state Medicaid programs beginning on July 1, 2028. States may seek waivers to provide HCBS to individuals without the need for certain determinations as to whether an individual requires hospital or institutional care (as is required for current waivers). States must establish other needs-based criteria for such services.

The section provides $50 million for FY2026 for the CMS to implement these provisions. It also provides $100 million for FY2027 to support state HCBS programs."

This section provides additional waivers for Medicaid services without the need for certain determinations giving easier access to certain levels of care.

I have covered SNAP and Medicare and nothing in this bill suggests substantial eliminations of benefits. Just simply more requirements like the work requirement if a person is able bodied to keep their current benefit. I hope you find this helpful, and I hope you will read the bill for yourself as I provided the link and educate yourself and not take the word of a someone that may be cherry picking items and not giving a fully accurate account of what is in the bill. I have chosen not to make this about opinion. I took the sections and gave simple explanations of what was in them. I didn't do this to share an opinion. I did this to help folks learn about the bill and make up their own mind based on the information.