State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act

On July 4, 2025, President Donald Trump signed into law the One Big Beautiful Bill Act (Public Law 119-21), a massive budget reconciliation package with implications for many sectors of the U.S. economy. The law contains a series of policy changes that aim to reduce federal spending and improve program integrity in Medicaid, the nation's joint state-funded and federally funded health program for people with low incomes and disabilities. Broadly, these Medicaid changes impose work requirements on non-disabled adults, increase the frequency and stringency of eligibility determinations and redeterminations, limit spending on immigrants, and tighten provisions that have historically enabled states to increase their federal funding. The authors of this study combined publicly available data, published literature, state and federal agency reports, and other sources of information and developed customized approaches to build state-level estimates through 2034 of Medicaid fund impact and enrollment changes associated with several key provisions of the law.