Affects on Medicaid by State

[breadcumbs]

Here's an overview of how the provisions in the Big Beautiful Bill (H.R. 1) could impact Medicaid in different states, considering their current policies, populations, and administrative capacities. Keep in mind that the bill sets federal standards, but states have varying Medicaid programs, so the actual effects can differ:

General State Impact Overview

State	Potential Impact Highlights	Notes
California	Likely to see reductions due to stricter eligibility verification, but currently has broad coverage.	May face disenrollments among non-citizens and those with unstable addresses.
Texas	Could experience significant reductions, especially since Texas already has limited Medicaid expansion.	Work requirements could disqualify many low-income adults.
Florida	Similar to Texas, with possible disenrollment of non-compliant individuals.	Large immigrant population may be affected by stricter citizenship verification.
New York	More resistant to work requirements; impact may be less severe but still present.	State policies may buffer some federal restrictions.
Pennsylvania	Moderate impact; work requirements and eligibility checks could reduce enrollment.	State plans may be approved with certain conditions.
Illinois	Likely to see some reductions, but state has historically protected coverage for vulnerable groups.	May face legal challenges to certain provisions.
Georgia	Significant impact expected; minimal Medicaid expansion and high low-income populations.	Work requirements could disproportionately affect low-income adults.
Alabama	Similar to Georgia, with potential for coverage losses among non-citizens and low-income adults.	State has not expanded Medicaid, so impact on expansion population is limited.
Ohio	Expected to experience some reductions; recent efforts to expand coverage may be affected.	Work requirements have faced legal challenges previously.
Arizona	Moderate impact; ongoing efforts to verify eligibility could be intensified.	Has expanded Medicaid, but stricter rules could lead to disenrollments.

Key Factors Influencing Impact

Medicaid Expansion Status: States that expanded Medicaid under the ACA (e.g., California, New York, Illinois, Arizona) may be more resistant or have legal avenues to protect coverage, but could still see reductions.
Existing Work Requirements: States like Arkansas and Kentucky have implemented work requirements; the bill could reinforce or expand these.
Immigrant Populations: States with large immigrant communities (California, Texas, Florida) may see more disenrollments due to stricter citizenship verification.
State Flexibility: States with more robust administrative capacity or legal resistance may mitigate some impacts.

Specific State Considerations

States with No Medicaid Expansion (e.g., Texas, Florida, Alabama): Likely to see fewer enrollees overall, as many low-income adults are not covered under Medicaid to begin with.
States with Existing Work Requirements: May see increased disenrollment if current policies are reinforced or tightened.
States with Large Non-Citizen Populations: May experience more significant coverage reductions due to citizenship verification provisions.

Summary

Impact Level	States	Notes
High	Texas, Florida, Georgia, Alabama	Significant potential for disenrollment, especially among low-income, non-citizen, or work-eligible populations.
Moderate	Ohio, Arizona, Pennsylvania	Mix of protections and potential reductions; state policies may influence outcomes.
Low	California, New York, Illinois	More likely to resist or mitigate impacts due to expanded protections, legal challenges, or existing coverage infrastructure.