Medicaid Compared to Current Law
Here's a comparison of how Medicaid operates under current law versus the potential impacts of the Big Beautiful Bill (H.R. 1) in specific states:
Medicaid Impact Comparison: Current Law vs. H.R. 1 (Big Beautiful Bill)
| State | Current Law Highlights | Impact of H.R. 1 | Notes |
|---|---|---|---|
| California | - Broad Medicaid expansion under ACA. - No work requirements. - Provides coverage for many non-citizens. |
- Increased eligibility verification may lead to disenrollments, especially among non-citizens and those with unstable addresses. | Less likely to see drastic coverage loss but could experience some reductions due to stricter verification. |
| Texas | - No Medicaid expansion. - Limited eligibility; mainly pregnant women, children, disabled, elderly. |
- Possible further reductions among the already limited population. - Work requirement enforcement may not significantly change coverage, but stricter citizenship verification could disqualify some non-citizens. |
Significant potential for coverage loss among non-citizens and low-income adults if work requirements are enforced. |
| Florida | - No Medicaid expansion. - Limited optional coverage for certain low-income adults. |
- Similar to Texas, potential disenrollments among non-citizens and those failing verification. - Possible increase in administrative barriers. |
May see some reductions, especially in immigrant populations. |
| New York | - Medicaid expansion. - No work requirements. - State has protections against some federal restrictions. |
- Possible minor reductions if federal verification measures are adopted. | Less impact expected, but some administrative changes could affect coverage. |
| Pennsylvania | - Expanded Medicaid under ACA. - No work requirements. |
- Slight reductions if eligibility checks become more frequent. | State may implement protections to minimize disenrollment. |
| Illinois | - Expanded Medicaid. - No work requirements. |
- Potential for some disenrollments due to increased verification. | State policies may mitigate impacts. |
| Georgia | - No Medicaid expansion. - Limited eligibility to specific populations. |
- Significant impact likely, especially among low-income adults and non-citizens. | Work requirements could lead to disenrollment of those not meeting criteria. |
| Alabama | - No expansion. - Narrow eligibility. |
- Similar to Georgia, potential for coverage reductions. | Stricter verification may disqualify some non-citizens and low-income adults. |
| Ohio | - Partial expansion. - No work requirements currently. |
- Possible slight reductions; work requirements could be introduced. | State may face legal challenges if implementing new requirements. |
| Arizona | - Expansion state. - No work requirements. |
- Possible small reductions due to verification, but protections may limit scope. | State’s existing infrastructure may help mitigate impact. |
Summary of Differences
| Aspect | Current Law | H.R. 1 Impact |
|---|---|---|
| Eligibility Redeterminations | Less frequent, typically annual. | Increased frequency (e.g., every 6 or 12 months). |
| Work Requirements | Generally absent, except in some states. | Mandated for certain populations, leading to potential disenrollments. |
| Citizenship Verification | Existing verification processes; some states more lenient. | Stricter and more frequent verification, risking disqualification of some eligible individuals. |
| Coverage for Non-Citizens | Many states provide coverage for certain non-citizens, especially children and pregnant women. | Federal restrictions could limit or eliminate some coverage options. |
| Administrative Oversight | State discretion within federal guidelines. | Increased federal oversight and verification requirements. |
Conclusion
- States with expanded Medicaid (e.g., California, New York, Illinois, Arizona) currently enjoy broader coverage and protections; impacts from H.R. 1 could be relatively minor but may include some disenrollments due to stricter verification.
- States without expansion (e.g., Texas, Florida, Georgia, Alabama) are more vulnerable to coverage reductions, especially if work requirements and citizenship checks are enforced more stringently.
