The One Big Beautiful Bill Act (OBBBA), signed into law in July 2025, imposes significant eligibility, enrollment, and other policy changes for the Medicaid and CHIP programs. Notably, the 43 states that implemented Medicaid expansions/waivers under the Affordable Care Act (ACA) must implement work/community engagement requirements for those populations by Jan. 1, 2027. These states must also implement semi-annual (rather than annual) renewal periods for expansion enrollees. The most recent annual survey of state Medicaid/CHIP officials conducted by the Kaiser Family Foundation (KFF) and Georgetown University opines that the OBBBA’s policy changes will also lead to state budget constraints, which could mean further eligibility restrictions and reductions in benefits and provider reimbursement rates as they seek to cut back Medicaid spending.
