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H.R.1
In July 2025, Congress passed the One Big Beautiful Bill Act (OBBBA), also known as H.R. 1, which enacted sweeping healthcare policy changes. Among these changes are Medicaid cuts, which fundamentally change coverage for enrollees and financing mechanisms for states.
This page is dedicated to highlighting the impact of Medicaid changes on rural health and upcoming implementation of these provisions by the Centers for Medicare and Medicaid Services (CMS).
Upcoming Statutory Deadlines
- Jan. 1, 2026: 2.5% MPFS payment increase, part of CY 2026 final rule
- Jan. 1, 2027: Duplicate-enrollment address checks and monthly verifications; 6-monthredeterminations; work requirements implementation; retroactive coverage
- Jan. 1, 2028: Phase-down of grandfathered SDPs begins; HCBS standalone waiver authority; Premium tax credit pre-verification
- Oct. 1, 2028: Cost-sharing up to $35 per service for expansion adults, with certain exemptions
CMS H.R.1 Guidance Letters:
- State Directed Payments (Sept. 9, 2025)
- Provider taxes (Nov. 14)
CMCS Informational Bulletin:
- Summary of Medicaid and CHIP provisions (Nov. 18, 2025)
- Duplicate enrollment enforcement (Nov. 6, 2025)
- Federal Medicaid Cuts Imperil Rural Hospitals and Residents - Report with Manatt Health
- NRHA Letter to CMS on H.R.1 Implementation
- NRHA Sign On Letter to Congress on Cuts to Medicaid
- NRHA Medicaid Cuts & Rural Impacts
- NRHA OBBBA Talking Points
- NRHA Rural Medicaid Talking Points
- NRHA Rural Medicaid Toolkit