REGULATORY TRACKER

In July 2025, Congress passed the One Big Beautiful Bill Act, a sweeping federal law that changes how Medicaid works across the country. Around the same time, CMS issued new guidance and opened public comment on key maternal health issues.

These changes will affect who gets covered, how care is delivered, and which services remain financially sustainable—especially in the South, where health systems are already stretched thin. CRPHI is tracking both the legislation and regulatory actions to help advocates, providers, and health innovators respond in real time.

The law slashes over $1 trillion from Medicaid and CHIP over 10 years. States will receive less federal support per enrollee—especially those that expanded Medicaid under the ACA.

Imagine a community health clinic that serves 8,000 patients a year—most of them on Medicaid. With less federal money coming in, that clinic may be forced to cut services, reduce staff, or shut down entirely.

The law now requires adults ages 19–64 to verify at least 80 hours of work or qualifying activity each month to keep their Medicaid coverage, with few exceptions.

Think of a single mother juggling part-time gigs with unstable hours. She might be working—but still lose coverage because her schedule doesn’t produce the “right” paperwork in time.

States can now charge Medicaid enrollees up to $35 per visit. This includes adults just above the poverty line who may already skip care due to cost.

If someone needs birth control, a follow-up ultrasound, and a mental health appointment in one month, those costs could add up to $100+—unaffordable for many families.

The law limits how far back Medicaid will cover past care—from 3 months down to 1 or 2 depending on the enrollee.

A pregnant person who finds out they’re eligible for Medicaid after visiting the ER in their first trimester may now be stuck with thousands of dollars in medical debt.

The law blocks Medicaid payments to any clinic that provides abortions or is affiliated with those that do, for at least one year—even if those funds aren't used for abortion.

In many counties, the local Planned Parenthood is the only provider offering affordable STI testing, cancer screenings, and contraception. Cutting off Medicaid funding doesn’t just affect abortion—it destabilizes basic preventive care.