The Breakthrough

What, Who, Why, and How?
Basic facts about what is happening in the US government, in plain language

Written by DNWML Community Engagement Coordinator, Eliot Carter

Medicaid and the “One Big Beautiful Bill” Act 

What? 

Medicaid was the topic of our first Breakthrough Blog post. Medicaid is a program that helps people pay for their health care. Many people are on Medicaid because they don’t have a lot of money. Other people are on Medicaid because it helps pay for Home and Community Based Services, or services that help people with disabilities live and receive care in the community of their choice. The federal government sets the basic rules about who can get Medicaid. States can create Medicaid programs on top of the basic federal rules to change how Medicaid works in their state.

The “One Big Beautiful Bill” is what people often call the latest Budget Reconciliation bill. Budget bills set rules about how the government will spend its money. The majority of the House of Representatives and the Senate, as well as the President and his staff, wanted to cut Medicaid spending, but they didn’t all agree on details like how to cut spending and by how much. The President signed the One Big Beautiful Bill Act on July 4th after it passed in the House and Senate, and the bill is now a law.

However, many members of Congress opposed the bill. In fact, the Senators were split 50-50 on the final version of the bill. When the Senate is split 50-50 on a bill, the Vice President can be the tie-breaking vote, which is what happened this time on July 3rd. Many disability rights groups opposed this bill as well, especially because it was going to cut Medicaid spending. The bill was more than just a budget though – it had a lot of other policy changes tucked into it. We are going to go into detail about some of the major ways the One Big Beautiful Bill Act will affect people with disabilities in Michigan. 

Who? 

President Donald Trump’s (R) staff made budget recommendations earlier this year. Fellow members of the Republican Party used this as a guide to making the final budget. You can see how Senators voted by clicking here. Both of Michigan’s Senators, Gary Peters (D) and Elissa Slotkin (D), voted against the bill. You can see how the House of Representatives voted by clicking here. All Democrats from Michigan voted no, and all Republicans from Michigan voted yes. J.D. Vance (R), the Vice President, was the tiebreaking vote that allowed the bill to move past the Senate.

The budget bill tells agencies within the federal government how much money they will get and how to spend it. These agencies still must figure out the details of how their programs will have to change. Some agencies will have to release guidance about how they will enforce these programs. The bill often mentions that the Secretary of Health and Human Services will have to come up with these changes after the bill passes. The Secretary of Health and Human Services is Robert F. Kennedy Jr, or RFK for short. The Secretary of Agriculture, Brooke Rollins, will be doing something similar with the changes to SNAP (also called food stamps) policy.

Why? 

President Trump and many of his supporters have said that they want to cut Medicaid because they want to address “waste, fraud, and abuse” within the system. Over the years, some politicians, both Democrats and Republicans, have argued that there are too many people using Medicaid who don’t “deserve” it. Others think that Medicaid should cover more people, not fewer. The Affordable Care Act of 2010 had a policy called “Medicaid Expansion” in it. This meant that states could allow more people to receive Medicaid if they chose to do so. Michigan is one of these Medicaid Expansion states. Some of the policies in the One Big Beautiful Bill Act (OBBBA) are directed towards people in the Medicaid Expansion group.  

One group that the OBBBA targets is non-US citizens without visas, often called undocumented or “illegal” immigrants. The Act does not actually ban all undocumented people from receiving Medicaid. Even before this law was made, non-Americans could not cross the border without papers and start receiving Medicaid. The US and various states may allow some types of immigrants to become “qualified” to apply for Medicaid. Usually, these people cannot even apply for Medicaid until they have lived in the US for over five years.1, 2 What the OBBBA does is take away some of the groups that had “qualified” status. Refugees and asylum seekers are people who have left their country because it was dangerous to stay there because of war or targeted violence. These people will no longer be eligible for Medicaid.3 

The US has also already created laws to make it so Medicaid cannot cover abortions (one of these is the Hyde Amendment). The OBBBA takes this a step further to prevent any nonprofit medical organization who provides family planning services from receiving Medicaid money. 3, 4 Family planning services include care like birth control or abortion. Even if these organizations provide other types of healthcare, they still will lose the ability to get money from Medicaid. These organizations will have to decide between getting rid of family planning services or no longer taking patients who have Medicaid. 

The disability community is an incredibly diverse group. The above policies will affect people with disabilities who are undocumented and people with disabilities who want to get family planning services. Here are some parts of the OBBBA that will have other effects on people with disabilities and their allies: 

Medicaid Redeterminations

- These refer to the paperwork that people must fill out to prove that they can still receive Medicaid. In the past, this had to be done every year. During the Public Health Emergency for COVID-19, people did not have to fill out this paperwork to continue receiving Medicaid. In the OBBBA, Medicaid recipients will have to fill out this paperwork every six months. The six-month redetermination cycle will begin in January of 2027 if we do not act.5

Medicaid Work Requirements

- The OBBBA will require a large percentage of Medicaid recipients to show that they are working, in a work program like Vocational Rehab, or doing community service 80 hours a month, or 20 hours a week. This policy will begin in January of 2027 if we do not act.5

- The OBBBA says that people with disabilities and parents/caregivers of people with significant disabilities will not have to complete these work requirements. However, we don’t yet know how the government will define disability. The federal government already defines disability in different ways. Some disability advocates are worried that many people with disabilities will still have to follow the work requirements, because the federal government may say that the person is not “disabled enough”. The Department of Health and Human Services (DHHS) should tell the public more about how they will define disability and other details about this policy by the end of the year.6

- A few states have tried to create work requirements for Medicaid. In Arkansas, work requirements resulted in 25% of people on Medicaid losing their coverage. This did not increase the employment rate in the state. Research found that many Arkansans on Medicaid weren’t aware or were confused about the change. Many people were disenrolled because they were unable to fill out the forms correctly or didn’t have internet access.6, 7

There are policies in the OBBBA that will improve some non-Medicaid programs that people with disabilities might use. However, they only apply to people in specific circumstances. These include: 

Increases to some tax credits

Parents and caregivers of people with disabilities can already claim some tax credits, which are ways you can owe less money when you pay taxes or potentially get some money back. Namely, the limits for Child Tax Credit and the Child Care Tax Credit will be higher and will continue to increase based on inflation.3

Changes to some employer-sponsored insurance plans

These changes are technical and specific to what every employer offers, so we will not get into them here. But as an example, High Deductible Health Plans (HDHPs) will now cover telehealth visits even if the person has not met their deductible.8

ABLE Account changes

ABLE Accounts are places where people who have Medicaid or some Social Security can save money. It’s hard to save money in regular bank accounts, because if someone has more than $2000 in savings, they can lose their benefits. The OBBBA increases how much money another person can put in someone’s ABLE account.3

Furthermore, the government made a change to ABLE Accounts in 2022 which will still likely happen. Currently, ABLE Accounts are only available to people who were born with a disability or people who became disabled before age 26. Starting on January 1, 2026, people who became disabled before age 46 will be able to have an ABLE Account.

There are many other changes that we didn’t cover that will have negative impacts, either by creating more paperwork for people to fill out or blocking rules that were meant to improve care and outcomes for people with disabilities. According to the non-partisan Congressional Budget Office, this bill will reduce spending for Medicaid by almost one trillion dollars ($990,000,000,000) over 10 years.9 

There will also be downstream effects from these Medicaid cuts. All hospitals and hospital systems will be getting less money to pay for the care they provide, and rural hospitals are already struggling to stay open. As a result, many rural hospital systems will likely close. People with and without disabilities in rural areas will have to travel long distances to simply see a doctor if this happens. 

How?

The OBBBA was a Budget Reconciliation Bill. Budget Reconciliation is a way for congress to pass a budget bill quickly because it does not have to follow all the same rules that other bills do. For example, if one person in the Senate doesn’t like a bill, usually they can filibuster (or delay other Senators from voting on) the bill. It takes 60 votes to end a filibuster, so it often takes 60 votes for most bills to actually get voted on. However, Senators cannot filibuster a Budget Reconciliation Bill. The House and the Senate sessions when this bill was debated went until 3:00 in the morning at times. This is highly unusual.

How to take action?

If you are on Medicaid, you can talk to one of our Information and Referral Specialists by calling 734-971-0277. We can help you gather the information you need to have when it’s time to renew your Medicaid.

But being personally prepared is only one part of the solution – we need to collectively work together to make sure people with disabilities don’t lose their life-saving health care coverage.  

DELAY – States will need time and money to design the systems that are needed to verify work requirements. States can request extensions to give them more time to figure this out. You can tell the Michigan Department of Health and Human Services if you are concerned about this policy and encourage them to delay putting the policy into place.

DECREASE – The OBBBA says that states can choose how they will determine if a person worked the required 80 hours a month. This can prevent people who may have recently lost a job or gotten too sick to work from immediately losing Medicaid. To decrease the amount of people who will be affected by Medicaid Work Requirements, states should:

Adopt a flexible 3-month “look-back” period

Use the “Temporary Hardship Exemptions”

DEMAND – Advocates will continue to speak out at events, rallies, vigils, and protests. The fight is not over. Demand for policymakers to use their power to stop these attacks on our nation’s essential services. Also, ask them what they plan to do to reverse these Medicaid cuts. People with disabilities and the policymakers who represent them need to prepare for a long fight to defend our healthcare.

I have a quote from Angela Davis in my office that I look at every day. It reads, “You have to act as if it were possible to radically change the world. And you have to do it all the time.” I’m doing my best to live up to her wise words. Things around us are changing, but the world is not ending. New beginnings are always possible.  

These blog posts are examples of how I use the internet to inform and educate people about social and political issues that affect me and my community. Would you like to do the same? Then join our workshop series, Emerging Voices in Advocacy, and learn how digital tools can help put your message in front of millions of people! Youth and young adults (ages 13-35) can apply for a chance to learn how to use internet technologies to create change. We have funds that we will use to make sure your technology is accessible to you, and eligible participants can receive a free tablet to help you participate!

Sound interesting? Fill out our interest form to receive updates: tinyurl.com/VoicesInterest    

The Breakthrough Advocacy Blog #3

The Breakthrough

What, Who, Why, and How? Basic facts about what is happening in the US government, in plain language

Written by DNWML Community Engagement Coordinator, Eliot Carter

Medicaid and the “One Big Beautiful Bill” Act

What, Who, Why, and How?
Basic facts about what is happening in the US government, in plain language

Medicaid and the “One Big Beautiful Bill” Act 