Every Medicaid section in the bill, what it requires, and when it takes effect — with the four sections that hit provider revenue first.
H.R. 1, signed on July 4, 2025 as Public Law 119-21, places its Medicaid changes in Title VII, Subtitle B, Chapter 1 — Sections 71101 through 71121. For providers, four sections drive most of the revenue risk: Section 71112 shortens retroactive coverage to one or two months, Section 71107 moves expansion adults to six-month redeterminations, Section 71119 adds an 80-hour monthly community engagement requirement, and Section 71120 adds cost sharing for some expansion adults. The first three begin in January 2027.
The law goes by several names. It passed as H.R. 1 in the 119th Congress, is widely called the One Big Beautiful Bill Act (OBBBA), and was enacted as Public Law 119-21. CMS guidance refers to it as the “Working Families Tax Cut” legislation. All four names point to the same statute.
Title VII of the bill covers finance, and Subtitle B covers health. Chapter 1 of that subtitle holds the Medicaid sections, numbered 71101 through 71121. A separate section, 71401, creates the Rural Health Transformation Program.
You can read the enacted text on Congress.gov. For a plain-language look at how these changes affect eligibility, see our guide to OBBBA and Medicaid eligibility.
Each of these changes how often a patient’s coverage moves — and how long a provider has to bill for care once it does.
Before H.R. 1, Medicaid could reach back three months before the month of application. Section 71112 cuts that to one month for the ACA expansion adult group and two months for everyone else, and applies the same two-month limit in CHIP. CMS guidance says the change applies to applications made on or after January 1, 2027.
What it means for revenue: the window is tied to the month of application, not the month of approval. An encounter that falls outside the shorter window can no longer be reached by a later Medicaid approval, so fewer old self-pay balances become billable.
The statute says that for redeterminations “scheduled on or after the first day of the first quarter that begins after December 31, 2026, a State shall make such a redetermination once every 6 months.” It applies only to the ACA expansion adult group; other eligibility groups keep 12-month renewals, and CMS guidance exempts certain American Indians and Alaska Natives. States must file a state plan amendment by March 31, 2027.
What it means for revenue: twice as many renewal points means twice as many chances for coverage to lapse on paperwork — and to be reinstated later, sometimes back to the date of service.
Expansion adults ages 19 to 64 must show at least 80 hours a month of work, community service, a work program or half-time education, or a combination. States verify compliance for one to three months before the application, and for at least one month in each six-month renewal period. Exemptions include pregnant and postpartum individuals, parents and caretakers of children 13 and under or of a disabled individual, medically frail individuals, veterans with a total disability rating, and people already meeting SNAP or TANF work rules.
CMS published its interim final rule on June 3, 2026 (91 FR 33348). States must implement by January 1, 2027; a state showing a good-faith effort can be granted more time, but no later than December 31, 2028.
What it means for revenue: missed documentation leads to disenrollment, and successful appeals or re-applications lead to reinstatement. Both create encounters whose payer status changes after the visit.
Starting October 1, 2028, states must charge expansion adults with income above 100% of the federal poverty line cost sharing of more than $0 and no more than $35 per item or service, with total cost sharing capped at 5% of family income. Services at FQHCs, rural health clinics and certified community behavioral health clinics are exempt, as are primary care, mental health, substance use disorder, pregnancy-related and emergency services, among others.
What it means for revenue: health centers are largely protected. Hospitals and specialists may see new small patient-responsibility balances on Medicaid visits; providers may deny services for nonpayment but can waive cost sharing case by case.
Title VII, Subtitle B, Chapter 1 of Public Law 119-21. Descriptions are plain-language summaries; the bill text controls.
| Section | What it does | Takes effect |
|---|---|---|
| 71101 | Delays parts of the 2024 Medicare Savings Program eligibility rule | Delay through Sept 30, 2034 |
| 71102 | Delays parts of the 2024 Medicaid/CHIP eligibility and enrollment rule | Delay through Sept 30, 2034 |
| 71103 | Address checks and a federal system to catch duplicate enrollment across states | Jan 1, 2027; federal system Oct 1, 2029 |
| 71104 | Quarterly death-record checks for enrollees | Jan 1, 2027 |
| 71105 | Quarterly death-record checks for enrolled providers | Jan 1, 2028 |
| 71106 | Limits waivers of erroneous excess payments; counts payments made on insufficient eligibility information as erroneous | FY2030 |
| 71107 | Six-month redeterminations for expansion adults | Renewals scheduled on or after Jan 1, 2027 |
| 71108 | New home equity limits for long-term care eligibility | Jan 1, 2028 |
| 71109 | Limits Medicaid/CHIP eligibility to citizens, nationals, lawful permanent residents, Cuban/Haitian entrants and certain COFA residents | Oct 1, 2026 |
| 71110 | Emergency Medicaid paid at the regular match, not the expansion match | Oct 1, 2026 |
| 71111 | Delays the 2024 nursing facility staffing standards rule | Delay through Sept 30, 2034 |
| 71112 | Retroactive coverage cut to 1 month (expansion adults) or 2 months (others) | Applications on or after Jan 1, 2027 |
| 71113 | Bars Medicaid payments to certain family planning providers | One year from enactment |
| 71114 | Ends the extra federal match incentive for newly expanding states | Jan 1, 2026 |
| 71115 | Freezes new provider taxes; steps expansion states’ safe harbor from 6% down to 3.5% | Freeze at enactment; step-down FY2028–FY2032 |
| 71116 | Caps state directed payments at 100% of Medicare (expansion states) or 110% (non-expansion); higher payments reduced 10 points a year | Phased |
| 71117 | Tightens waivers of the uniform provider tax requirement | At enactment; transition up to FY2028 |
| 71118 | Requires budget neutrality for Section 1115 demonstrations | Demonstrations approved on or after Jan 1, 2027 |
| 71119 | Community engagement — 80 hours a month for expansion adults 19–64 | Jan 1, 2027 (any delay ends Dec 31, 2028) |
| 71120 | Cost sharing up to $35 per service for expansion adults above 100% FPL; FQHC/RHC services exempt | Oct 1, 2028 |
| 71121 | New standalone HCBS waiver without an institutional level-of-care requirement | July 1, 2028 |
// Highlighted rows are the four sections covered above. Scroll sideways on mobile.
Three sections change how states pay for Medicaid rather than who qualifies. Section 71115 freezes new provider taxes and lowers the hold-harmless threshold for expansion states from 6% to 3.5% by FY2032; nursing facility and intermediate care facility taxes are exempt from the reduction. Section 71116 caps state directed payments, which many states use to raise hospital rates, at Medicare levels. Together they put pressure on the supplemental payments many hospitals depend on.
On the other side of the ledger, Section 71401 creates the Rural Health Transformation Program: $10 billion a year from FY2026 through FY2030, distributed to states for rural providers, including critical access hospitals. For a closer look at the hospital side, see how hospitals can recover missed Medicaid reimbursements.
The statute sets the floor, but the details are still arriving. CMS issued six-month renewal guidance in March 2026 and said more guidance on retroactive coverage is coming. Community engagement runs under an interim final rule, and each state is writing its own state plan amendments. Check your state Medicaid agency’s notices alongside the bill text, especially for how your state counts the application month and which renewal option it chose.
No section of H.R. 1 reopens an uncompensated encounter. What turns a self-pay visit into a billable one is a change in the patient’s Medicaid Benefit Profile after the date of service: a retroactive approval, a reinstatement after a lapse, a payer change. H.R. 1 makes those changes more frequent and gives providers less time to act on them.
Eligibility checks at registration still matter; they confirm coverage at the patient level on the day of the visit. RetroCAID® works after the fact, at the encounter level, reviewing every uncompensated encounter daily and sending a Patient Benefit Alert when a change makes it reimbursable. The two are complementary — see checking vs. monitoring, or the questions providers ask most about planning for H.R. 1 in 2027.
RetroCAID monitors every uncompensated encounter daily for the Benefit Profile changes that make it reimbursable — 100% contingency, paid only after you’re reimbursed.
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