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1
The CBO projected that the law would reduce federal Medicaid spending by $911 billion from 2025 through 2034 and increase the uninsured population by 7.5 million in 2034.
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2
Medicaid expansion states face the greatest restrictions, including work requirements in 41 states and 6-month eligibility redeterminations for expansion adults.
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3
Work requirements apply to certain adults in 44 states, including 3 states that did not adopt the ACA Medicaid expansion.
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4
Beginning October 1, 2026, every state must restrict Medicaid eligibility for specified lawfully present immigrants, including some refugees and asylees without green cards.
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5
Provider-tax restrictions affect every state, while limits on state directed payments cap future rates at or near Medicare rates; the rural health fund does not replace lost federal Medicaid support.
