The major Medicaid cuts included in the "One Big Beautiful Bill Act" (signed into law on July 4, 2025) will start going into effect at different times, primarily in 2026 and 2027, with some provisions phased in later years:
- January 1, 2027: Several important Medicaid changes begin, including a shortened retroactive coverage period (from 3 months down to 1 or 2 months depending on eligibility), new Medicaid work requirements, and more frequent eligibility renewals (twice yearly for some enrollees). These changes will apply to Medicaid applications submitted on or after this date and states cannot start these changes earlier. This timing means enrollees are more likely to face gaps in coverage and difficulties maintaining enrollment.
- December 31, 2026: The start date for more frequent Medicaid renewals can begin at this point, potentially earlier than January 2027, depending on the state.
- October 1, 2026: Immigrant eligibility restrictions take effect.
- October 1, 2028: Higher out-of-pocket costs start for Medicaid expansion enrollees.
- Some Medicaid coverage restrictions and related provisions took effect immediately upon enactment on July 4, 2025.
Overall, most of the Medicaid cuts and restrictive changes are concentrated in 2026 and 2027, with smaller reductions and restrictions continuing into 2028 and beyond. The shifts will result in millions of people losing coverage or facing increased barriers to obtaining and retaining Medicaid health benefits.
