Congressional Budget Update

On May 22nd, the House of Representatives passed H.R. 1, the One Big Beautiful Bill Act, by a vote of 215-214-1. The House moved the bill to the floor for a vote before the full chamber following a nearly 24-hour markup in the Rules Committee. The final House vote comes after a week of intense negotiations between fiscal hard-liners and blue state Republicans seeking changes to portions of the bill impacting Medicaid, the state and local tax (SALT) deduction limit and energy credits, among other provisions. House Republicans made changes to the bill prior to the Rules Committee markup and passed a manager’s amendment before moving the bill to the floor. Notably, the House did not vote to reduce the federal FMAP, impose per capita caps or block grants on Medicaid expansion states.

Our partners at The National Council for Mental Wellbeing provided a summary of key changes related to Medicaid below, which included:

• Creating exemptions for individuals with mental health and/or substance use disorder conditions to the cost-sharing requirements for Medicaid enrollees. Such individuals will not be required to participate in cost-sharing, nor will they be required to comply with the bill’s work/community engagement provisions, though many of the details concerning both exemptions will be determined at the state level.
• Moving up the start date for work/community engagement requirements, from the originally planned Jan. 1, 2029, to Dec. 31, 2026 (or earlier, if individual states elect to accelerate their own timeline).
• Reducing the Federal Medicaid Assistance Percentage from 90% to 80% for the expansion population in states that provide Medicaid or Children’s Health Insurance Program coverage to certain lawfully residing children and pregnant women (current estimates suggest this will impact 33 states and Washington, D.C.).
• Increasing the cap on state-directed payments for non-expansion states to 110% of the Medicare rate for a given service, while grandfathering in existing payments above that rate in those states. The 100% cap for new state-directed payments in expansion states remains unchanged.

Opportunities for Advocacy:

After the resolution’s passage, Senators from both parties expressed strong concerns with the measure and indicated major changes would be made. The bill now moves to the Senate, where significant changes are expected. Several senators on both sides of the aisle have expressed strong concerns with the House version’s impact on Medicaid.

• Now is the time to make your voice heard and continue to contact your Senators to urge them to change the bill’s Medicaid-related provisions.
• Now is the time to call their offices and express concerns over the House bill’s Medicaid cuts.
• Ask your lawmaker for an in-person or virtual meeting. Most offices have a website form you can fill out to request a meeting (example here). You can also customize the National Council for Mental Wellbeing’s “requesting a meeting” template within our Advocacy Handbook.

The Ohio Council will continue to keep partners appraised of new developments in the reconciliation process as the bill moves to the upper chamber.