Distributional Effects of HR1 Implementation on Medicaid Enrollment

• In Event: Effects of HR1 Implementation on Medicaid Enrollment and Mitigation Strategies

Abstract

Introduction/Background: The One Big Beautiful Bill (H.R. 1), passed in July 2025, includes extensive changes to the Medicaid program, including work requirements, more frequient verification, and limited eligibility for qualified noncitizens. The Congressional Budget Office estimates that H.R. 1 will reduce Medicaid spending by more than $900 billion over 10 years, mostly through coverage loss (Hinton et al. 2025). Elements of this reform will be implemented at different points of time, giving state and local governments some lead time to prepare for this dramatic loss of funding. 

Purpose/Question: This paper presents results of an ongoing partnership between Georgetown’s Better Government Lab (BGL) and the Alameda County Health Department (ACH) to forecast Medicaid coverage losses and fiscal effects throughout H.R.1 implementation. We will predict how many Alameda County residents will lose their Medicaid coverage as a result of the new requirements, evaluate how these changes affect the costs of care and costs borne by the County, and provide evidence-based insights to inform County decision-making and policy discussions.

Data/Findings: The Better Government Lab has developed a micro-simulation model based on county Medi-Cal enrollment data to project how many Alameda County residents will lose Medi-Cal coverage by the end of 2027. The initial projections show that 18% of Medi-Cal enrollees in Alameda County will lose their coverage by December 2026 and that another 18% of enrollees in the County will lose their coverage by December 2027. This represents a coverage loss of about 150,000 people.  Of note, these losses assume no further policy action to mitigate procedural discontinuations and churn. 
 
Implications/Future Analysis: Going forward, BGL will use administrative data on Medicaid enrollment and utilization that has been aggregated to the monthly, zipcode, demographic group level to estimate distributional effects of HR1 implementation on health coverage and healthcare costs. We will extend our sample forward in time for the next few years to compare realized and forecasted coverage losses for immigrant and work-required sub populations. In sum, this paper will provide detailed and timely evidence on how HR1 is impacting low income and immigrant communities in real time.

Author

• Katherine Richard, University of Wisconsin-Madison
  Presenting Author