President Donald Trump signed the One Big Beautiful Bill Act (OBBBA) into law on July 4, 2025. While congressional Republicans promoted the legislation as fiscal responsibility, the law implements massive reductions to federal healthcare programs to finance tax relief that disproportionately benefits higher-income Americans. By imposing substantial cuts to Medicaid, the Affordable Care Act marketplaces, and other health programs, the One Big Beautiful Bill Act (OBBBA) threatens to reduce coverage, raise healthcare costs, and create additional obstacles to care for millions of Americans. 

The nearly 900-page legislation passed through budget reconciliation despite unified Democratic opposition, with projections showing it will add roughly $3 trillion to the national debt while reducing tax revenue by approximately $4.46 trillion over a decade. Yet these fiscal figures represent only the surface of a fundamental restructuring of American healthcare and social policy. 

The Healthcare Revolution: $1 Trillion in Changes 

The healthcare provisions of the One Big Beautiful Bill Act (OBBBA) represent the most significant changes to American health policy since the ACA’s passage, fundamentally altering how healthcare is financed and delivered across the country. 

• Sweeping Immigration-Related Healthcare Restrictions 

The OBBBA implements some of the most restrictive immigration-related healthcare policies in decades. Starting October 2026, Medicaid payments will be restricted to a much smaller group of immigrants, specifically excluding refugees, DACA recipients, and abused spouses and children who previously qualified for coverage. 

The legislation also reduces Federal Medical Assistance Percentage (FMAP) payments for emergency Medicaid care provided to immigrants who are no longer eligible for regular coverage. 

• Administrative and Eligibility Reform Package 

The OBBBA includes extensive administrative reforms designed to tighten Medicaid eligibility processes. A moratorium on enrollment simplifications for Medicare Savings Programs, Medicaid, and CHIP will remain in effect until 2034, preventing administrative changes aimed at easing enrollment and eligibility processes. 

New eligibility verification procedures include requirements for regular address data updates, systems to reduce duplicate enrollments across states, and enhanced verification of deceased individuals and providers. These measures, while aimed at reducing fraud, will likely create additional barriers for legitimate beneficiaries seeking to maintain coverage. 

Starting in 2027, Medicaid expansion enrollees will face eligibility redeterminations twice yearly instead of annually, doubling the administrative burden on both states and beneficiaries. This change significantly increases the risk of eligible individuals losing coverage due to paperwork delays or administrative errors. 

• Long-Term Care and Home-Based Services Reforms 

The legislation sets new home equity limits of $1 million for Medicaid long-term care eligibility starting in 2028, potentially affecting middle-class families’ ability to qualify for nursing home coverage while protecting their homes. 

Paradoxically, while tightening some long-term care eligibility, the One Big Beautiful Bill Act (OBBBA) expands Medicaid home and community-based services (HCBS) coverage through new waivers starting in 2028.  

• Coverage Timeline and Retroactive Changes 

The OBBBA shortens retroactive Medicaid coverage significantly, reducing it to just one month for expansion enrollees and two months for other populations starting in 2027. This change from the current three-month retroactive coverage period will leave patients responsible for medical bills incurred in the months before their Medicaid applications are approved. 

The Congressional Budget Office estimates the One Big Beautiful Bill Act (OBBBA) will cut federal spending on Medicaid and CHIP benefits by $1.02 trillion, eliminating at least 10.5 million people from the programs by 2034. This isn’t just a budget number; it represents a philosophical shift from enrollment-focused policies to work-based eligibility. 

• Rural Healthcare: Crisis Meets Opportunity 

More than 300 rural hospitals are currently at “immediate risk” of closure, with the average operating margin for rural hospitals at just 3.1% in 2023 and 44% operating with negative margins. The OBBBA’s Medicaid cuts threaten to accelerate these closures, but the legislation also provides an unprecedented response. 

The $50 billion Rural Health Transformation Program represents the single largest investment in rural healthcare since the Medicare Modernization Act of 2003. Each participating state will receive at least $100 million annually for five years, with additional formula-based funding considering rural population and healthcare facility proportions. 

The program allows states who know the issues in their communities better than the federal government to work with providers to determine the best use of funds. This could include infrastructure improvements, workforce recruitment, technology upgrades, and care model innovations. 

However, even if every dollar of the $50 billion fund went exclusively to rural hospitals, it would cover only 43% of the funding gaps created by the bill’s Medicaid cuts. This arithmetic reality means rural communities will need innovative approaches to maintain access while operating more efficiently. 

Impact of the One Big Beautiful Bill Act on Healthcare Providers 

A member survey from the American Medical Group Association found that 85% of its member physician organizations would be forced to eliminate services for Medicaid patients, with 51% saying they would have to reduce pediatric care, 47% saying they would have to cut maternity services, and 72% anticipating layoffs or furloughs. 

This isn’t just about numbers. It’s about fundamental changes in how healthcare is delivered. The reduction in access to community-based care and preventative services will lead to people delaying care until it’s urgent, increasing emergency department wait times and compromising patient care. 

Navigating One Big Beautiful Bill Act Challenges with Advanced Healthcare Technology 

As healthcare organizations confront changes brought by the One Big Beautiful Bill Act (OBBBA), the need for sophisticated data analytics and population health management becomes critical. The legislation’s complex eligibility requirements, enhanced verification processes, and shift toward value-based care demand robust technological solutions that can help providers optimize operations while maintaining quality care. 

Persivia’s CareSpace® platform offers healthcare organizations the advanced analytics capabilities needed to navigate these OBBBA challenges effectively. The platform’s comprehensive population health analytics can help organizations identify at-risk patient populations before they lose Medicaid coverage, enabling proactive outreach and care coordination.  

As the healthcare landscape becomes increasingly complex under the One Big Beautiful Bill Act (OBBBA), organizations that leverage Persivia’s AI-powered CareSpace® platform to streamline operations, optimize reimbursements, and demonstrate value-based care outcomes will be better positioned to thrive in this transformed environment. Built on 15 years of healthcare expertise, CareSpace® adapts to rapidly changing regulatory requirements while providing actionable insights for both clinical and financial decision-making under the new OBBBA framework. 

Ready to navigate the OBBBA’s healthcare challenges successfully? Contact Persivia today to discover how CareSpace® can help your organization optimize operations, manage coverage transitions, and thrive under the new healthcare landscape.