Medicaid Cost Sharing Changes Under the One Big Beautiful Bill Act (OBBBA)

The report examines how the One Big Beautiful Bill Act (OBBBA) changes Medicaid cost sharing for certain low-income adults in expansion states, while leaving many existing protections intact. Although the law requires some cost sharing for enrollees between 100 percent and 138 percent of the federal poverty level, it gives states broad flexibility in how to implement these changes. The analysis emphasizes that even small out-of-pocket costs can create barriers to care, especially for midlife adults (50-64) who tend to use more health care services than younger populations. It ultimately urges states to minimize cost sharing and strengthen consumer protections to preserve access to essential health services. Read the full report.

Key Takeaways

• OBBBA changes Medicaid cost sharing requirements for the 41 states (including DC) that expanded Medicaid under the Affordable Care Act. Depending on state implementation decisions, some of these changes could result in higher out-of-pocket costs, whereas others may lower expenses for Medicaid enrollees.
• Fourteen states currently impose cost sharing in compliance with OBBBA requirements and will likely not need to make changes.
• Four states will need to lower cost sharing on at least one service, and one state will need to discontinue premiums.
• OBBBA eliminates cost sharing for certain commonly used services and providers.