The major cuts and structural changes established by the OBBBA federal legislation include: [1]
- Work Requirements: Low-income adults aged 19 to 64 must meet work, community engagement, or schooling thresholds—typically 80 hours per month—to maintain their coverage. [1, 2]
- Tighter Eligibility & Red Tape: The federal government reversed previous rules meant to streamline enrollment. Eligibility checks for the expansion population will now happen every six months, increasing the risk of people losing coverage due to "red tape" and missed paperwork. [1]
- Immigration Restrictions: Eligibility is restricted, limiting non-U.S. citizens covered under Medicaid strictly to lawful permanent residents (green card holders) and Cuban/Haitian entrants. [1]
- Higher Out-of-Pocket Costs: New cost-sharing requirements mandate that low-income adults pay a larger share for certain medical treatments. [1, Medicaid copayments have remained capped at nominal amounts for most standard enrollees, though some states have raised them significantly under recent policy changes. [1, 2, 3]Specific copay changes and updates include:
- Medicaid Expansion Enrollees: Recent federal rules and state-level legislation (such as changes in North Carolina) allow states to charge up to $35 per service for adults enrolled in Medicaid expansion who have incomes between 100% and 138% of the federal poverty level. [1, 2]
- Standard Copays: By federal statutory law, standard Medicaid copays for preferred drugs and non-exempt services are generally limited to small, nominal amounts (e.g., up to $4 to $8) for beneficiaries below 150% of the federal poverty level. [1, 2, 3]
- Exempt Services: Preventive care, mental health treatment, and family planning services generally remain exempt from any copayments, regardless of the policy changes. [1, 2]
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