One Big Beautiful Bill shifts $840B in Medicaid costs to states

The One Big Beautiful Bill Act, signed in 2025, imposed the largest Medicaid restructuring since the program's creation in 1965. CBO estimated the law would reduce federal Medicaid outlays by $840 billion over ten years, with work requirements projected to cause 4.8 million people to lose coverage by 2034. The law restricted states from using provider taxes and intergovernmental transfer tools to fund their Medicaid share, effectively shifting hundreds of billions in costs to state budgets with no offsetting revenue.