Trump signs One Big Beautiful Bill Act mandating Medicaid work requirements for all expansion states by 2027

President Trump signs the One Big Beautiful Bill Act on July 4, 2025, which includes a provision requiring all 42 states and the District of Columbia that have expanded Medicaid under the ACA to implement work requirements by January 1, 2027. The bill requires able-bodied adults ages 19-64 in the expansion population to work, attend school, participate in an approved training program, or volunteer for at least 80 hours per month to maintain coverage. The Congressional Budget Office estimates the Medicaid and SNAP provisions will reduce federal spending by over $1 trillion over 10 years, with 7 million people projected to lose Medicaid coverage by 2028 according to the Urban Institute. States may implement requirements early using a state plan amendment, bypassing the traditional Section 1115 waiver process.