Jan 1, 2033 · deadline
Medicare Hospital Insurance trust fund projected by Trustees to exhaust reserves, cutting hospital payments by 12%
The 2025 Medicare Trustees Report projects the Hospital Insurance trust fund — which pays for inpatient hospital care, skilled nursing, home health, and hospice under Medicare Part A — will be depleted in 2033, three years earlier than the previous estimate. CBO's February 2026 projection is somewhat less dire, estimating exhaustion around 2040, but attributes the 12-year acceleration from its prior estimate to reduced trust fund revenue from the One Big Beautiful Bill Act's senior deduction provision and higher-than-expected per-enrollee spending. Upon exhaustion, Medicare Part A payments to hospitals and providers would be immediately cut to match incoming payroll tax revenue — a reduction of roughly 12%. Congress has never allowed the Medicare Hospital Insurance fund to run dry, but has also enacted no structural reform to prevent it.
Oct 1, 2032 · effective_date
Medicaid provider tax cap is finalized at 3.5%
The phase-down of Medicaid provider taxes that began in October 2027 reaches its floor at 3.5%, completing a ~40% reduction in the provider tax revenue states use to fund Medicaid. Many states will face significant Medicaid funding gaps.
Oct 1, 2030 · deadline
OBBBA Rural Health Transformation Program expires after a three-year pilot, with no guaranteed successor
The One Big Beautiful Bill Act created the Rural Health Transformation Program, a Medicaid waiver program that provides enhanced federal matching funds to rural states that voluntarily redesign their Medicaid delivery systems. The program expires October 1, 2030, after a three-year authorization window. Rural hospitals — which face the highest closure rates in the country — received temporary federal relief through the program. Without reauthorization, rural states lose access to the enhanced matching rate and must either absorb higher state costs or restructure benefits. The program's expiration will test whether Congress prioritizes rural healthcare access in the context of broader Medicaid restructuring debates.
Oct 1, 2028 · effective_date
Medicaid cost-sharing requirements take effect for expansion enrollees
States must charge up to $35 per service (up to a max of 5% of income) for Medicaid expansion enrollees earning over 100% of the federal poverty level. First time in ACA history that significant cost-sharing is mandatory for expansion populations.
Jan 1, 2028 · effective_date
Medicare drug price negotiations expand to hospital-administered Part B drugs for the first time
Negotiated prices for the third round of Medicare drugs take effect — the first time Part B (hospital-administered) drugs enter the negotiation program. The round targets high-cost infusion drugs and biologics administered in physician offices and hospitals. Medicare negotiation now reaches clinical settings for the first time, beyond retail pharmacies. The OBBBA's expanded orphan drug exclusion may limit the pool of eligible drugs.
