Donald Trump’s big, beautiful bill pairs permanent tax cuts for America’s wealthiest people with nearly $1 trillion in Medicaid cuts over a decade. Starting Jan. 1, people on Medicaid will have to prove eligibility every six months.
Jennifer Tolbert, the deputy director of the Program on Medicaid and the Uninsured at KFF, said about 20 million people have to prove they meet Medicaid requirements every year. She described Medicaid as “a joint federal and state program that helps cover medical costs for some people with limited income and resources.”
Nebraska Medicaid rollout
Nebraska moved first, implementing the new Medicaid bureaucratic measures on May 1 instead of waiting until Jan. 1. Tolbert said Nebraska initially accepted self-attestation from Medicaid users that they qualified for the program, then used the new process before the broader federal timeline.
From May through August, Tolbert said 7% of the people in Nebraska in the program were disenrolled and 14% of new applicants were rejected. Nebraska will soon shift to the twice-per-year documentation rule that the One Big Beautiful Bill will impose nationwide.
Mike Johnson’s One Big Beautiful Bill Act pitch came as the measure drew criticism for the way it trades short-term, small-dollar tax cuts for working people for permanent tax cuts for wealthier Americans. The bill also cuts back on the abilities of states to tax health care providers, a change that matters more in places that rely heavily on Medicaid financing.
Rural areas and Republicans
The Brookings Institution found in June that Trump’s approval rating was falling in rural areas and that his economic policies were driving that drop. The same rural communities are more exposed to Medicaid cuts because they depend more heavily on the program and on state provider taxes that help fund care.
That leaves Republicans in the House and Senate with the political cost of a bill Trump can claim as a signature accomplishment. The people who use Medicaid, especially the working poor and rural residents, are the ones most likely to feel the documentation changes first.
The open question is how many Medicaid enrollees nationwide will lose coverage once the six-month documentation rule begins on Jan. 1. Nebraska’s early numbers give a possible preview, but the national impact will depend on how many people can repeatedly show they still qualify.
