ThinkTankWeekly

State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act

RAND | 2026-06-18 | health

Topics: United States

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English Summary

The One Big Beautiful Bill Act's Medicaid provisions are projected to impose substantial financial strain on state budgets, estimating a total reduction of $679 billion in state Medicaid funds over 2025–2034. The impact is highly variable by state; large expansion states that rely heavily on provider taxes and managed care face the largest losses, while smaller or non-expansion states may see minimal change or even gains from specific programs like the Rural Health Transformation Program (RHTP). Policymakers must anticipate significant budget cuts, as a majority of states are expected to see reductions of 5% or more in their Medicaid funding. This necessitates state-level strategic planning to mitigate deep financial shortfalls and maintain essential health services.

中文摘要

《一項宏大美好法案》(One Big Beautiful Bill Act)中的醫療補助(Medicaid)條款預計將對各州預算造成沉重財務壓力,估計在 2025 年至 2034 年期間,各州醫療補助基金總額將減少 6,790 億美元。其影響程度高度依賴於各州的情況;那些嚴重依賴提供者稅和管理式照護的大型擴張州(large expansion states)將面臨最大的損失,而較小或未進行擴張的州,則可能從「鄉村健康轉型計畫」(Rural Health Transformation Program, RHTP)等特定計畫中看到最小變動甚至增加。政策制定者必須預期重大的預算削減,因為大多數州的醫療補助資金預計將減少 5% 或更多。這要求各州進行戰略規劃,以減輕巨大的財政赤字並維持必要的健康服務。

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