Why it Matters: HR1’s Change to Medicaid Waiver Budget Neutrality Rules

Document Type

Blog Post

Publication Date

2-19-2026

Publisher

Petrie-Flom Center at Harvard Law School

Language

en-US

Abstract

The 2025 budget reconciliation bill (“HR1” or “One Big Beautiful Bill Act”) significantly amended Medicaid, the federal public health insurance program for low-income people. HR1 has garnered significant attention surrounding new rules like work reporting requirements that limit the ACA’s Medicaid eligibility expansion.

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