H.R. 1 is the federal tax bill passed by the US Congress and signed by President Trump in July 2025. The bill made major cuts and changes to Medicaid (called Medi-Cal in California), most of which take effect in 2027 or after. California, like all states, is preparing to implement H.R. 1’s Medicaid provisions in coordination with partners like county agencies, safety-net health care organizations, advocates, and community-based organizations.
At the same time, California has made state policy changes, especially related to Medi-Cal coverage for immigrants, that are already causing some coverage losses and will compound future losses under H.R. 1.
We will collect resources from across California and the nation to help partners: (1) project and plan for the potential impacts of H.R. 1 on Medi-Cal enrollees and local health care systems and (2) draw from existing and emerging research and best practices to implement H.R. 1 while mitigating as much harm as possible.
This page will be updated on an ongoing basis. Contact Anne Sunderland with suggestions.
While this page focuses mainly on H.R. 1’s impact on Medicaid and Medi-Cal, some resources below also touch on H.R. 1 changes to Medicare, the Affordable Care Act (ACA), and SNAP (called CalFresh in California) as well as California state policy changes to Medi-Cal.
What is H.R. 1 and What Changes Does It Make to Medicaid?
California-Specific Resources
Protect California Health Care (National Health Law Program, updated on a ongoing basis)
This collection of resources from NHLP describes threats to Medi-Cal from H.R. 1 and state budget actions, how they are impacting Californians’ coverage and access to care, and how to protect low-income individuals and families.
Timeline of Funding Cuts to Medi-Cal and CalFresh in California (California Budget Center, February 2026)
How Massive Federal Cuts Will Create Unprecedented Challenges for Medi-Cal Patients and Providers (California Health Care Foundation, Fall 2025)
Overview of Major Impacts of H.R. 1 – One Big Beautiful Bill Act (California Legislative Analyst’s Office, Summer 2025)
National Resources
Prepare. Enforce. Protect: Medicaid + ACA Defense (National Health Law Program, updated on an ongoing basis)
These NHLP resources explain what H.R 1 means, how it is being implemented, and what can be done to protect the people most at risk.
Health Provisions in the 2025 Federal Budget Reconciliation Law (KFF, Summer 2025)
Implementation Dates for 2025 Budget Reconciliation Law (KFF, Summer 2025)
Implementing H.R. 1 Work Requirements
This is H.R.1’s biggest change to Medicaid. The bill requires adults age 19 to 64 who are enrolled through the ACA’s Medicaid expansion, and aren’t eligible for an exemption, to complete 80 hours a month of work, education or community service to maintain coverage starting in 2027. Exemptions include having a disability or caring for young children, among others. This new requirement is expected to significantly increase administrative burden to enrollees and county eligibility offices and result in coverage losses.
California-Specific Resources
What is the H.R. 1 Work Requirement and How will it Affect Californians with Medi-Cal? Policy at a Glance (California Health Care Foundation, June 2026)
Medi-Cal May 2026 Local Assistance Estimate for Fiscal Year 2025-26 and 2026-27 (California Department of Health Care Services, May 2026)
DHCS estimates that 4.8 million Medi-Cal enrollees will be subject to the H.R. 1 work requirement. Of those, 2.2 million are projected to qualify for an exemption and 1.1 million will lose coverage (see page 413).
Overview of Individuals Impacted by H.R. 1 Work Requirement Policies in Medi-Cal and CalFresh (California Legislative Analyst’s Office, March 2026)
Implementation Plan for New Federal Eligibility and Enrollment Changes Under H.R. 1 (California DHCS, January 2026)
This page contains DHCS’ evolving H.R. 1 implementation plan. See page 10 for specifics on work requirements.
Enacted H.R.1 Reconciliation Legislation: Medi-Cal Impact Update (California DHCS, January 2026)
This document includes more information about work requirements and how DHCS is responding.
National resources
Medicaid Work Reporting Requirements: Implementation Update after CMS’ Interim Final Rule (Families USA, June 2026)
Administration’s Last-Minute Restrictions Likely to Worsen Impact of Medicaid Work Requirement (CBPP, June 2026)
Summary of Community Engagement Interim Final Rule (Sellers Dorsey, June 2026)
CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule (KFF, June 2026)
Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements (KFF, updated ongoing)
Tracking Implementation of H.R. 1 Medicaid Work Reporting Requirements (Georgetown Center for Children and Families)
Medicaid Work Requirements Implementation Series (Center for Health Care Strategies, updated April 2026)
Implementing New Medicaid Work Requirements: Strategies to Minimize Harm in Your State (Justice in Aging, February 2026)
Medicaid Work Requirements: Mitigating Harm through Implementation (National Health Law Program, November 2025)
A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law (KFF, summer 2025)
Work Requirements for Medicaid Enrollees (Commonwealth Fund, January 2025)
Implementing Six-Month Redeterminations
H.R. 1 requires adults enrolled through the ACA’s Medicaid expansion to prove they are still eligible for the program (a process called “redetermination”) every six months, compared to once a year, starting in 2027. This is expected to significantly increase administrative burden to enrollees and county eligibility offices and result in coverage losses.
Implementation Plan for New Federal Eligibility and Enrollment Changes Under H.R. 1 (California Department of Health Care Services, January 2026).
This page contains DHCS’ evolving H.R. 1 implementation plan. See page 13 for specifics on 6-month redeterminations.
Enacted H.R.1 Reconciliation Legislation: Medi-Cal Impact Update (Department of Health Care Services, January 2026).
DHCS estimated that 289,000 Medi-Cal members may lose coverage by June 2027, increasing to approximately 400,000 by 2029-30, because of six-month redeterminations.
Learning From the “COVID-19 Unwinding”
In 2023 and 2024, California undertook the unprecedented task of redetermining eligibility for roughly 14 million Medi-Cal enrollees when the COVID-19 public health emergency ended. There may be lessons from this time (often referred to as “the unwinding”) that can be applied to implementing more frequent redeterminations under H.R. 1.
Lessons from the Medi-Cal Unwinding: How California Protected Coverage and Policy Options to Improve Renewals (California Health Care Foundation, June 2025)
Key Takeaways from Medi-Cal Redetermination Data (California Health Care Foundation, August 2024)
Projections: How will H.R. 1 Impact Californians?
Health Care Coverage
Over two million more Californians projected to lack health insurance by 2030 (UC Labor Center, May 2026)
Projected Reductions in Medicaid Expansion Enrollment Under OBBBA’s Work Requirements and Six-Month Redeterminations (Urban Institute, March 2026).
This includes California-specific projections.
Projected reduction in Medi-Cal coverage due to federal H.R.1 and 2025-26 State Budget, by county, 2028 (UC Labor Center, February 2026)
Testimony: Medi-Cal losses from Federal and State Budget Cuts (UC Labor Center, February 2026)
Webinar: Updates on H.R. 1 Impacts on Medi-Cal and CalFresh (California Health and Human Services, January 2026)
Job Losses
California Health Care Employment by District and County 2023 and California Could Lose Up to 217,000 Jobs if Congress Cuts Medicaid (UC Labor Center, Spring 2025)
Implementation Costs to Counties and Their Health Care Programs
Realignment and County Indigent Health Care Programs (California Legislative Analyst’s Office, March 2026)
H.R. 1 Impacts to Counties (California State Association of Counties)
Implementation Costs to California budget
First Look: Understanding the Governor’s 2026-27 May Revision (California Budget and Policy Center, May 2026)
Specific Impacts to Immigrants
ACA Turns 16 as Megabill’s Anti-Immigrant Stance Sets Path to End Coverage Gains Among People With Lawful Immigration Status (Center on Budget and Policy Priorities, March 2026)
Breaking Down the “One Big Beautiful Bill Act” and Its Impact on Immigrant Californians (California Immigrant Policy Center, July 2025)
