Recent changes to federal law through H.R 1 (One Big Beautiful Bill Act) have generated concerns among individuals with disabilities and their families—particularly regarding how it might affect Medicaid and other public benefits. To help you understand this new law, Achieva staff reviewed the changes and have found that individuals with disabilities who rely on Medicaid-funded home and community-based services (HCBS) and Social Security benefits, are protected.
Here’s a breakdown of key issues in H.R. 1 and how they impact people with disabilities:
Medicaid Funding and Structure:
Although H.R. 1 does not cut current Medicaid funding, it slows down how fast Medicaid spending will grow in the future. This means the government will still spend more on Medicaid each year—but not as much as was originally expected.
Also, the bill does not change Medicaid into a block grant (a set amount of money given to states) or set a limit on spending per person. That’s good news for the disability community who were worried such changes might reduce funding for services they depend on.
Impact on the Expansion Population:
Most of the changes in H.R. 1 are directed at individuals who became eligible for Medicaid under the Affordable Care Act’s Medicaid expansion. People with disabilities enrolled in traditional Medicaid programs, including those receiving home and community-based services (HCBS waiver services), are not part of the expansion group and remain eligible under H.R. 1.
Eligibility Redetermination Requirements:
H.R. 1 introduces new Medicaid eligibility verification requirements every six months for the Medicaid expansion population. Individuals with disabilities in traditional Medicaid programs, including HCBS waiver services, are not directly impacted by this change. Concerns still remain that some people with disabilities in the expansion group could lose coverage if they are unable to comply with the new administrative requirements. Achieva will assist people with disabilities who have questions about this and continue advocating with policymakers to ensure people are supported with this process.
Work and Community Engagement Requirements:
The law includes an 80-hour per month community engagement requirement (any combination of work, work program, education program, or community service) for the Medicaid expansion population. However, this requirement is exempt for individuals who are blind, have physical, intellectual, or developmental disabilities, have mental illness or a substance use disorder, have serious or complex medical conditions, are disabled veterans, or are parents or caregivers of people with disabilities.
Provider Tax Adjustments:
H.R. 1 phases in reductions to Medicaid provider tax rates, a mechanism many states use to generate additional federal Medicaid funding. Notably, provider taxes for nursing homes and Intermediate Care Facilities (for individuals with intellectual disabilities or other related conditions) are exempt from these reductions.
ABLE Act Improvements:
The law also makes permanent certain enhancements to the Achieving a Better Life Experience (ABLE) Act that were previously set to expire in 2026. The ABLE program allows individuals with disabilities and others to save money and build financial resources in special accounts (for the benefit of the person with a disability) without those assets affecting the person’s eligibility for Medicaid or other public benefits.
Looking Ahead in Pennsylvania
Although H.R. 1 includes many protections for people with disabilities at the federal level, how the new law is implemented at the state level will be critical. In Pennsylvania, for example, there are concerns that budget decisions by the governor and legislature could shift funding away from disability services to maintain services for other populations impacted by H.R. 1. Additionally, individuals with disabilities who do not use HCBS waiver services or receive Social Security benefits may be more vulnerable to disruptions in services due to some of the new requirements. Achieva will continue to monitor the budget and policy decisions being made in Harrisburg over the next many months and years and will share information and opportunities for advocacy.
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