Recent changes to federal law through H.R. 1 (One Big Beautiful Bill Act) have raised questions and concerns among individuals with disabilities, their families, and service providers—particularly around how these changes could impact Medicaid and other public benefits. Below is a breakdown of key provisions in H.R. 1 and how they relate to individuals with disabilities.

H.R. 1 does not cut current Medicaid funding, but it slows the rate of future growth in Medicaid spending. This means federal Medicaid spending will still increase each year, though at a lower rate than previously projected. Importantly, the bill does not convert Medicaid into a block grant or impose per capita caps on spending. These were changes previously considered in other legislative proposals that would have significantly altered how services are funded. The current structure remains intact, which ensures continued support for services critical to the disability community.

The majority of changes in H.R. 1 focus on individuals who became eligible for Medicaid through the Affordable Care Act’s expansion. People with disabilities who are enrolled in traditional Medicaid programs—including those receiving Home and Community-Based Services (HCBS) waiver supports—are not included in the expansion group and remain eligible under the new law.

H.R. 1 introduces new eligibility redetermination requirements for the Medicaid expansion population. These individuals must now verify their eligibility every six months. While this change does not directly affect individuals enrolled in traditional Medicaid programs, concerns have been raised about the potential for some individuals with disabilities in the expansion group to lose coverage due to administrative hurdles.

Organizations like The Arc Alliance will continue to support individuals who have questions about this process and offer guidance where needed.

The new law also establishes an 80-hour per month community engagement requirement for individuals in the Medicaid expansion population. This can include work, job training, educational programs, or community service.

However, numerous exemptions are in place. Individuals who are:

        – Blind

        – Living with physical, intellectual, or developmental disabilities

        – Diagnosed with mental illness or substance use disorder

        – Living with serious or complex medical conditions

        – Disabled veterans

        – Parents or caregivers of individuals with disabilities are not subject to this requirement.

H.R. 1 also gradually reduces the allowable rates for Medicaid provider taxes, a financial mechanism states use to draw down federal Medicaid funds. However, provider taxes for nursing homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) are exempt from these reductions.

The law makes permanent certain provisions of the Achieving a Better Life Experience (ABLE) Act that were set to expire in 2026. ABLE accounts allow individuals with disabilities to save money in designated accounts without affecting their eligibility for Medicaid or other public benefits. These enhancements ensure that individuals can continue building financial security without risking access to vital services.

While H.R. 1 maintains many protections at the federal level, state-level implementation will play a significant role in how these changes affect individuals with disabilities in Pennsylvania. There is concern that state budget decisions could result in shifting resources away from disability services to maintain support for other populations impacted by H.R. 1.

Individuals who do not receive HCBS waiver services or Social Security benefits may be more susceptible to service disruptions as a result of new administrative requirements.