Medicaid Cost Sharing Changes Under the One Big Beautiful Bill Act (OBBBA)

The report examines how the One Big Beautiful Bill Act (OBBBA) changes Medicaid cost sharing for certain low-income adults in expansion states, while leaving many existing protections intact. Although the law requires some cost sharing for enrollees between 100 percent and 138 percent of the federal poverty level, it gives states broad flexibility in how to implement these changes. The analysis emphasizes that even small out-of-pocket costs can create barriers to care, especially for midlife adults (50-64) who tend to use more health care services than younger populations. It ultimately urges states to minimize cost sharing and strengthen consumer protections to preserve access to essential health services.

Read the full report. 

Key Takeaways:

• OBBBA changes Medicaid cost sharing requirements for the 41 states (including DC) that expanded Medicaid under the Affordable Care Act. Depending on state implementation decisions, some of these changes could result in higher out-of-pocket costs, whereas others may lower expenses for Medicaid enrollees.
• Fourteen states currently impose cost sharing in compliance with OBBBA requirements and will likely not need to make changes.
• Four states will need to lower cost sharing on at least one service, and one state will need to discontinue premiums.
• OBBBA eliminates cost sharing for certain commonly used services and providers.

Note: This is article was published by AARP by Andrea Callow , AARP Public Policy Institute, covering Medicare for AARP, and brought to you by the RJ Fichera Law Firm , where our mission is to provide trusted, professional legal services and strategic advice to assist our clients in their personal and business matters. Our firm is committed to delivering efficient and cost-effective legal services focusing on communication, responsiveness, and attention to detail. For more information about our services, contact us today ! 

Callow, Andrea. Medicaid Cost Sharing Changes Under the One Big Beautiful Bill Act (OBBBA): A Comprehensive Review of Policies in 41 Expansion States. Washington, DC: AARP Public Policy Institute, April 13, 2025. https://doi.org/10.26419/ppi.00403.001

Content in this material is for general information only and is not intended to provide specific advice or recommendations for any individual.

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