House of Representatives Passes Massive Spending Bill with Major Medicare and Medicaid Reforms

Sarah Hohman, Director of Government Affairs, NARHC & Mo Sullivan, Government Affairs Associate, NARHC

Early this morning, the House of Representatives narrowly passed a massive tax and spending bill by a vote of 215-214. The bill now advances to the Senate for a vote, where it requires only a simple majority to pass under the reconciliation process.

Every House Democrat voted against the bill, along with Republican Representatives Warren Davidson of Ohio and Thomas Massie of Kentucky.

The over 1,000-page bill combines legislation from various committees. Let’s discuss the most important provisions for RHCs.

Medicaid

• Work Requirements: The bill introduces new work requirements for Medicaid beneficiaries set to take effect by December 31, 2026. Beneficiaries aged 19-65 are required to work at least 80 hours per month, but exemptions are made for caregivers of children, people with disabilities, pregnant people, and others able to prove the need for an exemption. The work requirements were originally slated to take effect in 2029, so this bump in timeline is expected to impose challenges for states as they implement and comply with these requirements.
•  Increased Eligibility Checks: The bill increases the frequency of eligibility checks from one year to every 6 months.
• Cost-Sharing: The bill requires states to impose cost-sharing for Medicaid Expansion individuals with incomes over 100% of the poverty line beginning October 2028. This new requirement adds a component of administrative burden for providers, as they would be responsible for determining patient eligibility for costsharing. While the legislation exempts cost-sharing for primary care services, the bill language is unclear whether this exemption applies to RHC services. NARHC is engaged in advocacy efforts to ensure RHC services are included in the exemption.

The Congressional Budget Office has estimated that at least 7.6 million Americans will be uninsured over the next decade as a result of these provisions. Some of that is due to changes in eligibility, crack downs on ‘waste, fraud, and abuse,’ while other coverage losses will likely be because of administrative red-tape for otherwise eligible beneficiaries.

Sequestration

This legislation increases the overall deficit by over $2 trillion. This will trigger the Pay-As-You-Go (PAYGO) Act, which automatically reduces federal spending when Congress passes legislation that adds to the deficit. Medicare sequestration from PAYGO would be capped at a 4% cut if this passes the Senate and is signed into law.

In other pieces of legislation that have increased the deficit, Congress has elected to “waive” PAYGO. However, if they do not, the Congressional Budget Office estimates a resulting $500 billion+ in Medicare cuts over the next 10 years.

We encourage everyone with questions to register for NARHC’s upcoming members-only webinar on Thursday, May 29th at 2PM: Trump’s First 100 Days and What’s to Come – Policy Updates for RHCs. NARHC’s DC Team will discuss the latest on reconciliation, President Trump’s FY26 budget proposal, the Department of Health and Human Services (HHS) organizational restructuring, and more. Register here!

The bill will likely reach the Senate floor following next week’s Memorial Day recess where it is expected to be further modified.

Stay tuned for upcoming advocacy opportunities to convey to the Senate the significant impact these changes may have on RHCs and the communities they serve.

With any questions, please contact Sarah at Sarah.Hohman@narhc.org or Mo at Mo.Sullivan@narhc.org.

Sincerely,

National Association of Rural Health Clinics