Last Updated: November 21, 2025

H.R. 1 was passed on July 4, 2025, and includes significant funding cuts and policy changes to Medicaid and the ACA marketplace, physician payment, and medical student loans. Below is information to help you understand the impact of H.R. 1, specifically tying work requirements to Medicaid eligibility as well as resources for you to utilize in your advocacy to your state agencies and governor.

The Secretary of Health and Human Services (HHS) is required to issue an interim final rule on implementing and setting standards for community engagement requirements by June 1, 2026.

In addition, the Centers for Medicare & Medicaid Services (CMS) announced on July 17, 2025, that it would not approve or extend Section 1115 demonstration waivers for workforce initiatives, which use Medicaid dollars to fund job training or employment-related activities. According to CMS, California, Massachusetts, New York, North Carolina, and Vermont are currently operating such waivers, and CMS will allow those initiatives to expire.

• Timeline of Select Provisions of H.R. 1
• Overview of the Medicaid Community Engagement Requirements
• State Landscape of Work Requirements
• Talking Points When Speaking with State Medicaid Directors or Governors Offices
• Sample Letters and Communications
• Additional Resources