Here's a comparison of how Medicaid operates under current law versus the potential impacts of the Big Beautiful Bill (H.R. 1) in specific states:

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Medicaid Impact Comparison: Current Law vs. H.R. 1 (Big Beautiful Bill)

State	Current Law Highlights	Impact of H.R. 1	Notes
California	- Broad Medicaid expansion under ACA. - No work requirements. - Provides coverage for many non-citizens.	- Increased eligibility verification may lead to disenrollments, especially among non-citizens and those with unstable addresses.	Less likely to see drastic coverage loss but could experience some reductions due to stricter verification.
Texas	- No Medicaid expansion. - Limited eligibility; mainly pregnant women, children, disabled, elderly.	- Possible further reductions among the already limited population. - Work requirement enforcement may not significantly change coverage, but stricter citizenship verification could disqualify some non-citizens.	Significant potential for coverage loss among non-citizens and low-income adults if work requirements are enforced.
Florida	- No Medicaid expansion. - Limited optional coverage for certain low-income adults.	- Similar to Texas, potential disenrollments among non-citizens and those failing verification. - Possible increase in administrative barriers.	May see some reductions, especially in immigrant populations.
New York	- Medicaid expansion. - No work requirements. - State has protections against some federal restrictions.	- Possible minor reductions if federal verification measures are adopted.	Less impact expected, but some administrative changes could affect coverage.
Pennsylvania	- Expanded Medicaid under ACA. - No work requirements.	- Slight reductions if eligibility checks become more frequent.	State may implement protections to minimize disenrollment.
Illinois	- Expanded Medicaid. - No work requirements.	- Potential for some disenrollments due to increased verification.	State policies may mitigate impacts.
Georgia	- No Medicaid expansion. - Limited eligibility to specific populations.	- Significant impact likely, especially among low-income adults and non-citizens.	Work requirements could lead to disenrollment of those not meeting criteria.
Alabama	- No expansion. - Narrow eligibility.	- Similar to Georgia, potential for coverage reductions.	Stricter verification may disqualify some non-citizens and low-income adults.
Ohio	- Partial expansion. - No work requirements currently.	- Possible slight reductions; work requirements could be introduced.	State may face legal challenges if implementing new requirements.
Arizona	- Expansion state. - No work requirements.	- Possible small reductions due to verification, but protections may limit scope.	State’s existing infrastructure may help mitigate impact.

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Summary of Differences

Aspect	Current Law	H.R. 1 Impact
Eligibility Redeterminations	Less frequent, typically annual.	Increased frequency (e.g., every 6 or 12 months).
Work Requirements	Generally absent, except in some states.	Mandated for certain populations, leading to potential disenrollments.
Citizenship Verification	Existing verification processes; some states more lenient.	Stricter and more frequent verification, risking disqualification of some eligible individuals.
Coverage for Non-Citizens	Many states provide coverage for certain non-citizens, especially children and pregnant women.	Federal restrictions could limit or eliminate some coverage options.
Administrative Oversight	State discretion within federal guidelines.	Increased federal oversight and verification requirements.

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Conclusion

• States with expanded Medicaid (e.g., California, New York, Illinois, Arizona) currently enjoy broader coverage and protections; impacts from H.R. 1 could be relatively minor but may include some disenrollments due to stricter verification.
• States without expansion (e.g., Texas, Florida, Georgia, Alabama) are more vulnerable to coverage reductions, especially if work requirements and citizenship checks are enforced more stringently.

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