SUMMARY

Medicaid is the joint state -federal program created in 1965 that provides free or low -cost health care to about 70 million Americans, including low-income elderly people and those living with disabilities. The changes in the 2025 legislation, also known as the One Big Beautiful Bill or H.R. 1, affect eligibility standards for the program and changes in the way states can finance their portion of Medicaid costs.

On this episode, we’re joined by two policy experts on Medicaid. Kathryn Costanza is a fellow at NCSL who closely follows Medicaid policy and Neda Jasemi is a senior policy analyst at the National Association of Medicaid Directors. They both sat down to talk about the significant changes in Medicaid that were included in the 2025 Budget Reconciliation Act. 

Jasemi discussed the challenges state legislatures will face as they craft budgets for Medicaid in their states while facing significant uncertainty about both revenue and how many people will be signed up in their state. Costanza explained the ins and outs of provider taxes and how that will affect state revenue intended for Medicaid costs. She also talked about what we know about the new rules and how they will affect the number of people who will qualify for coverage. 

Resources

• How Medicaid Provider Taxes Work: An Explainer, National Association of Medicaid Directors
• Medicaid’s Next Chapter, National Association of Medicaid Directors
• Medicaid Road Ahead: Policy Options and Budget Impacts | Webinar Series, NCSL
• The Medicaid Puzzle: Piecing Together Policies for a Balanced Budget, NCSL 
• Medicaid Road Ahead: Policy Options and Budget Impacts, NCSL 
• Medicaid Toolkit, NCSL
• National Association of Medicaid Directors
• OBBBA Medicaid Policy Timeline, National Association of Medicaid Directors
• Why did they do it that way? Medicaid Financing, National Association of Medicaid Directors
• Medicaid Financing 101, NCSL