In this PYA Summer CPE Symposium session, Ramzi Fadayel and Patrick Birmingham discuss Medicaid and state tax implications associated with the One Big Beautiful Bill Act, referred to in the presentation as OB3. The Medicaid portion covers provider taxes, state-directed payments, community engagement requirements, Medicare DSH, 340B, retroactive coverage, cost sharing, and other related provisions.

The state tax portion addresses how states may respond to federal Medicaid funding pressure, including spending cuts, tax increases, reserves, decoupling from federal tax provisions, and selected state tax case studies.