A new law significantly reshapes Medicaid, introducing work requirements for enrollees aged 19-64 while exempting groups like pregnant women, the elderly, and disabled individuals, but increasing administrative burdens for many.

These Medicaid changes will have broad effects on the healthcare system, influencing costs, provider availability, and hospital operations, even for residents not directly enrolled.

Dubbed the 'One Big Beautiful Bill' (OBBBA), the legislation aims to cut $1 trillion in Medicaid and CHIP spending over nine years, impacting millions of Americans.

The timeline for implementation stretches from measures already in place to upcoming requirements in 2026, 2027, and 2028, affecting enrollment, verification, and benefits.

Starting in October 2028, Medicaid recipients in certain income brackets may face copays up to $36 per service, with some states like New Hampshire already implementing premiums.

The law also affects pregnant women, women’s health services, and immigrant eligibility, with many non-citizen lawful immigrants losing eligibility unless from specific countries such as Cuba and Haiti.

In New Hampshire, over 182,000 residents are enrolled in Medicaid, including many children and nursing home residents, with the state's Medicaid expansion at risk due to federal funding cuts.

Medicaid recipients will now need to verify their eligibility every six months, doubling the current requirement and adding bureaucratic complexity.

It is projected that 11.8 million people will lose Medicaid coverage over the next decade, mostly due to administrative hurdles rather than ineligibility, with an additional 4.8 million losing benefits because of new work rules.

Major reforms include work requirements, stricter eligibility checks, reduced federal funding to states, and the elimination of certain benefits like retroactive coverage and streamlined enrollment.

Medicaid primarily covers low-income individuals, pregnant women, the elderly, and disabled persons, distinguishing it from Medicare, which mainly covers those over 65 and is federally managed.