The "Big Beautiful Bill" brings major changes and cuts to both Medicare and Medicaid, affecting eligibility, funding, and requirements. Here’s a breakdown of the most important changes: Medicare: Key Changes and New Qualifications Automatic Funding Cuts: Medicare faces an automatic 4% funding cut (about $500 billion over eight years starting in 2026) due to budget caps in the bill. This could result in reduced payments to providers, fewer covered services, or higher out-of-pocket costs for beneficiaries unless Congress intervenes. Eligibility Changes for Noncitizens: Only U.S. citizens, lawful permanent residents, certain Cuban immigrants, and individuals from Compact of Free Association nations remain eligible. The bill eliminates eligibility for undocumented immigrants and narrows which noncitizens can receive benefits. The Senate version also allows some Haitian immigrants to qualify. Medicaid: Key Changes and New Qualifications Massive Funding Cuts: Medicaid will see $1 trillion in federal cuts over ten years, which could result in up to 12 million people losing coverage by 2034. Expansion states (those that broadened Medicaid under the ACA) will be hit hardest, with more uninsured and uncompensated care. Mandatory Work Requirements: Most adults ages 19–64 in the ACA Medicaid expansion population must now work, volunteer, or participate in job training at least 80 hours per month to qualify or maintain coverage. Exemptions: American Indians, veterans with disabilities, medically frail individuals, and parents of children under 14 or of a disabled child. States must re-evaluate compliance at least every six months. Failure to meet requirements results in disenrollment. Recertification and Administrative Burden: Expansion adults must recertify eligibility every six months, increasing paperwork and the risk of losing coverage for procedural reasons. Cost-Sharing: Expansion adults above the poverty line may face up to $35 in cost-sharing per visit for most services. Noncitizen Restrictions: The bill narrows which noncitizens can get full Medicaid. Humanitarian entrants (like many refugees and asylum seekers) lose eligibility; only lawful permanent residents, Cuban/Haitian entrants, and Compact of Free Association residents remain eligible. Federal Recoupment: The federal government can reclaim funds from states for payments made to individuals whose eligibility can’t be confirmed, disproportionately affecting noncitizens with pending status. Reduced Federal Support for Emergency Care: The federal match rate for emergency Medicaid for undocumented immigrants is reduced, shifting costs to states and providers. MAGA Upset with Donald Trump Over Big Beautiful Bill Lies