Settlement bill schedule extends into the future, providing some opportunities for corrections

On July 4, President Trump signed a harmful Republican budget settlement bill, becoming law. But this does not mean that every regulation will take effect immediately. Instead, implementation has lasted for many years, with many of the most controversial aspects lowering after future elections.

Below, we explore some of these timelines, focusing only on health-related aspects of bills that may affect Medicare people. This is not an exhaustive list. The National Health Law Program and the National Institute of Health Policy provide a more detailed analysis and extensive timetable on the numerous provisions of the law.

Regulations that come into effect immediately or in the short term

Reject health insurance coverage

After the bill was enacted, the bill immediately restricted the new Medicare coverage, denying admissions to those with legal immigration status, unless they are citizens, green card holders, they are from Cuba, Haiti, Haiti or the Freedom Association (COFA) countries (COFA) countries (Marshall Islands of Marshall Islands, Marshall Islace of Micronesia, Microseia and Issuproimia and Microseia and Indupertiatia and Microseia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia and Indupertiatia

The law will terminate existing coverage within 18 months because those who are not suitable for one of them and have already enrolled. The population will also not be able to participate in Medicaid or receive any Affordable Care Act (ACA) cost assistance.

For more information on many immigration provisions in the law, please see the Interpreter of the National Center for Immigration Law.

Prohibit important rules enforcement

Signed immediately, the law prevented the implementation of three rules. Two of these rules make it easier for people to obtain and retain Medicaid and Medicare Saving Plans (MSPs) by simplifying these systems. The Congressional Budget Office (CBO) expects that without these modernizations, while still eligible, nearly 1.4 million low-income people in low-income Medicare will lose MSP coverage. People with Medicare struggle to participate or retain Medicaid or MSP face lower social security checks, higher costs of coverage and prescription medications, and fewer opportunities for care.

The law also immediately blocks the enforcement of nursing home staffing rules, which require nursing homes to have enough staff on site to protect residents’ health and safety.

Automatically cut medical insurance

By stoking national deficits, the law will trigger $500 billion in mandatory Medicare cuts over the next decade, including a $45 billion reduction only next year – unless Congress steps in to prevent them.

After the 2026 midterm elections

Medicaid work report requirements

One of the most controversial aspects of the law, requiring states to establish and implement work report requirements for personnel coverage through the expansion of Medicaid, will take effect after mid-2026 on January 1, 2026. Most people are covered by those who are expanded Medicaid work or are part of one of the statutory exemptions, but this provision may knock out many qualified people as they will strive to provide the right paperwork and meet arbitrary, duplicate and strictly strict deadlines.

Limit retrospective Medicaid coverage

On January 1, 2027, the new law reduced retrospective Medicaid coverage, making people more likely to face non-coverage periods. For those with traditional Medicaid, its expansion population will drop from 3 months to 1, from 3 months to 2 months. This means that new enrollees may encounter unpaid medical expenses that they qualify for Medicaid but have not yet applied for. This also means that providers, especially hospitals, may end up in trouble with unpaid care.

Redetermination of population needs to be redetermined twice a year

Currently, Medicaid expansion must be re-established every 12 months. Starting from January 1, 2027, this burden will increase significantly – they will face re-determination twice a year. This will increase the rate of churn and uninsurance due to those who are still eligible for paperwork.

Long-term changes

Some of the most significant funding changes in the bill are gradually taking effect, but are likely to lead to devastating Medicaid changes at the state level. This includes restrictions on how states use provider taxes to help pay Medicaid costs and state-guided payments, as well as policies that will further undermine direct care workers.

Cutting money triggers the loss of optional services like HCBS

Because the bill transfers Medicaid costs to states that have been extended, many or all states may be forced to cut optional Medicaid services or eligibility. Special concern is home and community services (HCB), which allows people to age safely. HCBS services, such as those who attend the home with a direct daily caregiver, are optional benefits that states can choose not to cover. So, just like the past, they may be like the past.

Unlike HCB, the state must provide insurance for nursing homes. This means that people who need this level of care may be forced into the institution because they cannot live safely at home and in the community without the support provided by HCBS. It is troublesome that this care may not be very safe without the nursing home staffing rules discussed above.

Rural hospitals

Due to direct reductions in the law and its ripple effects, especially the risks of rural hospitals. States will be less able to bridge the existing gap in Medicaid funding, which will widen as further cuts take effect. These growing shortages, coupled with the surge in uninsured rates, could undermine the costs of rural communities.

Destroy direct care staff

Direct caregivers will be severely affected as money is squeezed out of Medicaid. This labor force has been abandoned due to years of low wages and long-term losses. Many workers are also covered by Medicaid, meaning that the traditional Chinese tapes and administrative pitfalls highlighted above may directly affect their own access to affordable care.

Expected advocacy opportunities

As these and other changes take effect, advocacy and participation remain critical. On Medicare rights, we expect an opportunity to impact implementation at the state and federal level, and we remain committed to doing so in a way that prioritizes the health and well-being of current and future Medicare participants.