Welcome to the H.R. 1 Hub!
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When H.R. 1 became law in July 2025, Medicaid started changing. Work requirements, more frequent eligibility redeterminations and cost-sharing requirements are just a few of the changes being phased in over the next several years.
There’s a lot to learn. You need a trustworthy source of information to navigate the challenges and opportunities associated with H.R. 1 implementation. This hub for National Council for Mental Wellbeing members is that source.
The National Council’s vision is to make mental wellbeing — including recovery from substance use — a reality for everyone, everywhere. We work with National Council members to advance the field. And we empower community-based mental health and substance use care organizations to make a difference as visible, trusted and preferred providers defined by their commitment to access, quality, outcomes and innovation.
This page will be updated frequently with current and critical information, tools and opportunities to learn more. If you have other questions about H.R. 1 implementation, email Policy@TheNationalCouncil.org.
Explore H.R. 1 Implementation Resources
| Rural Health Transformation (RHT) Program |
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| RHTP Template Letter |
| Webinar Recording |
| Webinar Slides |
| Eligibility Redeterminations |
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| Overview of CMS Guidance on Eligibility Redeterminations |
Frequently Asked Questions
What is H.R. 1?
- H.R. 1 (also called the “One Big Beautiful Bill Act” or “Working Families Tax Cuts Act”) is federal budget legislation signed into law in July 2025. It includes major changes to the Medicaid program that will take effect over several years.
What major Medicaid policy changes does H.R. 1 introduce?
- Key policy updates include:
- New community engagement (“work”) requirements
- More frequent eligibility verification
- Reductions in retroactive coverage periods
- Changes to Medicaid state financing arrangements and error rate penalties
When will the H.R. 1 changes take effect?
- The National Council has outlined Medicaid policy changes in its H.R. 1 Implementation Journey Map and simplified H.R. 1 timeline. Most of the new or revised Medicaid requirements are being rolled out between 2026 and 2029.
- Impacts on states will vary based on each state’s Medicaid program. We expect to see individual states implement policies in response.
What are Medicaid community engagement or work requirements?
- Beginning in January 2027, certain Medicaid beneficiaries (generally, those in the expansion population) will need to work, participate in a work program, perform community service, attend school half-time, or do a combination of these activities for a specified number of hours each month to maintain eligibility, unless they meet the requirements for exemption.
- The Centers for Medicare and Medicaid Services is expected to release an interim final rule on implementing Medicaid work requirements by June 2026.
How will reverifying an individual’s Medicaid eligibility change?
- Beginning in January 2027, states that provide coverage for the expansion population will need to conduct eligibility reviews every six months rather than annually for these beneficiaries.
- The Centers for Medicare and Medicaid Services’ most recent guidance on implementing eligibility redetermination gives states two options to approach implementation
What challenges could Medicaid beneficiaries face during implementation?
- Some beneficiaries may experience:
- Uncertainty about whether new requirements apply to them.
- Confusion about new requirements and exemptions.
- Difficulty completing applications or renewals.
- Additional documentation requests.
- Delays in eligibility decisions and coverage.
How might H.R. 1 implementation impact National Council members?
- Administrative workload may increase.
- Reimbursement structures or service arrays may change, depending on new requirements that apply to a state and that state’s policy response.
- Patient coverage may shift because of eligibility changes, which may lead to increases in uncompensated care.
How should National Council members prepare for H.R.1 implementation?
We’re invested in your success—every step of the way.
- Monitor federal and state guidance. The National Council will continue to provide updates.
- Develop internal policies and protocols in response to program requirement changes.
- Review expenses that can be controlled now, such as infrastructure and administrative costs.
- Update eligibility and enrollment systems, and strengthen proactive eligibility and reporting navigation support systems where possible.
- Train staff on new policies and procedures.
- Educate clients about new work requirements and eligibility redeterminations.
- Consider opportunities for innovative partnerships and funding diversification.
- Establish systems to collect impact data over time.