The Big Beautiful Bill was signed into law on July 4th and it has people on Medicaid wondering what it means and how it will impact them.

According to a report by KFF [1]

What Changed?

Fortunately for those in Florida, they won’t be affected by the new 80 hour per month work requirement imposed on other states that have expanded medicaid [2]. While that might be good in the short term, it may become difficult to expand medicaid in the future. Expanding medicaid means spending money on new systems, infrastructure, etc. Florida currently receives $22.6 billion of Medicaid funding from the federal government (65% of it’s total funding). The bill also removes a funding incentive for states who haven’t expanded already [3]. The bill plans to remove $1 trillion in Medicaid funding for all states over 10 years [4]. Another key factor is that Florida has low taxes. Losing federal funding, even though it’s a less amount compared to other states, means they don’t really have a way to recoup these funds by other means. Other states usually have higher taxes, but better funding so they have a bit more options compared to Florida to make up these lost funds.

Down The Line

By 2030, all baby boomers will be at least 65 years old, with 61 million seniors, most of them on Medicare. Low income/disabled seniors usually have Medicaid to help cover the costs that Medicare doesn’t fully cover. This means more strain on senior facilities and clinics. With these facilities being overpopulated, those uninsured or without Medicaid are left without options. Undocumented immigrants already don’t qualify for Medicaid, however some states, under certain circumstances, allowed undocumented immigrants non-emergency access to Medicaid. The government provided federal fund matching to states for Medicaid. Under the new bill, federal fund matching is now prohibited for undocumented immigrants. This as well as increasing eligibility requirements will lead to more uninsured population. More uninsured population means more financial burden on low income people that can’t afford it. This also means that hospitals/facilities will not have enough resources for everyone.

What are my options now?

If you're concerned about your Medicaid coverage in Florida, you should be aware of several options. First, check your eligibility status regularly as requirements may change. The Florida Department of Children and Families (DCF) provides resources and assistance for Medicaid recipients. In cases of emergencies, undocumented immigrants still have access to emergency Medicaid. Federally Qualified Health Centers (FQHCs) provide primary care to everyone, regardless of your income or immigration status, and charge on a sliding scale based on what you can afford. Check your community and see if you have one near your area. For those who may lose coverage, exploring healthcare marketplace options through Healthcare.gov could provide alternatives, though with the expiration of enhanced premium tax credits, costs may be higher than before.

Summary

This bill is focused on cutting spending by increasing requirements, and eliminating almost all together any assistance for undocumented immigrants, even some lawful residents/non-citizens. The unintended consequences are a major strain to hospitals/facilities especially by 2030 where baby boomers will mostly be all retired. Below are the major points affecting undocumented immigrants.

• Restricted ACA Marketplace Access: Access to ACA marketplace premium tax credits is now limited to a narrower group of "eligible aliens," including lawfully present/permanent residents and Cuban/Haitian entrants
• Stricter Verification for ACA Subsidies: The bill mandates that ACA Marketplaces must verify applicant information, including income, before subsidies can be applied to a coverage month.
• New Medicare Eligibility Limits: Medicare eligibility is restricted to U.S. citizens, lawful permanent residents, and a few other specific categories, which would exclude individuals with Temporary Protected Status or those with pending asylum claims.
• Reduced Funding for Emergency Care: The enhanced federal matching rate for emergency Medicaid services provided to certain non-citizens is eliminated, reducing federal support to states for this care. The bill also codifies that general Medicaid funds cannot be used for non-citizens beyond emergency care and a few other exceptions.
• Medicaid Expansion Disincentivized: The enhanced federal funding offered to states to expand their Medicaid programs will no longer be available to states that do not expand before January 1, 2026, making future expansion in Florida less likely.
• Expiration of Enhanced Premium Tax Credits

Sources:

[1] How Will the 2025 Reconciliation Bill Affect the Uninsured Rate in Each State?

[2] Big Beautiful Bill Sec. 71119 (2)

[3] Big Beautiful Bill Sec. 71114

[4] Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States