/ en Wed, 06 Aug 2025 23:55:12 -0500 Mon, 28 Jul 25 15:43:12 -0500 /advisory/2025-07-03-key-highlights-final-one-big-beautiful-bill-act <div class="container"><div class="row"><div class="col-md-8"><p>The Senate July 1, and the House July 3, passed a budget reconciliation bill, the <a href="https://sponsors.aha.org/rs/710-ZLL-651/images/07032025-Legis-language-h1_eas.pdf" target="_blank" title="Full text of the One Big Beautiful Bill Act (OBBBA) PDF.">One Big Beautiful Bill Act (OBBBA)</a>, H.R. 1, a sweeping package that enacts many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction. The bill includes significant policy changes to Medicaid and the Health Insurance Marketplaces.</p><p>The Medicaid program provides health insurance coverage for 72 million Americans, including children, pregnant women, the elderly, the disabled and millions of working Americans. According to the <a href="https://www.cbo.gov/publication/61534" target="_blank" title="Congressional Budget Office: Estimated Budgetary Effects of an Amendment in the Nature of a Substitute to H.R. 1, the One Big Beautiful Bill Act, Relative to CBO's January 2025 Baseline">Congressional Budget Office</a> (CBO) score of a draft version of the Senate bill, the OBBBA will lead to nearly $1 trillion in Medicaid cuts and result in more than 11.8 million people losing Medicaid and health insurance marketplace coverage.</p><p>Historically, provider taxes and state-directed payments (SDPs) allow hospitals to bridge the chronic and historic underpayment by Medicaid for the care they deliver. The legislation includes limitations on the use of provider taxes and SDPs. The CBO score for the policy changes related to SDPs and provider taxes is $340 billion and will result in direct decreases in hospital payments. The AHA estimates that the provider tax changes alone will result in a loss of federal payments to hospitals of $232 billion over 10 years.</p><h2>AHA Statement</h2><p>In a <a href="/press-releases/2025-07-03-aha-statement-house-passage-one-big-beautiful-bill-act" target="_blank" title="AHA Statement on House Passage of One Big Beautiful Bill Act">statement</a> shared with the media following passage in the House July 3, AHA President and CEO Rick Pollack said, “Today is an extremely disappointing and very difficult day for health care in America. Despite months of clearly demonstrating the implications that these Medicaid proposals will have on the patients and communities we serve, especially the most vulnerable populations, Congress has enacted cuts of nearly a trillion dollars to the Medicaid program. No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage — cannot be simply dismissed as waste, fraud, and abuse. The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.</p><p>“The AHA remains committed to working with all stakeholders to mitigate the impact of these cuts wherever possible. Our goal is to help ensure hospitals can remain open for their communities, and people can get the care they need when they need it. Our nation’s health and economic future depend on it.”</p><h2>AHA Summary of OBBBA Provisions Impacting Hospitals and Health Systems</h2><h3>SUBTITLE B — HEALTH</h3><h3>Chapter 1 — Medicaid</h3><h3><em>Subchapter A — Reducing Fraud and Improving Enrollment Processes</em></h3><h4>Section 71101: Moratorium on Implementation of Medicaid Savings Program Eligibility and Enrollment Rule (Effective from enactment through Sept. 30, 2034)</h4><p>Prohibits the Department of Health and Human Services (HHS) Secretary from implementing, administering or enforcing the amendments made by the Medicare Savings Program (MSP) rule for 10 years. This would rollback requirements that states 1) automatically enroll certain Supplemental Security Income recipients in the qualified Medicare beneficiary eligibility group of the MSP program, 2) use data from the low-income subsidy program as an application for MSPs and align the family size definitions between the MSP and Low Income Subsidy programs, and 3) accept self-attestation for certain types of income and resources. CBO estimates that this provision will result in a $85.3 billion reduction in federal spending over 10 years.</p><h4>Section 71102: Moratorium on Implementation of Medicaid, CHIP and Basic Health Program Eligibility and Enrollment Rule (Effective from enactment through Sept. 30, 2034)</h4><p>Prohibits the HHS secretary from implementing, administering or enforcing the amendments made by the provisions of the eligibility and enrollment rule for 10 years. This would limit states’ ability to use other data sources (such as payroll or state vital statistics data) to determine an individual’s eligibility for Medicaid and limit states’ use of prepopulated renewal forms. It also would allow states to impose annual and/or lifetime limits on Children’s Health Insurance Program (CHIP) benefits and to disenroll CHIP beneficiaries for failure to pay premiums or enrollment fees. CBO estimates that this provision will result in a $81.6 billion reduction in federal spending over 10 years.</p><h4>Section 71107: Eligibility Redeterminations (Effective Jan. 1, 2027)</h4><p>Requires states to redetermine eligibility once every six months for beneficiaries enrolled through the Medicaid expansion eligibility pathway, beginning in calendar year (CY) 2027. The HHS secretary must issue guidance related to implementing the rule no later than 180 days after enactment. The bill appropriates $75 million to the Centers for Medicare & Medicaid Services (CMS) administrator for fiscal year (FY) 2026 for implementation of the provisions. CBO estimates that this provision will result in a $62.6 billion reduction in federal spending over 10 years.</p><h4>Section 77109: Alien Medicaid Eligibility (Effective Oct. 1, 2026)</h4><p>Restricts eligibility for Medicaid to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. The bill appropriates $15 million to the CMS administrator for FY 2026 for implementation of the provisions. CBO estimates that this provision will result in a $6.2 billion reduction in federal spending over 10 years.</p><h4>Section 7110: Expansion FMAP for Emergency Medicaid (Effective Oct. 1, 2026)</h4><p>Beginning Oct. 1, 2026, the bill limits the Federal Medical Assistance Percentage (FMAP) to the state’s traditional FMAP for emergency Medicaid services provided to unlawfully present aliens who, except for their immigration status, would qualify for Medicaid expansion. The bill appropriates $1 million for FY 2026 to the CMS administrator for implementation of the provision. CBO estimates that this provision will result in a $28.2 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter B — Preventing Wasteful Spending</em></h3><h4>Section 71111: Moratorium on Implementation of Rule Relating to Staffing Standards for Long-term Care Facilities Under the Medicare and Medicaid Programs (Effective from enactment through Sept. 30, 2024)</h4><p>Prohibits HHS from implementing the Minimum Staffing Standards for long-term care facilities and the Medicaid Institutional Payment Transparency Reporting regulation for 10 years. CBO estimates that this provision will result in a $23.1 billion reduction in federal spending over 10 years.</p><h4>Section 71112: Reducing State Medicaid Costs (Effective Jan. 1, 2027)</h4><p>Limits the timeframe for retroactive Medicaid and CHIP eligibility to 30 days prior to the application date for expansion enrollees, and 60 days prior to the application date for traditional enrollees, as opposed to the current 90-day period. CBO estimates that this provision will result in a $4.2 billion reduction in federal spending over 10 years.</p><h4>Section 71113: Federal Payments to Prohibited Entities (Effective on enactment into 2026)</h4><p>Prohibits states from receiving federal matching funds for services rendered by providers who provide abortions (other than Hyde Amendment exceptions) and receive more than $800,000 in Medicaid payments in 2023. This applies to not-for-profit, essential community providers primarily engaged in family planning services, reproductive health and related medical care. This provision applies for one year, beginning on the date of enactment. The bill appropriates $1 million for FY 2026 to the CMS administrator for implementation of the provisions. CBO estimates that this provision will result in a $52 million increase in federal spending over 10 years.</p><h3><em>Subchapter C — Stopping Abusive Financing Practices</em></h3><h4>Section 71114: Sunsetting Increased FMAP Incentive. (Effective Jan. 1, 2026)</h4><p>Repeals the ability for states that have not yet expanded Medicaid to receive 5% enhanced FMAP funds should they later choose to expand. CBO estimates that this provision will result in a $13.6 billion reduction in federal spending over 10 years.</p><h4>Section 71115: Provider Taxes (Freeze effective upon enactment; reduction begins Oct. 1, 2027)</h4><p>Freezes existing provider taxes imposed by a state or local unit of government as of the date of enactment. Removes the ability of a state or local unit of government to impose a new provider tax after enactment by setting the “hold harmless threshold” at 0%. Beginning in FY 2028, the hold harmless threshold for <strong>expansion states</strong> with an existing tax will be reduced by 0.5% annually until the threshold reaches 3.5% in 2032. Provider taxes in non-expansion states and provider taxes imposed on nursing homes and intermediate care facilities will remain frozen at their rates as of enactment. The bill appropriates $20 million for FY 2026 to the CMS administrator for implementation of the provisions. CBO estimates that this provision will result in a $191.1 billion reduction in federal spending over 10 years.</p><h4>Section 71116: State-directed Payments (SDP cap effective on enactment; reduction effective by the rating period on or after Jan. 1, 2028)</h4><p>Caps SDPs at 100% of the total published Medicare rate in expansion states and 110% of the total published Medicare rate in non-expansion states. SDPs approved (or where there was a good faith effort to be approved) by May 1, 2025, and SDP payments for rural hospitals approved (or where there was a good faith effort to be approved) by enactment will be grandfathered in at a higher rate. Completed preprints for SDPs can be submitted until enactment and may be grandfathered in at a higher rate. Beginning with the rating period on or after Jan. 1, 2028, all grandfathered SDPs would be reduced by 10 percentage points annually until the specified Medicare payment rate limit is achieved. The total published Medicare rate is defined as provided in 438.6(a) of title 42 of the Code of Federal Regulations or any future regulation that replaces it. Rural hospitals are defined as those located in a rural area, treated as being in a rural area, or located in a rural census tract, as well as critical access hospitals, sole community hospitals, Medicare-dependent hospitals, low-volume hospitals and rural emergency hospitals. The bill appropriates $7 million for each FY between 2026 and 2033 for the implementation of the provision. CBO estimates that this provision will result in a $149.4 billion reduction in federal spending over 10 years.</p><h4>Section 71117: Requirements Regarding Waiver of Uniform Tax Requirement for Medicaid Provider Tax (Effective upon enactment)</h4><p>Modifies the requirements regarding the uniformity of provider taxes and, specifically, whether a state’s tax is considered “generally redistributive.” A tax will not be considered generally redistributive if:</p><ol type="a"><li>Lower-volume Medicaid health care entities are taxed at a lower rate than higher-volume Medicaid health care entities.</li><li>High Medicaid volume health care entities are taxed more heavily than non-Medicaid health care entities.</li><li>The tax establishes any target or exclusion related to a health care entity’s Medicaid participation status.</li></ol><p>The HHS secretary will determine an applicable transition period (up to three years) for taxes considered not generally redistributive. CBO estimates that this provision will result in a $34.6 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter D — Increasing Personal Accountability</em></h3><h4>Section 71119: Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals (Effective Dec. 31, 2026)</h4><p>Requires certain nonpregnant, nondisabled adult Medicaid beneficiaries to meet certain community engagement requirements (work requirements) beginning Dec. 31, 2026. Individuals must work or engage in qualifying activities (e.g., community service, educational programs, job training) for no less than 80 hours per month. The legislation exempts, among other groups, parents, guardians and caretaker relatives of children aged 14 or under, or disabled individuals. States are permitted to receive temporary exemptions with HHS approval. The legislation limits the types of entities that can contract with states to help implement this provision, effectively barring Medicaid managed care plans from assisting. The bill provides $200 million in FY 2026 for state implementation and $50 million for federal administration. CBO estimates that this provision will result in a $325.8 billion reduction in federal spending over 10 years.</p><h4>Section 71120: Modifying Cost-sharing Requirements for Certain Expansion Individuals Under the Medicaid Program (Effective Oct. 1, 2028)</h4><p>Requires Medicaid expansion enrollees with incomes above 100% of the federal poverty level to pay up to $35 in cost sharing per service. Cost sharing for non-emergency services provided in a hospital emergency department may exceed $35. The provision will exclude certain services, including primary care, pregnancy-related services, mental health or substance use disorder services. Total cost sharing may not exceed 5% of family income. CBO estimates that this provision will result in a $7.5 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter E — Expanding Access to Care</em></h3><h4>Section 71121: Making Certain Adjustments to Coverage of Home or Community-based Services Under Medicaid (Effective July 1, 2028)</h4><p>Provides states with the option to pursue a standalone waiver under section 1915(c) and expand access to home and community-based services. The bill appropriates $50 million for FY 2026 to the HHS secretary for implementation of the provisions. Further, the bill appropriates $100 million for FY 2027 for making payments to states delivering home or community-based services. CBO estimates that this provision will result in a $6.6 billion increase in federal spending over 10 years.</p><h3>Chapter 2 — Medicare</h3><h3><em>Subchapter A — Strengthening Eligibility Requirements</em></h3><h4>Section 71201: Limiting Medicare Coverage of Certain Individuals (Effective 18 months from enactment)</h4><p>Restricts eligibility for Medicare for non-citizens to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. CBO estimates that this provision will result in a $5.1 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter B — Improving Services for Seniors</em></h3><h4>Section 71202: Temporary Payment Increase Under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances (Effective Jan. 1, 2026)</h4><p>Provides a rate update to the Physician Fee Schedule of 2.5% for calendar year (CY) 2026 only. There is no adjustment for CY 2025. CBO estimates that this provision will result in a $1.9 billion increase in federal spending over 10 years.</p><h4>Section 71203: Expanding and Clarifying the Exclusion for Orphan Drugs Under the Drug Price Negotiation Program (Effective Jan. 1, 2028)</h4><p>Modifies the Inflation Reduction Act to exclude orphan drugs under the Drug Price Negotiation Program. CBO estimates that this provision will result in a $4.9 billion increase in federal spending over 10 years.</p><h3>Chapter 3 — Health Tax</h3><h3><em>Subchapter A — Improving Eligibility Criteria</em></h3><h4>Section 71301: Permitting Premium Tax Credit Only for Certain Individuals (Effective Jan. 1, 2027)</h4><p>Restricts eligibility premium tax credits for marketplace coverage for non-citizens to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. CBO estimates that this provision will result in a $69.8 billion reduction in federal spending over 10 years.</p><h4>Section 71302: Disallowing Premium Tax Credits During Periods of Medicaid Ineligibility Due to Alien Status (Effective Jan. 1, 2026)</h4><p>Disallows undocumented immigrants who report income below 100% of the federal poverty level and are in their five-year Medicaid waiting period (due to immigration status) from receiving premium tax credits to purchase health insurance on the marketplaces. CBO estimates that this provision will result in a $49.5 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter B — Preventing Waste, Fraud and Abuse</em></h3><h4>Section 71303: Requiring Verification of Eligibility for the Premium Tax Credit (Effective Jan. 1, 2028)</h4><p>Prohibits an individual from claiming the premium tax credit if the individual’s eligibility related to income, enrollment and other requirements is not actively verified annually. This will prohibit automatic reenrollment for enrollees receiving premium tax credits by requiring them to actively prove tax credit eligibility each year. CBO estimates that this provision will result in a $36.9 billion reduction in federal spending over 10 years.</p><h4>Section 71304: Disallowing Premium Tax Credit in Case of Certain Coverage Enrolled in During the Special Enrollment Period (Effective Jan. 1, 2026)</h4><p>Prohibits individuals from receiving premium tax credits if they enroll in health coverage on the marketplace through a special enrollment period associated with their income. CBO estimates that this provision will result in a $39.5 billion reduction in federal spending over 10 years.</p><h4>Section 71305: Eliminating Limitation on Recapture of Advance Payment of Premium Tax Credit (Effective Jan. 1, 2026)</h4><p>Removes the repayment limits and requires affected individuals to reimburse the Internal Revenue Service for the full amount of excess tax credit received. CBO estimates that this provision will result in a $17.3 billion reduction in federal spending over 10 years.</p><h3><em>Subchapter C — Enhancing Choice For Patients</em></h3><h4>Section 71306: Permanent Extension of Safe Harbor for Absence of Deductible for Telehealth Services (Effective Jan. 1, 2025)</h4><p>Provides a safe harbor to allow telehealth services to be provided pre-deductible for patients with high-deductible health plans. CBO estimates that this provision will result in a $4.3 billion reduction in federal revenue over 10 years.</p><h4>Section 71307: Allowance of Bronze and Catastrophic Plans in Connection with Health Savings Accounts (Effective Jan. 1, 2026)</h4><p>Allows bronze and catastrophic plans to contribute to health savings accounts. CBO estimates that this provision will result in a $3.6 billion reduction in federal revenue over 10 years.</p><h4>Section 71308: Treatment of Direct Primary Care Service Arrangements (Effective Jan. 1, 2026)</h4><p>Allows individuals in high-deductible health plans to enroll in direct primary care service arrangements and to use their health savings accounts for payment. CBO estimates that this provision will result in a $2.8 billion reduction in federal revenue over 10 years.</p><h3>Chapter 4 — Protecting Rural Hospitals and Providers</h3><h4>Section 71401: Rural Health Transformation Program (Effective upon enactment)</h4><p>Creates a rural stabilization fund with $50 billion, to be paid out as $10 billion annually across FYs 2026 through 2030. States will need to submit a one-time application to CMS to be eligible for an allotment of these funds during a submission period specified by CMS (with an application and decision date no later than Dec. 31, 2025). Of the $50 billion in funding, 50% of the funds for each fiscal year will be equally distributed among all the states with an approved application. Forty percent of the funds for each fiscal year will be distributed in a method determined by CMS. CMS will consider the following as its distribution method: the percentage of the state population located in rural geographies, the proportion of rural health facilities in the state relative to the nation, and any other factors deemed appropriate by CMS. Not more than 10% of the amount allocated to the states can be used for administrative expenses. Separately, the legislation appropriates $200 million to the CMS administrator for FY 2025 to implement the provision.</p><h3>SUBTITLE A — TAX</h3><h3>Chapter 4 — Investing In American Families, Communities and Small Businesses</h3><h3><em>Subchapter B — Permanent Investments in Students and Reforms to Tax-Exempt Institutions</em></h3><h4>Section 70415: Endowment Tax for Universities (Effective Jan. 1, 2026)</h4><p>Amends the excise tax rate for universities based on student endowments. The rates are as follows: 1.4% for student endowments ranging from $500,000-$750,000 , 4% for student endowments ranging from $750,000-$2 million, and 8% for all student endowments above $2 million. CBO estimates that this provision will result in a $761 million increase in federal revenue over 10 years.</p><h4>Section 70416: Executive Compensation (Effective Jan. 1, 2026)</h4><p>Limits tax-exempt organizations’ ability to deduct compensation over $1 million, including for former employees, dating back to tax year 2017. CBO estimates that this provision will result in a $3.8 billion increase in federal revenue over 10 years.</p><h3><em>Subchapter C — Permanent Investments in Community Development</em></h3><h4>Section 70426: One Percent Floor on Deduction of Charitable Contributions Made by Corporations (Effective Jan. 1, 2026)</h4><p>Allows a deduction for corporate charitable contributions only to the extent that the aggregate of corporate charitable contributions exceeds 1% of a taxpayer’s taxable income and does not exceed 10% of the taxpayer’s taxable income. CBO estimates that this provision will result in a $16.6 billion increase in federal revenue over 10 years.</p><h3>Chapter 5 — Ending Green New Deal Spending, Promoting America-First Energy and Other Reforms</h3><h3><em>Subchapter A — Termination of Green New Deal Subsidies</em></h3><h4>Section 70503: Termination of Qualified Commercial Clean Vehicles Credit (Credit terminates Sept. 30, 2025)</h4><p>Eliminates the tax credit that allowed for tax-exempt entities to receive a direct payment for the lesser of 1) 15% of the vehicle’s cost (30% for vehicles not powered by gas or diesel) or 2) the incremental cost of the vehicle relative to a comparable vehicle. CBO estimates that this provision will result in a $104.5 billion increase in federal revenue over 10 years.</p><h4>Section 70504: Termination of Alternative Fuel Vehicle Refueling Property Credit (Credit terminates June 30, 2026)</h4><p>Eliminates the tax credit that allowed for a tax-exempt owner of property to receive direct payment for the cost of installing a qualified alternative fuel vehicle refueling station on property, such as electric charging stations CBO estimates that this provision will result in a $1.96 billion increase in federal revenue over 10 years.</p><h4>Section 70507: Termination of Energy Efficient Commercial Buildings Deduction (Deduction terminates June 30, 2026)</h4><p>Eliminates a tax deduction for tax-exempt organizations for energy-saving commercial building property. The deduction will terminate for any property with construction beginning after June 30, 2026. CBO estimates that this provision will result in a $134 million increase in federal revenue over 10 years.</p><h4>Section 70513: Termination and Restrictions on Clean Electricity Investment Credit (Credit terminates Dec. 31, 2027)</h4><p>Eliminates a tax credit for investing in qualifying zero-emission electricity generation facilities or energy storage technology. Under the previous law, the credit was phased out in 2032. Specifically, this provision:</p><ul><li>Terminates eligibility for covered wind and solar facilities placed into service after Dec. 31, 2027.</li><li>Increases the domestic content requirement for projects to be eligible for the domestic content bonus. The current law requires that 40% of the manufactured products in a facility be from a domestic source. The act will increase the required threshold to 45% (or 27.5% for offshore wind) from June 16, 2025, until Dec. 31, 2025; 50% (or 35% for offshore wind) for CY 2026; and 55% after Dec. 31, 2026.</li><li>Prevents access to credits for wind and solar if the taxpayer rents or leases the property to a third party.</li><li>Prohibits credits that include any material assistance from a prohibited foreign entity.</li></ul><p>Additionally, the bill eliminates the investment tax credit for certain energy properties for qualified projects. Specifically, the provision eliminates the 2% base credit for projects not meeting prevailing wage and apprenticeship requirements, applies to construction beginning on or after June 16, 2025.CBO estimates that this provision will result in a $177.9 billion increase in federal revenue over 10 years.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><div class="sticky"><a href="/system/files/media/file/2025/07/Legislative-Advisory-Key-Highlights-of-the-Final-One-Big-Beautiful-Bill-Act.pdf" target="_blank" title="Click here to download the Legislative Advisory: Key Highlights of the Final One Big Beautiful Bill Act PDF."><img src="/sites/default/files/inline-images/Page-1-Legislative-Advisory-Key-Highlights-of-the-Final-One-Big-Beautiful-Bill-Act.png" data-entity-uuid="6a061d3b-a8fa-410e-baa3-17eaad87d657" data-entity-type="file" alt="Legislative Advisory: Key Highlights of the Final One Big Beautiful Bill Act page 1." width="696" height="900"></a></div></div></div></div> div.sticky { position: sticky; top: 0; } Thu, 03 Jul 2025 00:00:01 -0500 Member Non-Fed /action-alert/2025-07-28-take-action-engage-lawmakers-august-build-support-key-priorities <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives has left Washington, D.C., for its August district work period, and senators could return to their states as early as next week. It is important to engage with your lawmakers while they are home and discuss the impact that the recently passed One Big Beautiful Bill Act and additional policy proposals that are under consideration will have on hospitals’ ability to provide care.</p><p>Funding for the federal government, including certain important health care programs, is set to expire Oct. 1. Congress must pass all 12 appropriations bills by Sept. 30 to fund the federal government for the next fiscal year. If lawmakers fail to meet that deadline, they will need to enact a continuing resolution temporarily extending current funding levels to avoid a government shutdown. However, these health care programs including Low-volume Adjustment and Medicare-Dependent Hospital, telehealth and hospital-at-home waivers — as well as prolonging Medicaid DSH cuts from going into effect — are not guaranteed to be extended. Additionally, Congress needs to act before the end of the year to extend the Enhanced Premium Tax Credits. Meanwhile, some legislators are discussing another reconciliation package on deficit reduction efforts. Those efforts could include additional Medicaid and Medicare cuts. It is important that your legislators understand hospitals and health systems cannot sustain any additional cuts, especially as we are facing the implementation of Medicaid cuts in the <a href="/advisory/2025-07-18-detailed-summary-one-big-beautiful-bill-act-obbba-public-law-no-119-21">OBBBA</a>.</p><p>While your lawmakers are home next month, please make plans to visit them in their offices, speak with them at a community event or invite them to your hospital to show them the importance of supporting policies that allow hospitals to provide care to their communities. And share with them the impact that funding reductions would have on your ability to provide services and care for the people they represent.</p><p>The following are some of the top priority issues and resources that can assist you and your team in conversations with your lawmakers.</p><h2>Advocacy Priorities</h2><ul><li><strong>Extend the </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits"><strong>Enhanced Premium Tax Credits</strong></a><strong>.</strong> The Enhanced Premium Tax Credits help individuals and families purchase insurance on the Health Insurance Marketplaces. Policies enabling these credits will expire at the end of 2025. Urge your members of Congress to extend the enhanced premium tax credits that enable millions of people to have health care coverage.</li><li><strong>Reject </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>Site-neutral Payments</strong></a><strong>.</strong> Site-neutral payments would compensate hospital outpatient departments the same as independent physician offices and other ambulatory sites of care, ignoring the very different level of care provided by hospitals and the needs of the patients and communities cared for in that setting. Ask your members of Congress to reject efforts to enact additional site-neutral payments proposals.</li><li><strong>Protect the </strong><a href="/fact-sheets/fact-sheet-340b-drug-pricing-program"><strong>340B Drug Pricing Program</strong></a><strong>.</strong> Hospitals depend on the 340B program to manage rising prescription drug costs and expand access to care for patients. Ask your members of Congress to oppose any harmful changes to the 340B program.</li><li><strong>Extend </strong><a href="/fact-sheets/2025-02-07-fact-sheet-telehealth"><strong>Telehealth</strong></a><strong> and </strong><a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program"><strong>Hospital-at-home</strong></a><strong> Programs.</strong> These programs enable providers to care for patients at home, without having to make long drives to a facility. These programs are set to expire Sept. 30. Urge your lawmakers to extend these programs so providers can ensure continuity of care.</li><li><strong>Prevent </strong><a href="/advocacy/advocacy-issues/medicaid-dsh-payment-cuts"><strong>Medicaid Disproportionate Share Hospital</strong></a><strong> Cuts.</strong> The Medicaid DSH program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations, including children and those who are disabled and elderly. The Medicaid DSH cut for fiscal year 2026 is $8 billion and will go into effect on Oct. 1 unless Congress acts. Urge your lawmakers to provide relief from the Medicaid DSH cuts given the vital need for the program.</li><li><strong>Extend the </strong><a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-rural-mdh-and-lva-programs"><strong>Low-volume Adjustment and Medicare-dependent Hospital</strong></a><strong> Programs.</strong> The enhanced low-volume adjustment and Medicare-dependent hospital programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. Without action from Congress, the enhanced LVA and MDH programs will expire Sept. 30. Urge your lawmakers to extend these vital programs.</li><li><strong>Protect </strong><a href="/fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response"><strong>Health Care Workers</strong></a><strong> from Violence.</strong> The Save Healthcare Workers Act (H.R. 3178/S. 1600) is bipartisan legislation (that would make it a federal crime to assault a hospital staff member on the job. Urge your lawmakers to support this legislation.</li></ul><h2>AHA Resources</h2><p>Your voice is extremely important and your legislators listen to you. Be ready to tell your hospital’s story. Prepare for a successful encounter with these <a href="/advocacy/2023-03-07-advocacy-tips-and-best-practices">tips and best practices</a> for meeting with lawmakers and hosting them at your hospital. Visit the <a href="/advocacy/action-center">AHA Action Center</a> for information and resources to assist you in your advocacy.</p><h2>Further Questions</h2><p>If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/07/Action-Alert-TAKE-ACTION-Engage-Lawmakers-in-August-to-Build-Support-for-Key-Priorities.pdf" target="_blank" title="Click here to download the Action Alert: TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities"><img src="/sites/default/files/inline-images/Page-1-Action-Alert-TAKE-ACTION-Engage-Lawmakers-in-August-to-Build-Support-for-Key-Priorities.png" data-entity-uuid="f8d7fe18-60fc-49cc-9704-cacdc239ac3a" data-entity-type="file" alt="Action Alert: TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities page 1." width="695" height="900"></a></div></div></div> Mon, 28 Jul 2025 15:43:12 -0500 Member Non-Fed /advisory/2025-07-18-detailed-summary-one-big-beautiful-bill-act-obbba-public-law-no-119-21 <div class="container"><div class="row"><div class="col-md-8"><p>President Trump July 4 signed into law the <a href="https://www.congress.gov/bill/119th-congress/house-bill/1?s=1&r=1&q=%7B%22search%22%3A%22%5C%22One+Big+Beautiful+Bill+Act%5C%22%22%7D" target="_blank" title="Congress.gov: H.R.1 - One Big Beautiful Bill Act">OBBBA; Public Law No. 119-21</a>, a sweeping package that enacts many of the administration’s legislative priorities on taxes, border security and energy. The bill includes significant policy changes to Medicaid and the Health Insurance Marketplaces.</p><p>According to the <a href="https://www.cbo.gov/publication/61570" target="_blank">Congressional Budget Office (CBO) score of the bill</a>, the OBBBA will lead to more than $1 trillion in Medicaid and Marketplace cuts and will increase the number of people without health insurance by 10 million in 2034. A significant portion of the savings will result from new limits on the use of Medicaid provider taxes and state-directed payments (SDPs), which have historically allowed hospitals to bridge the chronic underpayments for the care they deliver to Medicaid enrollees. The CBO estimates that the policy changes related to SDPs and provider taxes will save more than $340 billion and result in direct decreases in provider payments.</p><div><h2>Key Highlights</h2><p>Among other provisions, the OBBBA:</p><ul><li>Restricts the ability of states to increase Medicaid provider taxes and phases the existing provider tax cap for expansion states down to 3.5% in FY 2032.</li><li>Lowers the upper payment limit for SDPs to 100% of the total published Medicare rate for expansion states and 110% of the total published Medicare rate in non-expansion states; for grandfathered SDPs, beginning CY 2028, reduces payment rates by 10 percentage points annually until the specified upper payment limit is achieved.</li><li>Increases the frequency of eligibility redeterminations to every six months for Medicaid expansion enrollees beginning CY 2027.</li><li>Requires states to establish work requirements for Medicaid expansion enrollees.</li><li>Establishes a $50 billion rural health transformation program for rural providers that allocates funds to states with an approved application from FYs 2026 through 2030.</li><li>Restricts eligibility for certain non-citizens under Medicaid, Medicare and the Health Insurance Marketplaces.</li><li>Establishes graduate and professional annual and aggregate loan limits for students, including medical students, beginning July 1, 2026.</li></ul></div><h2>AHA Take</h2><p>In a statement sent to the media July 3, upon passage of the bill, AHA President and CEO Rick Pollack stated, “Today is an extremely disappointing and very difficult day for health care in America. Despite months of clearly demonstrating the implications that these Medicaid proposals will have on the patients and communities we serve, especially the most vulnerable populations, Congress has enacted cuts of nearly a trillion dollars to the Medicaid program. No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage –- cannot be simply dismissed as waste, fraud, and abuse. The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors, and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.</p><p>“The AHA remains committed to working with all stakeholders to mitigate the impact of these cuts wherever possible. Our goal is to help ensure hospitals can remain open for their communities, and people can get the care they need when they need it. Our nation’s health and economic future depend on it.”</p><h2>What You Can Do</h2><ul><li>Review the OBBBA provisions with key members of your team to understand the implications for your organization.</li><li>Use the implementation timeline resource available here as well as at the end of this Advisory to keep track of when key provisions go into effect.</li><li>Watch for more information and resources from the AHA.</li></ul><h2>Further Questions</h2><p>If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p><hr><h2>Table of Contents</h2><p><a href="#subbchapter1">CHAPTER 1 — MEDICAID</a><br><a href="#section71101"><span>Section 71101: Moratorium on Implementation of Medicaid Savings Program Eligibility and Enrollment Rule</span></a><br><a href="#section71102"><span>Section 71102: Moratorium on Implementation of Medicaid, CHIP and Basic Health Program Eligibility and Enrollment Rule</span></a><br><a href="#section71107"><span>Section 71107: Eligibility Redeterminations</span></a><br><a href="#section71109"><span>Section 71109: Alien Medicaid Eligibility</span></a><br><a href="#section71110"><span>Section 71110: Expansion FMAP for Emergency Medicaid</span></a><br><a href="#section71111"><span>Section 71111: Moratorium on Implementation of Rule Relating to Staffing Standards for Long-term Care Facilities Under the Medicare and Medicaid Programs.</span></a><br><a href="#section71112"><span>Section 71112: Reducing State Medicaid Costs</span></a><br><a href="#section71113"><span>Section 71113: Federal Payments to Prohibited Entities</span></a><br><a href="#section71114"><span>Section 71114: Sunsetting Increased FMAP Incentive</span></a><br><a href="#section71115"><span>Section 71115: Provider Taxes</span></a><br><a href="#section71116"><span>Section 71116: State-directed Payments</span></a><br><a href="#section71117"><span>Section 71117: Requirements Regarding Waiver of Uniform Tax Requirement for Medicaid Provider Tax</span></a><br><a href="#section71119"><span>Section 71119: Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals</span></a><br><a href="#section71120"><span>Section 71120: Modifying Cost-sharing Requirements for Certain Expansion Individuals Under the Medicaid Program</span></a><br><a href="#section71121"><span>Section 71121: Making Certain Adjustments to Coverage of Home or Community-based Services Under Medicaid</span></a></p><p><a href="#subbchapter2">CHAPTER 2 — MEDICARE</a><br><a href="#section71201"><span>Section 71201: Limiting Medicare Coverage of Certain Individuals</span></a><br><a href="#section71202"><span>Section 71202: Temporary Payment Increase Under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances</span></a><br><a href="#section71203"><span>Section 71203: Expanding and Clarifying the Exclusion for Orphan Drugs Under the Drug Price Negotiation Program</span></a></p><p><a href="#subbchapter3">CHAPTER 3 — HEALTH TAX</a><br><a href="#section71301"><span>Section 71301: Permitting Premium Tax Credit Only for Certain Individuals</span></a><br><a href="#section71302"><span>Section 71302: Disallowing Premium Tax Credits During Periods of Medicaid Ineligibility Due to Alien Status</span></a><br><a href="#section71303"><span>Section 71303: Requiring Verification of Eligibility for the Premium Tax Credit</span></a><br><a href="#section71304"><span>Section 71304: Disallowing Premium Tax Credit in Case of Certain Coverage Enrolled in During the Special Enrollment Period</span></a><br><a href="#section71305"><span>Section 71305: Eliminating Limitation on Recapture of Advance Payment of Premium Tax Credit</span></a><br><a href="#section71306"><span>Section 71306: Permanent Extension of Safe Harbor for Absence of Deductible for Telehealth Services</span></a><br><a href="#section71307"><span>Section 71307: Allowance of Bronze and Catastrophic Plans in Connection with Health Savings Accounts</span></a><br><a href="#section71308"><span>Section 71308: Treatment of Direct Primary Care Service Arrangements</span></a></p><p><a href="#subbchapter4">CHAPTER 4 — PROTECTING RURAL HOSPITALS AND PROVIDERS</a><br><a href="#section71401"><span>Section 71401: Rural Health Transformation Program </span></a></p><p><a href="#subtitlea">SUBTITLE A — TAX 17</a></p><p><a href="#subachapter4">CHAPTER 4 — INVESTING IN AMERICAN FAMILIES, COMMUNITIES AND SMALL BUSINESSES</a><br><a href="#section70415"><span>Section 70415: Endowment Tax for Universities</span></a><br><a href="#section70416"><span>Section 70416: Executive Compensation</span></a><br><a href="#section70424"><span>Section 70424: Charitable Contributions for Non-itemizers</span></a><br><a href="#section70425"><span>Section 70425: Floor on Charitable Contributions</span></a><br><a href="#section70426"><span>Section 70426: One Percent Floor on Deduction of Charitable Contributions Made by Corporations</span></a></p><p><a href="#subachapter5">CHAPTER 5 — ENDING GREEN NEW DEAL SPENDING, PROMOTING AMERICA-FIRST ENERGY AND OTHER REFORMS</a><br><a href="#section70503"><span>Section 70503: Termination of Qualified Commercial Clean Vehicles Credit</span></a><br><a href="#section70504"><span>Section 70504: Termination of Alternative Fuel Vehicle Refueling Property Credit</span></a><br><a href="#section70507"><span>Section 70507: Termination of Energy Efficient Commercial Buildings Deduction</span></a><br><a href="#section70513"><span>Section 70513: Termination and Restrictions on Clean Energy Investment Credit</span></a></p><p><a href="#subtitleb">SUBTITLE B — LOAN LIMITS</a></p><p><a href="#section81001"><span>Section 81001: Establishment of Loan Limits for Graduate and Professional Students and Parent Borrowers; Termination of Graduate and Professional PLUS Loans</span></a></p><hr><h2>AHA Summary of OBBBA Provisions of Interest to Hospitals and Health Systems</h2><h3 id="subbchapter1">CHAPTER 1 — MEDICAID</h3><h4 id="section71101">Section 71101: Moratorium on Implementation of Medicaid Savings Program Eligibility and Enrollment Rule (Effective from enactment through Sept. 30, 2034)</h4><p>This section prohibits the Department of Health and Human Services (HHS) Secretary from implementing, administering or enforcing the amendments made by the Medicare Savings Program (MSP) rule for 10 years. The MSP is a Medicaid program that covers the cost of Medicare Parts A and B premiums and cost-sharing requirements for low-income older adults. The rule would streamline eligibility determination and enrollment in the MSP and result in an estimated additional 860,000 eligible individuals enrolled in an MSP, according to the Centers for Medicare & Medicaid Services (CMS). While several provisions of the final rule were not due to be fully implemented until 2026, CBO estimates that this provision will result in a $66 billion reduction in federal spending over 10 years.</p><ul><li><strong>Auto-enrollment.</strong> The moratorium will remove the requirement for states to participate in auto-enrollment into the MSP program until 2034. Under the rule, states would have been required to automatically enroll Supplemental Security Income (SSI) recipients in the qualified Medicare beneficiary (QMB) eligibility group of the MSP program. As of Oct.1, 2024, 36 states and the District of Columbia (i.e., Part A “buy-in” states) were required to automatically enroll certain SSI recipients in the QMB eligibility group of MSP. The auto-enrollment policy was optional but recommended for 14 “group payer” states.</li><li><strong>Low-income Subsidy Program Data.</strong> Under the rule, by April 1, 2026, states must use data from the Low-Income Subsidy (LIS) program as an application for MSPs; limit requests to applicants for additional information needed that was not collected by the Social Security Administration for LIS; and align the family size definitions of MSPs and LIS. The moratorium delays these requirements until 2034.</li><li><strong>Self-attestation.</strong> Under the rule, by April 1, 2026, states were required to accept self-attestation for certain types of income and resources (e.g., burial funds, non-liquid resources, face value of whole life insurance, income from interest and dividends). The moratorium delays implementation and enforcement of these requirements until 2034.</li></ul><h4 id="section71102">Section 71102: Moratorium on Implementation of Medicaid, CHIP and Basic Health Program Eligibility and Enrollment Rule<br>(Effective from enactment through Sept. 30, 2034)</h4><p>The section prohibits the HHS secretary from implementing, administering or enforcing the amendments made by the provisions of the eligibility and enrollment rule for 10 years. The rule was intended to streamline eligibility processes for Medicaid applicants and beneficiaries and make it easier for eligible beneficiaries to apply for and maintain coverage. Several key provisions have not yet been implemented, as states were required to be in full compliance with the provisions of the rule by June 2027. CBO estimates that this provision will result in a $55.9 billion reduction in federal spending over 10 years.</p><ul><li><strong>Enrollment and Renewal Requirements.</strong> The law removes the requirement (until 2034) that states must conduct beneficiary renewals for elderly, blind or disabled beneficiaries and individuals who receive long-term services and supports (i.e., non-modified adjusted gross income (MAGI) populations) no more than once every 12 months, use prepopulated forms for renewals, eliminate mandatory in-person interviews at application and renewal, provide beneficiaries with 30 days to return a signed renewal form or to confirm a change in circumstances, and provide a 90-day reconsideration period for terminations tied to a failure to respond.</li><li><strong>Eligibility Verification.</strong> The law removes the requirement (until 2034) that if the information provided by an individual is reasonably compatible with the information returned from an asset verification system, states are not allowed to request further information verifying assets for the individual. Further, it rolls back the guidance that verifications of birth and U.S. citizenship with the state's vital statistics records and the Department of Homeland Security's Systematic Alien Verification Entitlements (SAVE) system do not require additional proof of identity.</li><li><strong>Lifetime Children’s Health Insurance Program (CHIP) Limits.</strong> The law delays, until 2034, the prohibition on states from imposing annual and/or lifetime limits on CHIP benefits.</li><li><strong>Medicaid and CHIP Program Transitions.</strong> The law removes the requirement (until 2034) that Medicaid and CHIP agencies make eligibility determinations on behalf of the other program, accept eligibility determinations made by these programs (except for Medicaid eligibility determinations that are not made on the basis of MAGI), and transition individuals to the program for which they are determined eligible based on available data.</li><li><strong>CHIP Lock Out Period.</strong> The law delays the implementation and enforcement of the requirement that states allow CHIP beneficiaries to remain enrolled or re-enroll in coverage without a lock-out period due to failure to pay premiums.</li></ul><h4 id="section71107">Section 71107: Eligibility Redeterminations<br>(Effective Jan. 1, 2027)</h4><p>The section requires states (i.e., the 50 states and the District of Columbia) to redetermine eligibility once every six months for beneficiaries enrolled through the Medicaid expansion eligibility pathway, beginning in calendar year (CY) 2027. Currently, states are required to conduct redeterminations every 12 months for populations whose eligibility is determined on the basis of MAGI, including expansion adults. Non-expansion enrollees will continue to have their eligibility redetermined at least every 12 months. The HHS secretary must issue guidance related to implementing the rule no later than 180 days after enactment, or Dec. 31, 2025. The bill appropriates $75 million to CMS for fiscal year (FY) 2026 for implementation of the provisions. CBO estimates that this provision will result in a $62.5 billion reduction in federal spending over 10 years.</p><h4 id="section71109">Section 71109: Alien Medicaid Eligibility<br>(Effective Oct. 1, 2026)</h4><p>The section restricts eligibility for Medicaid and CHIP to the following groups, based on the modified definition of “qualified alien”: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. Under this section, non-citizens, including refugees, asylees and humanitarian enrollees, are no longer eligible for coverage. The bill appropriates $15 million to CMS for FY 2026 for implementation of the provisions. CBO estimates that this provision will result in a $6.2 billion reduction in federal spending over 10 years.</p><h4 id="section71110">Section 71110: Expansion FMAP for Emergency Medicaid<br>(Effective Oct. 1, 2026)</h4><p>The section limits the Federal Medical Assistance Percentage (FMAP) to the state’s traditional FMAP for emergency Medicaid services provided to aliens who, except for their immigration status, would qualify for Medicaid expansion. Prior to this change, states could receive a 90% federal match for such services when provided to an individual who would otherwise be eligible for Medicaid expansion. The provision has no impact on the statutory requirement under the Emergency Medical Treatment and Labor Act (EMTALA) that requires hospitals to provide emergency care for individuals regardless of their immigration or coverage status. The bill appropriates $1 million in FY 2026 for implementation of the provision. CBO estimates that this provision will result in a $28.2 billion reduction in federal spending over 10 years.</p><h4 id="section71111">Section 71111: Moratorium on Implementation of Rule Relating to Staffing Standards for Long-term Care Facilities Under the Medicare and Medicaid Programs.<br>(Effective from enactment through Sept. 30, 2034.)</h4><p>The section prohibits HHS from implementing the Minimum Staffing Standards for long-term care (LTC) facilities and the Medicaid Institutional Payment Transparency Reporting regulation for 10 years. Within two years of the final rule publication (May 10, 2026), non-rural LTC facilities would have had to comply with minimum nurse staffing requirements, which include 3.48 hours of total direct nursing care per resident per day. The rule also requires that a registered nurse be on-site 24 hours per day, seven days per week. Through this provision, the minimum staffing standards will not be implemented until 2034. CBO estimates that this provision will result in a $23.1 billion reduction in federal spending over 10 years.</p><h4 id="section71112">Section 71112: Reducing State Medicaid Costs<br>(Effective Jan. 1, 2027)</h4><p>The section limits the timeframe for retroactive Medicaid eligibility to 30 days prior to the application date for Medicaid expansion enrollees, and 60 days prior to the application date for all other enrollees. Additionally, retroactive CHIP eligibility is limited to 60 days prior to the application date. Currently, states have the option to allow retroactive eligibility 90 days prior to the application date for all enrollees. The provision applies to applications submitted on or after Jan. 1, 2027. CBO estimates that this provision will result in a $4.2 billion reduction in federal spending over 10 years.</p><h4 id="section71113">Section 71113: Federal Payments to Prohibited Entities<br>(Effective on enactment through July 4, 2026)</h4><p>The section prohibits states from receiving federal matching funds for services rendered by providers who provide abortions (other than Hyde Amendment exceptions) and received more than $800,000 in Medicaid payments (including both federal and state reimbursements) in 2023. This prohibition of federal funds applies for one year, beginning on the date of enactment and ending July 4, 2026. The bill appropriates $1 million for FY 2026 for the implementation of the provisions. CBO estimates that this provision will result in a $53 million increase in federal spending over 10 years.</p><ul><li><strong>Prohibited Entities.</strong> Prohibited entities include not-for-profit, essential community providers primarily engaged in family planning services, reproductive health and related medical care. An essential community provider is defined as a provider that serves low-income and medically underserved individuals, which include 340B providers, public or nonprofit entities; entities based at an institution of higher learning whose primary purpose is to provide health care services to students of that institution; a state-owned, governmental or not-for profit family planning service site that does not receive federal funding under special programs; or an Indian health care provider.</li><li><strong>Hyde Amendment Exceptions.</strong> The law allows for exceptions for the use of federal funds for abortion, including for pregnancies that result from rape or incest, or pregnancies wherein a woman requires an abortion due to a physical disorder, physical injury or physical illness, including a life-endangering physical condition arising from the pregnancy that would place the woman in danger of death.</li></ul><h4 id="section71114">Section 71114: Sunsetting Increased FMAP Incentive<br>(Effective Jan. 1, 2026)</h4><p>The section repeals the ability for non-expansion states to receive a temporary 5 percentage point increase to a state’s traditional FMAP if they expand Medicaid. The temporary enhancement would have been applied to a states’ traditional population and would have been available for eight quarters upon expansion. Beginning Jan. 1, 2026, the incentive will no longer be available to the 10 states that have not adopted Medicaid expansion. CBO estimates that this provision will result in a $13.6 billion reduction in federal spending over 10 years.</p><h4 id="section71115">Section 71115: Provider Taxes<br>(Provider tax rate freeze begins Oct. 1, 2026; reduction for expansion states begins Oct. 1, 2027)</h4><p>Beginning in federal FY 2027, the law prohibits all states from increasing the provider tax hold harmless threshold above the rate that was in place on the date of enactment. The law also incrementally reduces the hold harmless threshold for provider taxes in expansion states beginning in federal FY 2028. These changes effectively freeze provider tax rates to the rates that were in place on the date of enactment for all states, but there appears to be some flexibility for states to make temporary changes until FY 2027, at which point the rates would revert to the provider tax rates that were in place on the date of enactment. The bill appropriates $20 million for FY 2026 to CMS for implementation of the provisions. CBO estimates that this provision will result in a $191.1 billion reduction in federal spending over 10 years.</p><ul><li><strong>Non-expansion States.</strong> Beginning in federal FY 2027, the law freezes the hold harmless threshold to the existing provider tax rate imposed by a state or local unit of government as of the date of enactment (July 4, 2025). For states that have not enacted or do not impose provider taxes as of the date of enactment, the hold harmless threshold for FY 2027 and subsequent years is 0%.</li><li><strong>Expansion States.</strong> In addition to the freeze described above, the law reduces the hold harmless threshold for expansion states beginning in FY 2028 by 0.5 percentage points annually. The hold harmless threshold will be the lower of the existing percentage in a state or: 5.5% in federal FY 2028, 5.0% in federal FY 2029, 4.5% in federal FY 2030, 4.0% in federal FY 2031, and 3.5% for federal FY 2032 and subsequent years. Provider taxes imposed on nursing homes and intermediate care facilities will remain frozen at the rates that were in place as of enactment. The section defines expansion states as any state that provides Medicaid expansion coverage beginning on Jan. 1, 2014, or thereafter.</li></ul><h4 id="section71116">Section 71116: State-directed Payments<br>(SDP cap effective on enactment; reduction effective by the rating period on or after Jan. 1, 2028)</h4><p>This section establishes an upper payment limit for state-directed payments — 100% of the total published Medicare rate in expansion states and 110% of the total published Medicare rate in non-expansion states. The total published Medicare rate is defined as provided in 438.6(a) of title 42 of the Code of Federal Regulations or any future regulation that replaces it. The bill appropriates $7 million for each fiscal year between 2026 and 2033 for the implementation of the provision. CBO estimates that this provision will result in a $149.4 billion reduction in federal spending over 10 years.</p><ul><li><strong>Grandfathering.</strong> SDPs approved (or where there was a good faith effort to be approved) by May 1, 2025, and SDP payments for rural hospitals approved (or where there was a good faith effort to be approved) by the date of enactment (July 4, 2025) can continue at that rate (subject to HHS approval). Rural hospitals are defined as those located in a rural area, treated as being in a rural area, or located in a rural census tract, as well as critical access hospitals, sole community hospitals, Medicare-dependent hospitals, low-volume hospitals and rural emergency hospitals. Beginning with the rating period on or after Jan. 1, 2028, all grandfathered SDPs would be reduced by 10 percentage points annually until the specified Medicare payment rate limit is achieved.</li></ul><h4 id="section71117">Section 71117: Requirements Regarding Waiver of Uniform Tax Requirement for Medicaid Provider Tax<br>(Effective from enactment)</h4><p>This section modifies the requirements regarding the waiver of uniformity available for provider taxes in the 50 states and the District of Columbia and, specifically, whether a state’s non-uniform provider tax is considered “generally redistributive.” The HHS secretary will determine an applicable transition period (up to three fiscal years) for taxes considered not generally redistributive. CBO estimates that this provision will result in a $34.6 billion reduction in federal spending over 10 years.</p><ul><li><strong>Generally Redistributive Requirement.</strong> The section clarifies that any class of provider tax will not be considered generally redistributive if lower-volume Medicaid health care entities are taxed at a lower rate than higher-volume Medicaid health care entities, high Medicaid volume health care entities are taxed more heavily than non-Medicaid health care entities, or if the tax establishes any target or exclusion related to a health care entity’s Medicaid participation status. Currently, states may obtain a waiver of non-uniform tax requirements if they meet the statistical test established by CMS to determine whether a tax is generally redistributive. This provision expands the definition of generally redistributive.</li><li><strong>Medicaid Taxable Unit Definition.</strong> The section establishes a new definition for a “Medicaid taxable unit,” which includes any unit that is used as the basis for payment under Medicaid (e.g., Medicaid bed days), Medicaid revenue, costs associated with Medicaid (e.g., claims or expenditures), or other units associated with Medicaid.</li></ul><h4 id="section71119">Section 71119: Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals<br>(Effective Jan. 1, 2027)</h4><p>The section establishes that states (i.e., the 50 states and the District of Columbia) must require certain nonpregnant, nondisabled adults applying for or enrolled in Medicaid expansion coverage to meet community engagement requirements (work requirements) beginning Dec. 31, 2026. The bill provides $200 million in FY 2026 grants for state implementation and $50 million for federal administration. CBO estimates that this provision will result in a $325.6 billion reduction in federal spending.</p><ul><li><strong>Qualifying Activities.</strong> Medicaid expansion enrollees must work or engage in qualifying activities for no less than 80 hours per month. An enrollee will be compliant with the requirement if they meet at least one or a combination of the following qualifying activities each month: work, community service, participation in a work program, or enrollment in an educational program at least half-time. An individual also may meet the requirement if they have a monthly income not less than the federal minimum wage (under the Fair Labor Standards Act) multiplied by 80 hours, or if they are a seasonal worker with an average monthly income over the previous six months that meets the same minimum income threshold (i.e., federal minimum wage multiplied by 80 hours).</li><li><strong>Mandatory Exceptions.</strong> States must treat an applicable individual as having met community engagement requirements for a given month and may choose not to require proof of meeting the requirement if the individual is a specified excluded individual, under the age of 19, enrolled in Medicare Parts A or B, or an inmate in a public institution. A specialized excluded individual is defined as an individual who meets any of the following criteria:<ul><li>An Indian or Urban Indian or eligible for Indian Health Service benefits.</li><li>The parent, guardian, caretaker relative or family caregiver (i.e., as defined in the RAISE Family Caregivers Act) of a child under 14 or a disabled individual.</li><li>A veteran with a disability.</li><li>Medically frail or has special medical needs (as defined by the secretary).</li><li>A member of a household that receives Supplemental Nutrition Assistance Program (SNAP) benefits.</li><li>Participating in a drug addiction or alcohol treatment program.</li><li>Pregnant or entitled to postpartum medical assistance.</li></ul></li><li><strong>Optional Exception for Short-term Hardship Events.</strong> States have the option to determine that an individual has met engagement requirements for a given month if they experience a short-term hardship event. Short-term hardship events include receiving inpatient hospital, nursing facility, intermediate care, and/or inpatient psychiatric hospital services; residing in a county where an emergency or disaster is declared; or residing in an area with a high unemployment rate. Individuals who themselves or their dependents must travel outside of their community to receive medical services may also qualify for a short-term hardship exception.</li><li><strong>State Exemptions.</strong> Subject to HHS approval, a state may apply for and receive temporary exemptions from compliance if it demonstrates a good-faith effort to comply with the provision. Exemptions may be granted until no later than Dec. 31, 2028, and cannot be renewed. The secretary may rescind the exemption at any time if reporting requirements are not met or the state fails to make a continued good-faith effort toward compliance.</li><li><strong>Non-compliance.</strong> If an individual is not compliant with community engagement requirements, they will have 30 days to become compliant and will continue to receive Medicaid benefits during that period. If the individual does not come into compliance, the state may deny the individual’s application or disenroll the individual from Medicaid no later than the end of the month following the month that the 30-day period ends. An individual who is disenrolled for failure to comply is not eligible for subsidized Marketplace coverage.</li><li><strong>Conflicts of Interest.</strong> Medicaid Managed Care Organizations (MCOs) and other contractors with a financial relationship with a Medicaid MCO are prohibited from administering community engagement requirements.</li></ul><h4 id="section71120">Section 71120: Modifying Cost-sharing Requirements for Certain Expansion Individuals Under the Medicaid Program<br>(Effective Oct. 1, 2028)</h4><p>This section requires Medicaid expansion enrollees with incomes above 100% of the federal poverty level (FPL) to pay up to $35 in cost sharing per service beginning Oct. 1, 2028. Cost sharing for non-emergency services provided in a hospital emergency department may exceed $35. The provision excludes certain services, including primary care, pregnancy-related services, and mental health and substance use disorder services. Additionally, certain services provided by federally qualified health centers, behavioral health clinics and rural health clinics are excluded. Total cost sharing may not exceed 5% of the family income of the family involved, as applied on a quarterly or monthly basis, as specified by the state. Currently, states have the option to set cost-sharing requirements for certain enrollees above 100% FPL, which can be applied to institutional care, non-institutional care, non-emergency use of the ER, and prescription drug services and supplies. The provision would make cost sharing mandatory for specified expansion enrollees and would not impact existing cost-sharing policies states may have in place for other populations. The bill appropriates $15 million for FY 2026 for the implementation of the provision. CBO estimates that this provision will result in a $7.4 billion reduction in federal spending over 10 years.</p><h4 id="section71121">Section 71121: Making Certain Adjustments to Coverage of Home or Community-based Services Under Medicaid<br>(Effective July 1, 2028)</h4><p>The section provides states with the option to pursue a standalone waiver under section 1915(c) and expand access to home and community-based services (HCBS). A waiver may be approved for an initial term of three years and may be extended for additional five-year periods. States are required to establish needs-based criteria (subject to the secretary’s approval) for determining whether an individual requires the level of care provided in a hospital, nursing facility or intermediate care facility. States may use funding to support HCBS waivers under section 1115. States may not make payments to a third party on behalf of an individual HCBS practitioner for health insurance benefits, skills training and other benefits customary for employees. The bill appropriates $50 million for FY 2026 to the HHS secretary for implementation of the provisions. Further, the bill appropriates $100 million for FY 2027 for making payments to states delivering HCBS. CBO estimates that this provision will result in a $6.6 billion increase in federal spending over 10 years.</p><h3 id="subbchapter2">CHAPTER 2 — MEDICARE</h3><h4 id="section71201">Section 71201: Limiting Medicare Coverage of Certain Individuals<br>(Effective 18 months from enactment)</h4><p>The section restricts eligibility for Medicare for non-citizens to the following groups: legal permanent residents, certain Cuban immigrants and Compact of Free Association migrants lawfully residing in the United States. CBO estimates that this provision will result in a $5.1 billion reduction in federal spending over 10 years.</p><h4 id="section71202">Section 71202: Temporary Payment Increase Under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances<br>(Effective Jan. 1, 2026)</h4><p>This section provides a set update to the Physician Fee Schedule of 2.5% for calendar year (CY) 2026 only. There is no adjustment for CY 2025. CBO estimates that this provision will result in a $1.9 billion increase in federal spending over 10 years.</p><h4 id="section71203">Section 71203: Expanding and Clarifying the Exclusion for Orphan Drugs Under the Drug Price Negotiation Program<br>(Effective Jan. 1, 2028)</h4><p>This section expands and clarifies the exemption for orphan drugs under the Inflation Reduction Act’s (IRA) Medicare Drug Price Negotiation Program. Under the IRA, certain drugs designated for rare diseases — known as orphan drugs — were excluded from mandatory price negotiations under Medicare; however, that was limited to orphan drugs with one rare disease or condition indication. This section now expands this exclusion to allow for orphan drugs that are indicated for one or more rare diseases or conditions. This section is set to take effect on Jan. 1, 2028. CBO estimates that this provision will result in a $4.9 billion increase in federal spending over 10 years.</p><h3 id="subbchapter3">CHAPTER 3 — HEALTH TAX</h3><h4 id="section71301">Section 71301: Permitting Premium Tax Credit Only for Certain Individuals<br>(Effective Jan. 1, 2027)</h4><p>Prior law allowed lawfully present immigrants to access premium tax credits for Marketplace coverage if other eligibility criteria were met. At the time, “lawfully present” was defined as immigrants with permanent residence status, humanitarian statuses or circumstances (e.g., immigrants with Temporary Protected Status, refugees, asylees, victims of trafficking), and those with valid non-immigrant visas.</p><p>This section amends the premium tax credit eligibility criteria to exclude most lawfully present immigrants. Beginning in 2027, only the following groups of non-citizens will be eligible for premium tax credits: legal permanent residents, certain Cuban immigrants, and immigrants residing in the United States under the Compact of Free Association. CBO estimates that this provision will result in a $69.8 billion reduction in federal spending over 10 years.</p><h4 id="section71302">Section 71302: Disallowing Premium Tax Credits During Periods of Medicaid Ineligibility Due to Alien Status<br>(Effective Jan. 1, 2026)</h4><p>Prior law allowed undocumented immigrants who reported income below 100% of the FPL and were in their five-year Medicaid waiting period due to immigration status to be eligible for premium tax credits for Marketplace coverage. This section removes that provision, thereby disallowing access to premium tax credits for this population. CBO estimates that this provision will result in a $49.5 billion reduction in federal spending over 10 years.</p><h4 id="section71303">Section 71303: Requiring Verification of Eligibility for the Premium Tax Credit<br>(Effective Jan. 1, 2028)</h4><p>This section requires those receiving premium tax credits for Marketplace coverage to verify their tax credit eligibility annually. This will require enrollees to resubmit on an annual basis: household income, family size, immigration status, other health care coverage and eligibility, place of residence, and other information deemed necessary by the HHS secretary.</p><p>Until premium tax credit eligibility is verified, enrollees will not have access to premium tax credits. They can enroll in Marketplace coverage while they wait, but will be required to pay the full premium amount.</p><p>This section also effectively ends the automatic renewal process for individuals receiving tax credits, which allowed previous year enrollees to passively reenroll by not actively disenrolling or switching plans. In 2025, nearly 11 million people enrolled through this process, which is over half of all returning enrollees.<a href="#fn1"><sup>1</sup></a> CBO estimates that this provision will result in a $36.9 billion reduction in federal spending over 10 years.</p><h4 id="section71304">Section 71304: Disallowing Premium Tax Credit in Case of Certain Coverage Enrolled in During the Special Enrollment Period<br>(Effective Jan. 1, 2026)</h4><p>Most marketplace enrollees must enroll in coverage during the annual open enrollment period. However, some enrollees qualify to enroll outside of the open enrollment during a special enrollment period (SEP). Typically, enrollees must experience a qualifying life event, such as a move, job loss, marriage or new baby, to enroll during a SEP. However, recently, marketplaces had a monthly SEP that all low-income enrollees qualified for, regardless of other changes in their personal circumstances.</p><p>This section prohibits the reestablishment of the monthly low-income SEP by prohibiting individuals from receiving premium tax credits if they enroll in health coverage on the Marketplace through a SEP based on their income rather than a qualifying life event. CBO estimates that this provision will result in a $39.5 billion reduction in federal spending over 10 years.</p><h4 id="section71305">Section 71305: Eliminating Limitation on Recapture of Advance Payment of Premium Tax Credit<br>(Effective Jan. 1, 2026)</h4><p>Premium tax credit amounts are based on expected income for the enrollment period. Previously, if an enrollee received excess premium tax credits due to their actual income exceeding their expectations, they were required to repay some or all the excess during the tax filing process. For most enrollees, there was a repayment cap based on household income.</p><p>This section removes the repayment cap so that all premium tax credit recipients are required to pay the full amount of the excess, regardless of their income. In addition to those with incomes that exceed their expectations, those with incomes below 100% of the FPL who expected to make above 100% of the FPL will have to repay the full premium tax credit amount. This is because household income must be at least 100% of the federal poverty level to be eligible for premium tax credits. CBO estimates that this provision will result in a $17.3 billion reduction in federal spending over 10 years.</p><h4 id="section71306">Section 71306: Permanent Extension of Safe Harbor for Absence of Deductible for Telehealth Services<br>(Effective Jan. 1, 2025)</h4><p>The section provides a safe harbor to allow telehealth and other remote care services to be provided pre-deductible for patients with high-deductible health plans. CBO estimates that this provision will result in a $4.3 billion reduction in federal revenue over 10 years.</p><h4 id="section71307">Section 71307: Allowance of Bronze and Catastrophic Plans in Connection with Health Savings Accounts<br>(Effective Jan. 1, 2026)</h4><p>This section changes the definition of high-deductible health plans to include bronze and catastrophic individual Marketplace plans. This allows bronze and catastrophic plan enrollees to contribute to health savings accounts — a tax-advantaged savings account available to high-deductible health plan enrollees to use for certain health care expenses. CBO estimates that this provision will result in a $3.6 billion reduction in federal revenue over 10 years.</p><h4 id="section71308">Section 71308: Treatment of Direct Primary Care Service Arrangements<br>(Effective Jan. 1, 2026)</h4><p>The section allows individuals in high-deductible health plans to enroll in direct primary care service arrangements and to use their health savings accounts for payment. Through the provision, fees paid for direct primary care service arrangements may be treated as qualified medical expenses as eligible under health savings accounts. Monthly fees may not exceed $150 for an individual or $300 for more than one individual. Certain primary care services are excluded, such as procedures requiring anesthesia, prescription drugs and lab services not administered in an ambulatory primary care setting. CBO estimates that this provision will result in a $2.8 billion reduction in federal revenue over 10 years.</p><h3 id="subbchapter4">CHAPTER 4 — PROTECTING RURAL HOSPITALS AND PROVIDERS</h3><h4 id="section71401">Section 71401: Rural Health Transformation Program<br>(Effective from enactment)</h4><p>The section establishes a rural health transformation program that appropriates $50 billion in funding for rural providers, with $10 billion allocated each year in FYs 2026-2030.</p><ul><li><strong>Application.</strong> States will need to submit a one-time application to CMS to be eligible for these funds. CMS must approve or deny all applications by Dec. 31, 2025. (Note: CMS has not yet released the application.) The application must include a rural health transformation plan that describes how the funds will support rural residents in the state, including but not limited to ways to improve access to hospitals and other providers, strategies to manage hospitals’ long-term financial solvency and operating models, and certification that none of the funds will be used by the state to finance the non-federal share of expenditures.</li><li><strong>Funding Distribution.</strong> Only the 50 states are eligible for these funds (i.e., not the District of Columbia or U.S. territories). The $50 billion in funding will be distributed from FYs 2026 through 2030, with $10 billion distributed each year. For each fiscal year, 50% of the funds will be equally distributed among all the states with an approved application. The other 50% of the funds will be distributed in a method determined by CMS; however, CMS must allot funds to at least a quarter of the states with an approved application. The law requires CMS to consider the following as its allocation methodology: the percentage of the state population that is located in rural geographies, the proportion of rural health facilities in the state relative to the nation, the situation of hospitals in the state, and any other factors deemed appropriate by CMS. Not more than 10% of the amount allocated to the states can be used for administrative expenses.</li><li><strong>Rural Health Facilities Definition.</strong> The law defines a “rural health facility” to include hospitals located in a rural area or treated as being located in a rural area, critical access hospitals, sole community hospitals, Medicare-dependent hospitals, low-volume hospitals, rural emergency hospitals, rural health clinics, federally qualified health centers, community mental health centers, opioid treatment programs in rural areas, and community behavioral health clinics in rural areas.</li><li><strong>Use of Funds.</strong> Funds allocated to the state will need to be used for the following health activities:<ul><li>Providing payments to health care providers.</li><li>Recruiting and retaining clinical workforce talent in rural areas.</li><li>Promoting evidence-based interventions to improve prevention and chronic disease management.</li><li>Promoting technology-driven solutions and training for the adoption of such technology.</li><li>Assisting rural communities to right-size health delivery systems.</li><li>Supporting access to opioid use disorder treatment services.</li><li>Developing projects that support value-based care arrangements.</li><li>Other additional uses as determined by CMS.</li></ul></li></ul><h3 id="subtitlea">SUBTITLE A — TAX</h3><h3 id="subachapter4">CHAPTER 4 — INVESTING IN AMERICAN FAMILIES, COMMUNITIES AND SMALL BUSINESSES</h3><h4 id="section70415">Section 70415: Endowment Tax for Universities<br>(Effective Jan. 1, 2026)</h4><p>This section amends the excise tax rate for universities based on student endowments. The rates are as follows: 1.4% for student endowments ranging from $500,000-$750,000 (current law), 4% for student endowments ranging from $750,000-$2 million, and 8% for all student endowments above $2 million. CBO estimates that this provision will result in a $761 million increase in federal revenue over 10 years.</p><h4 id="section70416">Section 70416: Executive Compensation<br>(Effective Jan. 1, 2026)</h4><p>This section limits tax-exempt organizations’ ability to deduct compensation over $1 million, including for former employees, dating back to tax year 2017. CBO estimates that this provision will result in a $3.8 billion increase in federal revenue over 10 years.</p><h4 id="section70424">Section 70424: Charitable Contributions for Non-itemizers<br>(Effective Jan. 1, 2026)</h4><p>This section creates a permanent deduction on charitable contributions for taxpayers who do not elect to itemize. CBO estimates that this provision will result in a $73.8 billion reduction in federal revenue over 10 years.</p><h4 id="section70425">Section 70425: Floor on Charitable Contributions<br>(Effective Jan. 1, 2026)</h4><p>This section imposes a 0.5% floor on charitable contributions for taxpayers who elect to itemize for taxable years after Dec. 31, 2025. CBO estimates that this provision will result in a $63.1 billion increase in federal revenue over 10 years.</p><h4 id="section70426">Section 70426: One Percent Floor on Deduction of Charitable Contributions Made by Corporations<br>(Effective Jan. 1, 2026)</h4><p>This section allows a deduction for corporate charitable contributions only to the extent that the aggregate of corporate charitable contributions exceeds 1% of a taxpayer’s taxable income and does not exceed 10% of the taxpayer’s taxable income. CBO estimates that this provision will result in a $16.6 billion increase in federal revenue over 10 years.</p><h3 id="subachapter5">CHAPTER 5 — ENDING GREEN NEW DEAL SPENDING, PROMOTING AMERICA-FIRST ENERGY AND OTHER REFORMS</h3><h4 id="section70503">Section 70503: Termination of Qualified Commercial Clean Vehicles Credit<br>(Credit terminates Sep. 30, 2025)</h4><p>This section terminates the tax credit that allowed for tax-exempt entities to receive a direct payment for the lesser of 1) 15% of the vehicle’s cost (30% for vehicles not powered by gas or diesel) or 2) the incremental cost of the vehicle relative to a comparable vehicle. Under the previous law, the credit expired Dec. 31, 2032. CBO estimates that this provision will result in a $104.5 billion increase in federal revenue over 10 years.</p><h4 id="section70504">Section 70504: Termination of Alternative Fuel Vehicle Refueling Property Credit<br>(Credit terminates June 30, 2026)</h4><p>This section terminates the tax credit that allowed a tax-exempt owner of property to receive direct payment for the cost of installing a qualified alternative fuel vehicle refueling station on property, such as electric charging stations. Under the previous law, the credit expired Dec. 31, 2032. The credit will now be eliminated for projects place in service after June 30, 2026. CBO estimates that this provision will result in a $2 billion increase in federal revenue over 10 years.</p><h4 id="section70507">Section 70507: Termination of Energy Efficient Commercial Buildings Deduction<br>(Deduction terminates June 30, 2026)</h4><p>This section terminates the tax deduction for tax-exempt organizations to be allocated for energy-saving commercial building property. The deduction terminates for any property with construction beginning after June 30, 2026. CBO estimates that this provision will result in a $134 million increase in federal revenue over 10 years.</p><h4 id="section70513">Section 70513: Termination and Restrictions on Clean Energy Investment Credit<br>(Credit terminates Dec. 31, 2027)</h4><p>This section phases out and terminates the clean energy investment tax credit. Under the previous law, the credit was phased out in 2032.</p><ul><li>Terminates for covered wind and solar facilities for properties placed into service after Dec. 31, 2027.<ul><li>Increases the domestic content requirement for projects to be eligible for the domestic content bonus. The current law requires that 40% of the manufactured products in a facility must be from a domestic source. The bill would increase the required threshold to 45% (or 27.5% for offshore wind) from June 16, 2025, until Dec. 31, 2025; 50% (or 35% for offshore wind) for CY 2026; and 55% after Dec. 31, 2026.</li><li>Prevents access to credits for wind and solar if the taxpayer rents or leases the property to a third party.</li><li>Prohibition on credit that includes any material assistance from a prohibited foreign entity.</li></ul></li><li>Eliminates the energy credit for energy property not listed in the underlying statute (those listed include property such as small wind, biogas, and energy storage technology. This applies to construction beginning on or after June 16, 2025.</li></ul><p>CBO estimates that this provision will result in a $164 billion increase in federal revenue over 10 years.</p><h3 id="subtitleb">SUBTITLE B — LOAN LIMITS</h3><h4 id="section81001">Section 81001: Establishment of Loan Limits for Graduate and Professional Students and Parent Borrowers; Termination of Graduate and Professional PLUS Loans<br>(Effective July 1, 2026)</h4><p>This section establishes graduate and professional annual and aggregate loan limits and eliminates the Federal Direct PLUS Loan Program for students beginning July 1, 2026 (i.e., 2026-2027 academic year). Under the provision, graduate students who are not professional students can borrow up to $20,500 annually under the Federal Direct Unsubsidized Stafford Loan Program. Professional students may borrow up to $50,0000 annually. In aggregate, the maximum amount of Federal Direct Unsubsidized Stafford loans will be limited to $100,000 for a graduate student who is not a professional student, and $200,000 for a professional student. Students are subject to a lifetime maximum aggregate borrowing limit across all loan programs of $257,500, not including loans borrowed by parents on behalf of a dependent student. Previously, graduate and professional loans were limited to the cost of attendance.</p><p>Under the provision, Federal Direct PLUS loans will no longer be available to graduate or professional student borrowers. Parents borrowing through the Federal Direct PLUS Loan Program on behalf of a dependent student will be limited to borrowing $20,000 per student annually or $65,000 per student in aggregate.</p><ul><li><strong>Professional student.</strong> A professional student is defined as a student enrolled in a program of study that awards a professional degree upon completion of the program, including medical students (as defined under section 668.2 of title 34, Code of Federal Regulations).</li><li><strong>Interim exception for certain students.</strong> Individuals who, as of June 30, 2026, are enrolled in higher education and have received a loan will not be subject to the annual or aggregate limits for the lesser of the duration of their program or up to three academic years.</li></ul><p>CBO estimates that this provision will result in a $44.2 billion reduction in federal spending over 10 years.</p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/advisory/2025-07-18-one-big-beautiful-bill-act-obbba-provisions-timeline" target="_blank" title="Click here to view the One Big Beautiful Bill Act (OBBBA) Provisions Timeline.">View the One Big Beautiful Bill Act (OBBBA) Provisions Timeline</a></div><hr><ol><li id="fn1"><a href="https://cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf">cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf</a></li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2025/07/Legislative-Advisory-Detailed-Summary-of-One-Big-Beautiful-Bill-Act-OBBBA-Public-Law-No-119-21-w-Timeline.pdf" target="_blank" title="Click here to download the Legislative Advisory: Detailed Summary of One Big Beautiful Bill Act (OBBBA; Public Law No. 119-21) PDF."><img src="/sites/default/files/inline-images/Page-1-Legislative-Advisory-Detailed-Summary-of-One-Big-Beautiful-Bill-Act-OBBBA-Public-Law-No-119-21-w-Timeline.png" data-entity-uuid="16fb6a0d-ac19-4b1a-b24c-6a089e04fe78" data-entity-type="file" alt="Legislative Advisory: Detailed Summary of One Big Beautiful Bill Act (OBBBA; Public Law No. 119-21) page 1." width="695" height="900"></a><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/advisory/2025-07-18-one-big-beautiful-bill-act-obbba-provisions-timeline" target="_blank" title="Click here to view the One Big Beautiful Bill Act (OBBBA) Provisions Timeline.">View the OBBBA Timeline</a></div><hr><p><div class="views-element-container"><div class="js-view-dom-id-3ed905895d4c55b3d685ca670cefafa7e37b14d80e775d53dee5a3ef91512a7f"> <header> <h3>The Latest on the One Big Beautiful Bill Act</h3> </header> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care" hreflang="en">Chair File: The OBBBA and What’s Next for Health Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T10:16:20-05:00" title="Monday, July 28, 2025 - 10:16">Jul 28, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion" hreflang="en">CBO projects OBBBA to increase uninsured by 10 million, federal deficit by $3.4 trillion</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-21T15:37:59-05:00" title="Monday, July 21, 2025 - 15:37">Jul 21, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2025-07-16-aha-expresses-support-protect-medicaid-and-rural-hospitals-act" hreflang="en">AHA Expresses Support for Protect Medicaid and Rural Hospitals Act </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T14:21:17-05:00" title="Wednesday, July 16, 2025 - 14:21">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and" hreflang="en">Chair File: Leadership Dialogue — Continuing the Work to Strengthen Health in America With AHA President and CEO Rick Pollack</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T10:53:03-05:00" title="Wednesday, July 16, 2025 - 10:53">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025" hreflang="en">Resources on the One Big Beautiful Bill Act Signed Into Law July 4, 2025</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-15T14:49:30-05:00" title="Tuesday, July 15, 2025 - 14:49">Jul 15, 2025</time> </span> </div></div> <div class="more-link"><a href="/topics/budget-reconciliation">More on the One Big Beautiful Bill Act (OBBBA)</a></div> </div> </div> </p></div></div></div> div.sticky { position: sticky; top: 0; } .meta.custom-lock-position { position: relative; top: 0px; right: inherit; display: block; float: right; } .views-field-title { font-weight: bold; } .views-field-created { color: #000000 !important; } .views-row { margin-bottom: 20px; } Mon, 21 Jul 2025 06:00:00 -0500 Member Non-Fed /advisory/2025-07-18-one-big-beautiful-bill-act-obbba-provisions-timeline <div class="container"><div class="row"><div class="col-md-8"><p>President Trump July 4, 2025, signed into law the budget reconciliation bill, the <a href="https://www.congress.gov/bill/119th-congress/house-bill/1/text" target="_blank">One Big Beautiful Bill Act</a> (OBBBA), a sweeping package that enacts many of the administration’s legislative priorities on taxes, border security, energy, and deficit reduction. The bill includes significant policy changes to Medicaid and the Health Insurance Marketplaces. The AHA has developed this resource to visualize the enactment timeline for provisions impacting hospitals and health systems. See <a href="/advisory/2025-07-18-detailed-summary-one-big-beautiful-bill-act-obbba-public-law-no-119-21">AHA’s Legislative Advisory</a> for a summary of each provision.</p><h2>In Effect 2025</h2><table><thead><tr><th>Provision Description</th><th>Effective Date(s)</th><th>Section</th></tr></thead><tbody><tr><td>Permanent Extension of Safe Harbor for Absence of Deductible for Telehealth Services</td><td>Applies to taxable years beginning January 1, 2025</td><td>71306</td></tr><tr><td>State Directed Payments – New SDP Payment Cap (110% Medicare for Non-Expansion States, 100% of Medicare for Expansion States)</td><td>Effective upon enactment</td><td>71116</td></tr><tr><td>Uniform Tax Requirement</td><td>Effective upon enactment</td><td>71117</td></tr><tr><td>Rural Health Transformation Program</td><td>Effective upon enactment</td><td>71401</td></tr><tr><td>FMAP for Services Rendered by Abortion Providers (Federal Payments to Prohibited Entities)</td><td>Effective from enactment for one year (July 2026)</td><td>71113</td></tr><tr><td>Moratorium on Implementation of Medicaid Savings Program Eligibility and Enrollment Rule</td><td>Effective from enactment through September 30, 2034</td><td>71101</td></tr><tr><td>Moratorium on Implementation of Medicaid, CHIP and Basic Health Program Eligibility and Enrollment Rule</td><td>Effective from enactment through September 30, 2034</td><td>71102</td></tr><tr><td>Moratorium on Rule Relating to Long-Term Care Staffing Standards</td><td>Effective from enactment through September 30, 2034</td><td>71111</td></tr><tr><td>Termination of Qualified Commercial Clean Vehicles Credit</td><td>Credit terminates September 30, 2025</td><td>70503</td></tr><tr><td>Termination of qualified commercial clean vehicles credit</td><td>Effective September 30, 2025</td><td>70503</td></tr></tbody></table><hr><h2>In Effect 2026</h2><table><thead><tr><th>Provision Description</th><th>Effective Date(s)</th><th>Section</th></tr></thead><tbody><tr><td>Sunsetting Increased FMAP Incentive</td><td>Effective January 1, 2026</td><td>71114</td></tr><tr><td>Temporary Payment Increase Under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances</td><td>Effective January 1, 2026</td><td>71202</td></tr><tr><td>Disallowing Premium Tax Credit in Case of Certain Coverage Enrolled in During the Special Enrollment Period</td><td>Effective January 1, 2026</td><td>71304</td></tr><tr><td>Eliminating Limitation on Recapture of Advance Payment of Premium Tax Credit</td><td>Effective January 1, 2026</td><td>71305</td></tr><tr><td>Allowance of Bronze and Catastrophic Plans in Connection with Health Savings Accounts</td><td>Effective January 1, 2026</td><td>71307</td></tr><tr><td>Treatment of Direct Primary Care Service Arrangements</td><td>Effective January 1, 2026</td><td>71308</td></tr><tr><td>Disallowing Premium Tax Credits During Periods of Medicaid Ineligibility Due to Alien Status</td><td>Effective January 1, 2026</td><td>71302</td></tr><tr><td>Endowment Tax for Universities</td><td>Effective January 1, 2026</td><td>70415</td></tr><tr><td>Executive Compensation</td><td>Effective January 1, 2026</td><td>70416</td></tr><tr><td>Charitable Contributions for Non-itemizers</td><td>Effective January 1, 2026</td><td>70424</td></tr><tr><td>Floor on Charitable Contributions</td><td>Effective January 1, 2026</td><td>70425</td></tr><tr><td>One Percent Floor on Deduction of Charitable Contributions Made by Corporations</td><td>Effective January 1, 2026</td><td>70426</td></tr><tr><td>Termination of Alternative Fuel Vehicle Refueling Property Credit</td><td>Credit terminates June 30, 2026</td><td>70504</td></tr><tr><td>Termination of Energy Efficient Commercial Buildings Deduction</td><td>Deduction terminates June 30, 2026</td><td>70507</td></tr><tr><td>Loan Limits for Graduate and Professional Students and Parent Borrowers</td><td>Effective July 1, 2026</td><td>81001</td></tr><tr><td>Provider Taxes – Hold Harmless Threshold limited to the rate a state had in place as of July 4, 2025.</td><td>Effective October 1, 2026</td><td>71115</td></tr><tr><td>Limiting Qualified Alien Medicaid Eligibility</td><td>Effective October 1, 2026</td><td>71109</td></tr><tr><td>Expansion FMAP For Emergency Medicaid</td><td>Effective October 1, 2026</td><td>71110</td></tr><tr><td>Medicaid Community Engagement Requirements</td><td>Effective December 31, 2026</td><td>71119</td></tr></tbody></table><hr><h2>In Effect 2027</h2><table><thead><tr><th>Provision Description</th><th>Effective Date(s)</th><th>Section</th></tr></thead><tbody><tr><td>Limiting Medicare Coverage of Certain Individuals</td><td>Effective 18 months from enactment (January 2027)</td><td>71201</td></tr><tr><td>Eligibility Redeterminations</td><td>Effective January 1, 2027</td><td>71107</td></tr><tr><td>Limiting Retroactive Eligibility (Reducing State Medicaid Costs)</td><td>Effective January 1, 2027</td><td>71112</td></tr><tr><td>Permitting Premium Tax Credit Only for Certain Individuals</td><td>Effective January 1, 2027</td><td>71301</td></tr><tr><td>Provider Taxes – Hold Harmless Reduction (Expansion States)</td><td>Begins October 1, 2027</td><td>71115</td></tr><tr><td>Termination and Restrictions on Clean Energy Investment Credit</td><td>Credit terminates December 31, 2027</td><td>70513</td></tr></tbody></table><hr><h2>In Effect 2028</h2><table><thead><tr><th>Provision Description</th><th>Effective Date(s)</th><th>Section</th></tr></thead><tbody><tr><td>State Directed Payments – Phased Reduction for Grandfathered SDPs</td><td>Effective for the rating period beginning on or after Jauary 1, 2028</td><td>71116</td></tr><tr><td>Expanding and Clarifying the Exclusion for Orphan Drugs Under the Drug Price Negotiation Program</td><td>Effective January 1, 2028</td><td>71203</td></tr><tr><td>Requiring Verification of Eligibility for the Premium Tax Credit</td><td>Effective January 1, 2028</td><td>71303</td></tr><tr><td>Making Certain Adjustments to Coverage of Home or Community Based Services Under Medicaid</td><td>Effective January 1, 2028</td><td>71121</td></tr><tr><td>Modifying Cost-sharing Requirements for Certain Expansion Individuals Under the Medicaid Program</td><td>Effective October 1, 2028</td><td>71120</td></tr></tbody></table><hr><h2>Regulatory/Guidance Calendar</h2><p>The table below summarizes the provisions that may require regulations or other guidance for implementation. This is subject to change and the administration may release guidance on any provision included in the final OBBBA.</p><table><thead><tr><th>Future Regulation or Guidance</th><th>Agency(ies)</th><th>Due Date</th><th>Section</th></tr></thead><tbody><tr><td>Guidance related to implementing more frequent Medicaid eligibility redeterminations.</td><td>Health and Human Services, Centers for Medicare & Medicaid Services</td><td>December 31, 2025 (No later than 180 days after enactment)</td><td>71107</td></tr><tr><td>Guidance on the implementation of the rural transformation fund (e.g., application period)</td><td>Centers for Medicare & Medicaid Services</td><td><em>TBD;</em> Application period must end no later than December 31, 2025</td><td>71401</td></tr><tr><td>Guidance related to implementing community engagement (work) requirements (e.g., compliance criteria, short term hardship events, and compliance and ex parte verification procedures)</td><td>Health and Human Services</td><td>June 1, 2026</td><td>71119</td></tr><tr><td>Guidance on non-uniform provider tax transition period (up to three years)</td><td>Health and Human Services</td><td><em>TBD</em></td><td>71117</td></tr><tr><td>Regulations or other guidance on the application of excluded services under direct primary care service arrangements</td><td>Health and Human Services, Centers for Medicare & Medicaid Services</td><td><em>TBD</em></td><td>71308</td></tr><tr><td>Potential future rulemaking on the definition of total published Medicare rate in 438.6(a) of title 42</td><td>Health and Human Services, Centers for Medicare & Medicaid Services</td><td>N/A</td><td>71116</td></tr></tbody></table></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/07/One-Big-Beautiful-Bill-Act-OBBBA-Provisions-Timeline.pdf" target="_blank" title="Click here to download the One Big Beautiful Bill Act (OBBBA) Provisions Timeline PDF.">Download the Timeline PDF</a></div><p><a href="/system/files/media/file/2025/07/One-Big-Beautiful-Bill-Act-OBBBA-Provisions-Timeline.pdf" target="_blank" title="Click here to download the One Big Beautiful Bill Act (OBBBA) Provisions Timeline PDF."><img src="/sites/default/files/inline-images/Page-1-One-Big-Beautiful-Bill-Act-OBBBA-Provisions-Timeline.png" data-entity-uuid="d6601854-7c6d-4cfd-8e5a-224b8704b45a" data-entity-type="file" alt="One Big Beautiful Bill Act (OBBBA) Provisions Timeline page 1." width="693" height="900"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/advisory/2025-07-18-detailed-summary-one-big-beautiful-bill-act-obbba-public-law-no-119-21" target="_blank" title="Click here to view the Legislative Advisory: : Detailed Summary of One Big Beautiful Bill Act (OBBBA; Public Law No. 119-21)">View the Legislative Advisory: Detailed Summary of One Big Beautiful Bill Act</a></div><hr><p><div class="views-element-container"><div class="js-view-dom-id-3e61544938cf386cd7b225c3a86a4abd0184054685aa9f6ff5f858d6c0d4dabb"> <header> <h3>The Latest on the One Big Beautiful Bill Act</h3> </header> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care" hreflang="en">Chair File: The OBBBA and What’s Next for Health Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T10:16:20-05:00" title="Monday, July 28, 2025 - 10:16">Jul 28, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion" hreflang="en">CBO projects OBBBA to increase uninsured by 10 million, federal deficit by $3.4 trillion</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-21T15:37:59-05:00" title="Monday, July 21, 2025 - 15:37">Jul 21, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2025-07-16-aha-expresses-support-protect-medicaid-and-rural-hospitals-act" hreflang="en">AHA Expresses Support for Protect Medicaid and Rural Hospitals Act </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T14:21:17-05:00" title="Wednesday, July 16, 2025 - 14:21">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and" hreflang="en">Chair File: Leadership Dialogue — Continuing the Work to Strengthen Health in America With AHA President and CEO Rick Pollack</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T10:53:03-05:00" title="Wednesday, July 16, 2025 - 10:53">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025" hreflang="en">Resources on the One Big Beautiful Bill Act Signed Into Law July 4, 2025</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-15T14:49:30-05:00" title="Tuesday, July 15, 2025 - 14:49">Jul 15, 2025</time> </span> </div></div> <div class="more-link"><a href="/topics/budget-reconciliation">More on the One Big Beautiful Bill Act (OBBBA)</a></div> </div> </div> </p></div></div></div> table, th, td { border: 1px solid; } tr:nth-child(even) { background-color: #b9d9eb33; } th { background-color: #002855; color: white; } h2 { color: #9d2235; } div.sticky { position: sticky; top: 0; } .meta.custom-lock-position { position: relative; top: 0px; right: inherit; display: block; float: right; } .views-field-title { font-weight: bold; } .views-field-created { color: #000000 !important; } .views-row { margin-bottom: 20px; } Fri, 18 Jul 2025 06:15:00 -0500 Member Non-Fed /case-studies/2025-07-07-presumptive-eligibility-case-study-corewell-health <div class="container"><div class="row"><div class="col-md-8"><h2>Background</h2><p>Corewell Health, a 21-hospital nonprofit health system headquartered in Michigan, is strongly committed to communicating the availability of financial assistance to patients and the public, and to ensuring that consistent guidelines are applied to requests for financial assistance across its system. Compassion is a core value of Corewell Health. The health system is resolute in ensuring that all patients receive emergency or medically necessary care irrespective of their financial status. Determination of eligibility for financial assistance occurs after care is delivered and is based on the demonstrated financial need of individual patients as identified through traditional financial assistance applications, conversations with financial counselors and through new presumptive eligibility analytics tools. Corewell is partnering with financial services vendor FinThrive to help design and administer its presumptive eligibility tool, which pulls in publicly available financial data and other information to help identify eligible patients. Presumptive eligibility is not intended to take the place of traditional screening, but rather to augment the existing process.</p><div class="row"><div class="col-md-8"><h2>Financial Assistance Process, Including Presumptive Eligibility</h2><p>Corewell has long maintained a strong commitment to providing charity care and financial assistance to uninsured patients and patients of limited financial means. The Corewell Health team communicates widely with patients and the public about the availability of financial assistance from the beginning of a patient’s encounter with the health system, through signage in each hospital emergency department, registration areas and other public locations, and on the Corewell Health website. Corewell also includes a plain language summary of the <a href="https://assets.contentstack.io/v3/assets/blt3055f692fe7bf193/bltc1707ea925a2190c/faep-summary-english.pdf" target="_blank" title="Corewell Health: Financial Assistance Eligibility Policy Summary">Financial Assistance Eligibility Policy</a> in both the patient intake and discharge materials.</p></div><div class="col-md-4"><div><p>The presumptive eligibility process has opened up a new channel of financial relief for patients, generating positive feedback from patients and financial counselors. <strong>Since implementing presumptive eligibility for charity care, the system has seen an increase of 181% in total charity care.</strong></p></div></div></div><p>To maximize the effectiveness of the financial assistance program, Corewell provides multiple touchpoints for patients to share information in support of receiving financial assistance. After discharge, patients receive information about the financial assistance eligibility policy and are invited to connect with the health system’s team to learn more and apply for assistance.</p><p>After a patient receives care and before financial assistance is applied, patients and Corewell Health pursue third-party payment from insurers. Additionally, Corewell provides support for eligible patients to enroll in long-term coverage options, including Medicaid and coverage options in the Health Insurance Marketplace.</p><p>After insurance coverage or self-pay status has been determined, patients who self-report that they are financially unable to pay, or have otherwise been identified by Corewell Health as potentially unable to pay, are connected with financial counselors for evaluation. Patients may be asked to proceed with the traditional financial assistance application process to determine the appropriate level of financial assistance. For certain qualified patients with balances under $2,000, the application process may be streamlined. If Corewell receives even an incomplete financial assistance application, it will move away from collections efforts and instead continue to work with the patient to determine what financial assistance might be available.</p><p>Over a period of at least 120 days from the first post-discharge bill, or four billing statements, patients are repeatedly notified about financial assistance opportunities. After the fourth statement, Corewell conducts a presumptive eligibility screening, taking into account elements such as credit scores, income, household size and health payment scores.</p><p>Through the presumptive eligibility screening, Corewell Health generates a “likelihood to pay” score using a model developed by FinThrive that utilizes credit report information, self-reported data, marketing data sources and average incomes for others near the patient’s reported address. In certain cases, such as individuals deemed to be homeless, patients will presumptively qualify for 100% financial assistance for their cost-sharing in the form of a charity care adjustment. An uninsured or self-pay patient falling below 250% of the federal poverty guidelines would receive an automatic discount before a bill is sent.</p><h2>Benefits to Patients</h2><p>The effort to hardwire presumptive eligibility into the health system’s financial assistance processes was driven by a desire to streamline the process for patients and the growing Corewell Health system without supplanting entirely the real human conversations between patients and their providers about their coverage and ability to pay. In addition to increasing efficiency for patients, the presumptive eligibility process expands financial assistance access to patients who qualify but have not applied through the traditional process. This enables Corewell to support a broader population of patients through its charity care program.</p><p>Finally, presumptive eligibility brings added consistency to the financial assistance program across the Corewell Health system. Presumptive eligibility is applied to both professional and technical service line items, and the same policy is applied throughout the entire system, ensuring consistency across locations and with physicians.</p><h2>Lessons Learned</h2><p>As Corewell Health worked to build and implement the presumptive eligibility tool into their process, the team quickly learned the importance of investing time with vendors and understanding the algorithm. It took six to eight months to capture the correct data and adjust the tool and discount automation before it was fully operational, and the process is always being monitored.</p><p>Corewell recommends that hospitals developing a presumptive eligibility process ensure that finance, reimbursement and other departments involved have deliberate and intentional conversations about how the process is working and what the timing will be, and model the likely impact on reserves, bad debt and charity care.</p><p>The Corewell team stressed the need to work with their ecosystem of suppliers and vendors, including Epic, to leverage the tools across all locations. For example, Corewell works closely with Epic to automate the write-off logic and file data returned from FinThrive to ensure a consistent process for all patients who qualify. Strong vendor partners were particularly instrumental in the testing phase, identifying ranges and populating scores to drive the evolution of the automated presumptive eligibility process. Along with vendor partners, Corewell began with an interface to trigger the query during the registration process, and ultimately determined that moving registration and financial counseling teams under the same umbrella at Corewell was advantageous.</p><p>The team at Corewell notes that presumptive eligibility tools need to be monitored frequently to ensure they are capturing the appropriate data to identify eligible patients, as well as tracking other markers of charity care eligibility. To support this work, Corewell recommends that financial counselors and data analytics teams work collaboratively to test and retest algorithms and advises that the teams be trained to fully understand the system’s financial assistance policies and practices. It is equally important to fully train front-end and registration staff as the process of collecting and inputting information requires careful attention to detail. The Corewell team monitors data monthly to review traditional counseling versus automation and adjust as appropriate.</p><h2>Next Steps</h2><p>In the future, Corewell envisions presumptive eligibility playing an even greater role in providing financial assistance paths for uninsured patients, as well as potentially for certain categories of underinsured patients. Moving forward, financial counselors will remain a key element of the charity care and financial assistance process at Corewell Health, continuing to offer presentations, discussions and trainings about related policies and processes with all staff, and particularly clinical teams and discharge planners, to ensure all are aware of the support Corewell’s financial counselors can provide. The system is also engaged in active conversations with community partners to determine where financial counselors are most needed and will be identifying additional opportunities to leverage this effort for future health equity and social drivers of health work.</p></div><div class="col-md-4"><div class="sticky"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/05/Presumptive-Eligibility-Case-Study-Corewell-Health.pdf"" target="_blank" title="Click here to download the Presumptive Eligibility Case Study: Corewell Health PDF.">Download the Case Study PDF</a></div><a href="/system/files/media/file/2025/05/Presumptive-Eligibility-Case-Study-Corewell-Health.pdf"" target="_blank" title="Click here to download the Presumptive Eligibility Case Study: Corewell Health PDF."><img src="/sites/default/files/inline-images/Page-1-Presumptive-Eligibility-Case-Study-Corewell-Health.png" data-entity-uuid="8fa2da21-c196-4678-a583-7e46106b14f1" data-entity-type="file" alt="Presumptive Eligibility Case Study: Corewell Health page 1." width="695" height="900"></a><hr><div><a class="btn btn-wide btn-primary" href="/advocacy/advocacy-issues/presumptive-eligibility" target="_blank" title="Click here to see advocacy resources on Presumptive Eligibility.">Advocacy Issue: Presumptive Eligibility</a></div><hr><div><a class="btn btn-wide btn-primary" href="/fact-sheets/2025-05-30-fact-sheet-presumptive-eligibility" target="_blank" title="Click here to read the Fact Sheet: Presumptive Eligibility.">Fact Sheet: Presumptive Eligibility</a></div><hr><div><a class="btn btn-wide btn-primary" href="/case-studies/2025-06-02-presumptive-eligibility-case-study-houston-methodist" target="_blank" title="Click here to read the Presumptive Eligibility Case Study: Houston Methodist.">Presumptive Eligibility Case Study: Houston Methodist</a></div></div></div></div></div> h2 { color: #9d2235; } h3 { color: #9d2235; } div.sticky { position: sticky; top: 0; } Mon, 07 Jul 2025 09:37:33 -0500 Member Non-Fed /special-bulletin/2025-07-01-senator-scotts-amendment-withdrawn-senate-vote <div class="container"><div class="row"><div class="col-md-8"><p>Sen. Rick Scott, R-Fla., has withdrawn his amendment to the Senate’s budget reconciliation bill. This withdrawal comes after a vigorous advocacy campaign by the AHA, with the great assistance of our members, to urge senators to vote no on the amendment. Thanks to our unified effort, this harmful policy will not be included in the Senate’s version of the budget reconciliation bill.</p><p>The amendment would have required, in expansion states, that any Medicaid beneficiary who temporarily loses coverage and reapplies would be enrolled at the traditional Medicaid Federal Medical Assistance Percentage. In addition, the amendment would have required that only Medicaid expansion enrollees who were “grandfathered” (those enrolled as of Dec. 31, 2030) could receive the enhanced match. <a href="/fact-sheets/2025-06-29-estimated-impact-fmap-reduction-90-traditional-result-churn-federal-medicaid-hospital-spending">AHA analysis</a> showed that the impact of the amendment would have been a reduction of Medicaid payments to hospitals by $99.2 billion over five years.</p><p>The Senate is finishing the reconciliation process vote-a-rama, where unlimited amendments can be presented prior to the final vote. There will also be a process for a final amendment that could provide the opportunity for additional changes. The Senate bill will be sent back to the House for their final vote.</p><p>The AHA continues to monitor the progress of the budget reconciliation process and will provide members with critical updates.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/07/Special-Bulletin-Senator-Scotts-Amendment-Withdrawn-from-Senate-Vote.pdf" target="_blank" title="Click here to download the Special Bulletin: Senator Scott’s Amendment Withdrawn from Senate Vote PDF."><img src="/sites/default/files/inline-images/Special-Bulletin-Senator-Scotts-Amendment-Withdrawn-from-Senate-Vote.png" data-entity-uuid="089c23c5-d875-45ad-b8b5-9a4accf80210" data-entity-type="file" width="698" height="900"></a></p></div></div></div> Tue, 01 Jul 2025 09:30:00 -0500 Member Non-Fed /special-bulletin/2025-06-29-aha-urges-senate-amend-budget-reconciliation-bill-final-passage <div class="container"><div class="row"><div class="col-md-8"><p>The AHA today sent <a href="/lettercomment/2025-06-29-aha-urges-senate-amend-budget-reconciliation-bill-protect-access-care">senators a letter</a> urging them to amend its budget reconciliation bill before its final passage in the Senate. The Senate version of the One Big Beautiful Bill Act (OBBBA) proposes even greater cuts to the Medicaid program than the House-passed version.</p><p>AHA President and CEO Rick Pollack said in the letter, “The magnitude of nearly a trillion-dollar reduction to the Medicaid program cannot be characterized solely as waste, fraud and abuse. The real-life consequences of these reductions will result in irreparable harm to access to care for all Americans and undermine the ability of hospitals and health systems to care for our most vulnerable patients.”</p><p>The reconciliation process is underway in the Senate with up to 20 hours of debate followed by unlimited amendments prior to the final vote. There will also be a process for a final amendment that could provide the opportunity for additional changes. The Senate bill will be sent back to the House for their final vote. See <a href="/action-alert/2025-06-28-time-act-now-contact-senate-and-house-lawmakers-today">AHA’s Action Alert</a> for more details.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/06/aha-urges-senate-to-amend-budget-reconciliation-bill-before-final-passage-bulletin-6-29-2025-f.pdf" target="_blank" title="Click here to download the Special Bulletin: AHA Urges Senate to Amend Budget Reconciliation Bill Before Final Passage PDF."><img src="/sites/default/files/2025-06/cover-aha-urges-senate-to-amend-budget-reconciliation-bill-before-final-passage-bulletin-6-29-2025-f.png" alt="Special Bulletin: AHA Urges Senate to Amend Budget Reconciliation Bill Before Final Passage" width="640" height="834"></a></p></div></div></div> Sun, 29 Jun 2025 19:55:59 -0500 Member Non-Fed /action-alert/2025-06-29-scott-amendment-could-drastically-impact-medicaid-expansion-states <div class="container"><div class="row"><div class="col-md-8"><p>Senator Rick Scott, R-Fla., is expected to introduce an amendment to the Senate budget reconciliation bill during the vote-a-rama in the coming hours. The amendment would dramatically impact expansion states.</p><p>If approved, the amendment would require, in expansion states, that any Medicaid beneficiary who temporarily loses coverage and reapplies would be enrolled at the traditional Medicaid Federal Medical Assistance Percentage (FMAP) rather than the 90% federal match rate. <strong>This, along with other Medicaid changes in the Senate bill, would be devastating for Medicaid expansion states’ ability to provide coverage for the millions of Americans on the program and would unfairly penalize low-income workers.</strong></p><p>While the federal government, under the Affordable Care Act, covers 90% of the costs for individuals eligible for Medicaid due to the expansion, the traditional (or regular) FMAP for services used by beneficiaries ranges by state from 50% to 70%. The <a href="/fact-sheets/2025-06-29-estimated-impact-fmap-reduction-90-traditional-result-churn-federal-medicaid-hospital-spending">AHA estimates</a> that this amendment would reduce the federal share of Medicaid payments to hospitals by $198.3 billion over 10 years. Coupled with the $1 trillion in cuts to the Medicaid program already in the Senate budget reconciliation bill, this is simply unsustainable.</p><h2>Contact your senators immediately to urge them to VOTE NO on the Scott amendment.</h2><p>Under the rules, the reconciliation bill is limited to 20 hours of debate, which is expected to begin this afternoon. This is followed by an unlimited amendment period before the final vote. <strong>It is imperative that you contact your senators prior to the start of the amendment period to ensure they do not support the Scott amendment.</strong></p><p><strong>WE URGE YOU TO PLEASE PROVIDE YOUR HOSPITAL DATA AND IMPACTS AS PART OF YOUR ADVOCACY.</strong> Use the background information below to assist in your advocacy efforts.</p><h2>Background</h2><p>The proposal would require that any Medicaid expansion population beneficiary who drops off the rolls and then later reapplies for Medicaid coverage only be eligible for coverage at the state’s traditional match rate instead of the 90% match rate.</p><ul><li>There can be significant “churn” in the Medicaid program, as low-income individuals cycle on and off the program. This policy will have a massive impact on the expansion states’ programs.<ul><li>People can move off and on to the program due to fluctuating household incomes and difficulties navigating the Medicaid renewal process.<ul><li>Many low-income individuals experience income volatility due to hourly or seasonal work, making them temporarily ineligible for Medicaid when their income rises, even if it fluctuates back down.</li><li>Renewal procedures and reporting requirements can lead to disenrollment even for those who remain eligible for the program.</li></ul></li><li>Policies that are part of the Senate package — including community engagement requirements in expansion states, increased redetermination of eligibility checks, and preventing the eligibility and enrollment rules from going into effect — will likely lead to many Medicaid beneficiaries cycling off the program, and then later requalifying for it.</li></ul></li><li>The hospitals in expansion states will also be negatively impacted, and this is on top of absorbing the nearly $1 trillion in Medicaid cuts that are part of the underlying package.<ul><li>The provider tax and state-directed payment provisions alone cut $340 billion from the program, which are direct hits to how Medicaid programs are financed and providers are reimbursed.</li><li>The policy lowering the FMAP from 90% to traditional match would result in an additional $198.3 billion hit to hospitals over 10 years.</li></ul></li><li>When coupled with all the other Medicaid changes in the bill, this policy is unsustainable for Medicaid expansion states and the hospitals serving patients in those states.</li><li>This change in policy will most impact low-income workers, many of whom are Trump supporters, and who rely on the Medicaid program for their health insurance.</li></ul><p>Visit the <a href="/advocacy/advocacy-issues/medicaid">AHA Action Center Medicaid Issues</a> page for resources to support your advocacy. <strong>Don’t wait, contact your lawmakers now.</strong></p><h2>Further Questions</h2><p>Visit the <a href="/advocacy/action-center">AHA Action Center</a> for more resources on these issues and other priorities important to hospitals and health systems. If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><div class="sticky"><p><a href="/system/files/media/file/2025/06/Sen-Scott-Amendment-Could-Drastically-Impact-Medicaid-Expansion-States.pdf" target="_blank" title="Click here to download the Action Alert: Sen. Scott Amendment Could Drastically Impact Medicaid Expansion States; Urge Senators to Vote No on the Scott Amendment PDF."><img src="/sites/default/files/inline-images/Page-1-Sen-Scott-Amendment-Could-Drastically-Impact-Medicaid-Expansion-States.png" data-entity-uuid="5ebcf109-5b22-4fd1-8267-6c37f8486fe3" data-entity-type="file" alt="Action Alert: Sen. Scott Amendment Could Drastically Impact Medicaid Expansion States; Urge Senators to Vote No on the Scott Amendment page 1." width="696" height="900"></a></p></div></div></div></div> div.sticky { position: sticky; top: 0; } Sun, 29 Jun 2025 15:29:22 -0500 Member Non-Fed /fact-sheets/2025-06-29-estimated-impact-fmap-reduction <div class="container"><div class="row"><div class="col-md-8"><p>The table below summarizes the 10-year impact on federal Medicaid hospital spending if the Federal Medical Assistance Percentage (FMAP) were reduced to the traditional level for Medicaid expansion enrollees due to program churn.</p><table><thead><tr><th>State</th><th>10-year Reduction in Federal Medicaid Hospital Spending<br>(FYs 2026-2035)</th></tr></thead><tbody><tr class="red-row"><td class="red-row">United States</td><td class="red-row">-$198.3B</td></tr><tr><td>Alabama</td><td>-$0B</td></tr><tr><td>Alaska</td><td>-$343M</td></tr><tr><td>Arizona</td><td>-$6.7B<a href="#fn1">*</a></td></tr><tr><td>Arkansas</td><td>-$1.2B<a href="#fn1">*</a></td></tr><tr><td>California</td><td>-$53.5B</td></tr><tr><td>Colorado</td><td>-$2.5B</td></tr><tr><td>Connecticut</td><td>-$2.8B</td></tr><tr><td>Delaware</td><td>-$512M</td></tr><tr><td>DC</td><td>-$494M</td></tr><tr><td>Florida</td><td>-$0B</td></tr><tr><td>Georgia</td><td>-$0B</td></tr><tr><td>Hawaii</td><td>-$819M</td></tr><tr><td>Idaho</td><td>-$447M<a href="#fn1">*</a></td></tr><tr><td>Illinois</td><td>-$11.0B<a href="#fn1">*</a></td></tr><tr><td>Indiana</td><td>-$2.8B<a href="#fn1">*</a></td></tr><tr><td>Iowa</td><td>-$2.0B<a href="#fn1">*</a></td></tr><tr><td>Kansas</td><td>-$0B</td></tr><tr><td>Kentucky</td><td>-$4.4B</td></tr><tr><td>Louisiana</td><td>-$4.7B</td></tr><tr><td>Maine</td><td>-$605M</td></tr><tr><td>Maryland</td><td>-$3.6B</td></tr><tr><td>Massachusetts</td><td>-$4.3B</td></tr><tr><td>Michigan</td><td>-$6.0B</td></tr><tr><td>Minnesota</td><td>-$2.9B</td></tr><tr><td>Mississippi</td><td>-$0B</td></tr><tr><td>Missouri</td><td>-$2.3B</td></tr><tr><td>Montana</td><td>-$809M<a href="#fn1">*</a></td></tr><tr><td>Nebraska</td><td>-$581M</td></tr><tr><td>Nevada</td><td>-$3.0B</td></tr><tr><td>New Hampshire</td><td>-$350M<a href="#fn1">*</a></td></tr><tr><td>New Jersey</td><td>-$7.6B</td></tr><tr><td>New Mexico</td><td>-$1.6B<a href="#fn1">*</a></td></tr><tr><td>New York</td><td>-$15.3B</td></tr><tr><td>North Carolina</td><td>-$8.9B<a href="#fn1">*</a></td></tr><tr><td>North Dakota</td><td>-$248M</td></tr><tr><td>Ohio</td><td>-$5.0B</td></tr><tr><td>Oklahoma</td><td>-$2.8B</td></tr><tr><td>Oregon</td><td>-$4.8B</td></tr><tr><td>Pennsylvania</td><td>-$7.3B</td></tr><tr><td>Rhode Island</td><td>-$634M</td></tr><tr><td>South Carolina</td><td>-$0B</td></tr><tr><td>South Dakota</td><td>-$228M</td></tr><tr><td>Tennessee</td><td>-$0B</td></tr><tr><td>Texas</td><td>-$0B</td></tr><tr><td>Utah</td><td>-$873M<a href="#fn1">*</a></td></tr><tr><td>Vermont</td><td>-$208M</td></tr><tr><td>Virginia</td><td>-$15.2B<a href="#fn1">*</a></td></tr><tr><td>Washington</td><td>-$8.6B</td></tr><tr><td>West Virginia</td><td>-$513M</td></tr><tr><td>Wisconsin</td><td>-$0B</td></tr><tr><td>Wyoming</td><td>-$0B</td></tr></tbody></table><p><strong>Source:</strong> AHA analysis of modeling conducted by Manatt Health Strategies, LLC.</p><p> </p><hr><h2>Notes</h2><p id="fn1">*12 states have trigger laws in place that would automatically end Medicaid expansion or require program changes if their FMAP is reduced from 90%. The impact for these 12 states is likely to be significantly larger if they end or limit Medicaid expansion.</p><p>This analysis reflects the reduction in federal Medicaid hospital spending from a churn-based FMAP reduction. It does not account for potential changes in state Medicaid hospital spending that may occur. Our estimates show the midpoint between historical Medicaid enrollment churn levels of 10% per year and 100% conversion of all expansion-eligible adults to regular FMAP.</p></div><div class="col-md-4"><div class="sticky"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/06/Estimated-Impact-of-FMAP-Reduction-from-90%25-to-Traditional.pdf" target="_blank" title="Click here to download the Estimated Impact of FMAP Reduction (from 90% to Traditional) as a Result of Churn on Federal Medicaid Hospital Spending fact sheet PDF.">Download the Fact Sheet PDF</a></div><a href="/system/files/media/file/2025/06/Estimated-Impact-of-FMAP-Reduction-from-90%25-to-Traditional.pdf" target="_blank" title="Click here to download the Estimated Impact of FMAP Reduction (from 90% to Traditional) as a Result of Churn on Federal Medicaid Hospital Spending fact sheet PDF."><img src="/sites/default/files/inline-images/Page-1-Estimated-Impact-of-FMAP-Reduction-from-90%25-to-Traditional-900x695.png" data-entity-uuid="4a30cd4c-7769-4dad-87a3-1d94be0bb591" data-entity-type="file" alt="Estimated Impact of FMAP Reduction (from 90% to Traditional) as a Result of Churn on Federal Medicaid Hospital Spending fact sheet page 1." width="695" height="900"></a></div></div></div></div> table, th, td { border: 1px solid; } th { background-color: #003087; color: #ffffff; } .red-row { background-color: #9d2235; color: #ffffff; font-style: italic; } div.sticky { position: sticky; top: 0; } Sun, 29 Jun 2025 14:48:02 -0500 Member Non-Fed /special-bulletin/2025-06-24-register-special-june-24-aha-all-member-call-ahead-possible-senate-vote-week-reconciliation-bill <div class="container"><div class="row"><div class="col-md-8"><p>The Senate draft budget reconciliation bill is expected to be introduced and considered for a vote as early as the middle of this week. As the AHA has <a href="/advisory/2025-06-16-senate-finance-committee-releases-legislative-text-reconciliation-bill">shared previously</a>, the Senate version of the budget reconciliation bill proposes even greater cuts to the Medicaid program, among other provisions, than the House bill.</p><p><strong>Please join AHA President and CEO Rick Pollack, Executive Vice President of Government Relations and Public Policy Stacey Hughes, and other AHA leaders for a member-only call June 24 at 5 p.m. ET. </strong><a href="https://www.directrsvp.com/DirectRSVP/WebForms/EventRegistration.aspx?InvCode=fdd20b75-1622-4b33-8198-2ba6457d1743&mkt_tok=NzEwLVpMTC02NTEAAAGbPZ4CttxUBCFgPmITVKPqGq6C3CWl1fM0RKz8YyHjqLmH29i3aIzXhYwN7eryHP6debAB-oJnZkk3jNtMFnKw3iQDClwT2Qx9WafG1kw82tDKP_Fr" target="_blank" title="Special AHA Call on Reconciliation Bill with Medicaid, Other Health Care Changes registration"><strong>Register for the call.</strong></a></p><h2>Action Needed</h2><p><strong>As we shared in our June 20 </strong><a href="/action-alert/2025-06-20-urgent-senate-budget-reconciliation-vote-expected-next-week-contact-senate-and-house-lawmakers-today"><strong>Action Alert</strong></a><strong>,</strong> the Senate could vote this week, sending the bill back to the House before the July 4 recess for a final vote. It is uncertain if the House could pass the Senate version.</p><p><strong>Please contact your senators and representatives today and urge them to protect Medicaid and access to health care and services in your community.</strong> Advocate to your Republican senators to oppose the Senate reconciliation bill as drafted related to provider taxes and state-directed payments. Equally important, tell your Republican House members, who could still have significant influence over the final product, to oppose the current Senate changes to provider taxes and state-directed payments.</p><p><strong>Please see the recent </strong><a href="/action-alert/2025-06-20-urgent-senate-budget-reconciliation-vote-expected-next-week-contact-senate-and-house-lawmakers-today"><strong>AHA Action Alert</strong></a><strong> for more details and resources to assist your advocacy efforts.</strong></p><h2>New AHA TV and Digital Ad</h2><p>The AHA this week is launching a <a href="https://www.youtube.com/watch?v=iQTYkTA27qM" target="_blank" title="YouTube: 
Protect Hospital Care">new TV and digital ad</a> urging Congress to protect access to hospital care across the nation as it considers legislation that could have far-ranging negative consequences for patients, communities and hospitals across America.</p><p>The ad highlights how, when every second counts, America’s hospitals and health systems are there 24/7 to care for patients during all of life’s moments. “People count on us; now we’re counting on you,” the ad says. “Congress: Protect hospital care.”</p><p>The campaign includes a TV ad that will run on broadcast and cable TV in Washington, D.C., as well as digital ads.</p><h2>Further Questions</h2><p>If you have further questions, please contact AHA at 800-424-4301.</p></div></div></div> Tue, 24 Jun 2025 09:17:23 -0500 Member Non-Fed