H.R. 1, the One Big Beautiful Bill Act, requires significant policy and funding changes to state Medicaid programs over the coming years that will
disproportionately harm people experiencing homelessness. However, there are options states can take to lessen these harms.
This policy brief outlines state-level advocacy options the Health Care for the Homeless (HCH) Community should pursue to offset the impact of Medicaid cuts—with some options specific to homelessness, and others aimed at the broader Medicaid population.
With many provisions set to take effect January 1, 2027, states will have to make critical decisions in the coming months in anticipation of budget shortfalls – likely during the upcoming 2026 state legislative sessions. Advocates must act now to build support for allowable policy options that will decrease coverage loss and service reductions.
