Medicaid Rural health transformation: The bill establishes a $50 billion fund to support rural hospitals FY 2026 through FY 2030. Effective Immediately.

Free Choice of Provider: Prohibits Medicaid funds to be paid to providing nonprofit organizations, essential community providers primarily engaged in family planning services or reproductive services that have received $800,00 or more in payments from Medicaid in FY2023. Effective immediately.

Gender Affirming Care: Prohibits federal matching funds for “gender transition procedures”, defined to include puberty blockers, hormone treatment, and surgery, for any individuals enrolled in Medicaid and Chip. Effective immediately.

Retroactive Coverage: Limits retroactive coverage for two months prior to application for coverage. Additionally, CHIP coverage may retroactively begin two months prior to the application filing date. Effective December 31, 2026.

Provider Taxes: States cannot increase existing provider tax rates or introduce new ones to qualify for federal matching funds. Effective FY2027.

Long-Term Care Coverage: Revising home equity limit for determining eligibility for long-term care services under the Medicaid program Limits the amount states can set for home equity when determining eligibility for long-term care. Also eliminates the yearly inflation increase. Effective January 1, 2028.

State Directed Payments: The Senate measure would gradually decrease the federal matching rate for SDPs from the average commercial rate until the rate is 10% above the Medicare rate. Effective FY2028-FY2031.

Improper Payments: Reduces federal payments to states with improper payments including payments to ineligible people, overpayments and payments made when there was insufficient information to confirm eligibility. Effective FY 2030.

Requiring states to pay a portion of SNAP benefits for the first time in program history, up to 15%, based on their payment error rates, beginning in FY2028. Note: For states with 10% or higher error rates, implementation for payments will be delayed by 2 years.

Administrative Cost Share: State administrative cost share of 75% will be Effective FY 2027.

Work Requirements: Expands work requirements by increasing the age from 54 to age 64 and includes adults with dependent children ages 14 and older. Note: Unclear when the new requirement will go into effect.

Work Requirements: Prior exemptions eliminated for veterans, homeless individuals and youth transitioning out of foster care. Note: Unclear when the new requirement will go into effect.

Work Requirements: Limits waivers of the work requirements to areas where the unemployment rate is 10% or higher. Note: Unclear when the new requirement will go into effect.