Story Highlights
- Approximately 3.5 million Americans have lost food stamp benefits since the Big Beautiful Bill’s SNAP provisions began taking effect, according to federal data analyzed by the Center on Budget and Policy Priorities
- The Centers for Medicare and Medicaid Services released a nearly 400-page rule on June 1 laying out strict new Medicaid work requirement standards that experts say will be harder to implement and more restrictive than states had anticipated
- The Congressional Budget Office estimates that by 2034, more than 5 million additional Americans will lose health insurance due to Medicaid work requirements, while SNAP changes will cut $186.7 billion from the food assistance program over the decade
What Happened
President Donald Trump signed the One Big Beautiful Bill Act on July 4, 2025, delivering $4.5 trillion in tax cuts while simultaneously cutting more than $1 trillion over a decade from Medicaid and SNAP, the nation’s two largest safety net programs. Republicans argued the cuts were necessary to reduce waste, fraud, and abuse in programs that had grown beyond their intended scope, and that work requirements would encourage self-sufficiency and labor force participation. Democrats, who provided zero votes for the bill, argued the cuts would devastate low-income families, children, elderly Americans, veterans, and people with disabilities.
The SNAP changes began taking effect almost immediately. New work requirements raised the age threshold from 54 to 64, meaning able-bodied adults up to age 64 without qualifying exemptions must now document 80 hours of work, education, or community service per month to receive food benefits. As states implemented the new eligibility rules, enrollment dropped sharply. By early 2026, roughly 3.5 million people had lost SNAP benefits nationwide. Arizona became the most prominent early case study: the state saw dramatic declines in participation, food banks reported serving more people than at the height of the Covid-19 pandemic, and lines formed outside eligibility offices as families struggled to document compliance with the new rules.
The Medicaid work requirements operate on a slightly later timeline, with full implementation mandated by January 1, 2027. On June 1 of this year, the Centers for Medicare and Medicaid Services, led by CMS Administrator Mehmet Oz, released a nearly 400-page interim final rule laying out the detailed mechanics of how states must implement the requirements. The rule requires able-bodied Medicaid enrollees between the ages of 19 and 64 to document 80 hours per month of qualifying activity — work, education, job training, or community service — or lose their coverage. People must requalify every six months.
The rule’s standards for medical exemptions were significantly stricter than most states and health advocates had anticipated. States had spent months developing implementation systems based on preliminary guidance from CMS, only to find that the final rule changed key definitions in ways that render much of that preparation unusable. The standard for “medical frailty,” the category that exempts individuals who cannot work due to health conditions, now requires demonstrating not only a qualifying condition but also a specific impairment of the ability to engage in work activities. Many chronically ill or disabled individuals who expected to qualify for exemptions may not meet the new threshold.
Nebraska became the first state to implement Medicaid work requirements under the new law, beginning May 1, 2026. Iowa, Montana, and Arkansas have announced plans to implement ahead of the January 2027 deadline. States must complete required outreach to Medicaid enrollees between June 30 and August 31 of this year, and the final rule takes effect July 31.
Why It Matters
The implementation of these work requirements is the most consequential domestic policy rollout of Trump’s second term in terms of its direct impact on the daily lives of ordinary Americans. Medicaid covers approximately 68 million people across the United States, making it the nation’s largest health insurance program by enrollment. SNAP provides benefits averaging nearly $200 per person monthly to roughly 40 million recipients. Together, these programs represent the core of the safety net for low-income families, disabled individuals, elderly adults, veterans, and children.
The scale of projected coverage loss is staggering. The CBO estimates that the work requirements’ portion of the law alone will push more than 5 million additional Americans off Medicaid by 2034, while total Medicaid cuts in the law will increase the uninsured population by 10 to 16 million people depending on modeling assumptions. For SNAP, the CBO projects the law will reduce program participation by roughly 3 million people and cut benefits, resulting in an average reduction of $14 per month per recipient by 2034.
Research consistently shows that the majority of Medicaid recipients who are capable of working already do work. The most common reasons people lose coverage under work requirement programs are not that they are idle, but that they cannot successfully navigate the administrative paperwork required to document compliance. For people with irregular work schedules, limited internet access, language barriers, or unstable housing, documenting 80 hours of qualifying activity each month and submitting that documentation to a state agency is a substantial bureaucratic obstacle. Studies of prior state-level work requirement experiments have found that most coverage losses occur among people who were already working or who were exempt — not among the small fraction who truly were capable of working and choosing not to.
Economic and Global Context
The Medicaid and SNAP cuts are the fiscal mechanism that finances much of the tax relief in the Big Beautiful Bill. The $4.5 trillion in tax cuts over the decade — including the extension of the 2017 individual income tax cuts, the elimination of taxes on tips and overtime, and expanded child tax credits — are funded in part by the $1.1 trillion reduction in Medicaid spending and the $186.7 billion in SNAP cuts projected by the CBO. Critics argue this represents a direct transfer from low-income Americans to wealthier ones, while supporters contend that the work requirements generate savings while incentivizing employment.
The state-level economic effects are significant and varied. States that expanded Medicaid under the Affordable Care Act — covering 41 states plus the District of Columbia — face the most direct impact, as those are the populations now subject to work requirements. States must also begin sharing in at least five percent of SNAP benefit costs starting in 2028, a shift from the current 100 percent federal funding model. States with high error rates in SNAP administration may face a 5 to 15 percent cost-sharing burden. Those added costs will pressure state budgets, potentially forcing tradeoffs with education, transportation, and other spending.
Healthcare providers in rural and low-income communities are particularly exposed. Rural hospitals, which often operate with thin margins and depend heavily on Medicaid reimbursement, face a reduction in revenue if patient populations lose coverage and show up in emergency rooms as uninsured. The CBO estimated that rural areas would see $155 billion in reduced Medicaid spending under the law, even as it created a $50 billion Rural Health Transformation Program intended to partially offset the damage.
Implications
For the November midterms, the Medicaid and SNAP rollout represents a major political liability for Republicans in competitive districts. Voters rank healthcare affordability and access consistently near the top of their concerns, and polling shows that most Americans support maintaining or increasing funding for Medicaid and food assistance programs. Republicans who voted for the Big Beautiful Bill will need to explain coverage losses and benefit cuts to constituents who are directly affected, even as the law’s tax cut provisions have already taken effect for higher-income households.
Legal challenges to the Medicaid work requirements are expected and have been signaled by advocacy organizations and Democratic attorneys general. Prior state-level work requirement programs were struck down by federal courts in Arkansas, Kentucky, and New Hampshire on the grounds that work requirements conflict with Medicaid’s statutory purpose of providing healthcare to eligible individuals. Whether the federal requirements, authorized by statute in the Big Beautiful Bill itself, survive legal scrutiny under the current Supreme Court is uncertain.
For the millions of Americans whose coverage hangs in the balance, the next six months are critical. States must complete outreach, build or overhaul eligibility systems, train caseworkers, and stand up new data-matching infrastructure — all while also managing the ongoing legacy of the SNAP changes already in effect. The human cost will be visible in emergency rooms, food banks, and community health clinics well before any final legal resolution arrives.
