H.R.1 (One Big Beautiful Bill Act)
Key Provisions Impact in Missouri
H.R.1, known as the One Big Beautiful Bill Act, is a federal law that combines different pieces of legislation from several congressional committees.
Below is a timeline highlighting the key provisions affecting Missouri and their implementation dates.
Print a copy of the Timeline of Key Provisions Impact in Missouri (Overview)(Expanded).
- Restriction on Funding to Certain Family Planning Providers
Section 71113
Temporarily restricts federal funding for one year to certain 501(c)(3) providers that offer abortions, primarily deliver reproductive health services, and received at least $800,000 in Medicaid payments in FY 2023, among other characteristics.
Effective July 4, 2025 (for 1 year)
Category: Medicaid Financing
- Freeze on New Medicaid State Directed Payments
Section 71116
Caps state directed payments in managed care programs at 100% of Medicare rates in expansion states and 110% of Medicare rates in non-expansion states. Grandfathered payments must be reduced by 10 percentage points per year starting in 2028.
Effective for rating periods beginning on or after July 4, 2025.
Category: Medicaid Financing
- Freeze on Current Provider Tax Rates
Section 71115
Prohibits new provider taxes on previously untaxed provider classes, caps overall tax rates at levels in place on date of enactment, and phases down hold harmless thresholds in expansion states, excluding Skilled Nursing Facilities (SNFs) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IDDs)
Effective: taxes will be capped as they were structured on July 4, 2025. Cap goes into effect on October 1, 2026. Expansion state phase down begins in FY 2028
Category: Medicaid Financing
- Elimination of Funding for SNAP-Ed
Section 10107
Sunsets funding for the SNAP-Ed program at the end of FY25.
Effective: September 30, 2025
Category: SNAP
- Some Non-Citizens Removed from SNAP Eligibility
Section 10108
Limits SNAP eligibility to lawful permanent residents, certain Cuban and Haitian entrants, and individuals from the Compacts of Free Association nations, Excludes refugees, asylees, and other humanitarian groups.
Effective: November 1, 2025
Category: SNAP
- Rural Health Transformation Program
Section 71401
Establishes a $50 billion grant program (FY2026- 2030) for states to improve rural health care delivery. States must implement at least three eligible activities; CMS must make award decisions by December 31, 2025.
Award Decision Deadline: December 31, 2025
Funding Period: FY 2026-2030
Category: Other
- Some Non-Citizens Removed from Medicaid Eligibility
Section 71109
Limits Medicaid and CHIP eligibility to lawful permanent residents, certain Cuban and Haitian entrants, and individuals from the Compacts of Free Association nations. Excludes refugees, asylees, and other humanitarian groups.
Effective: October 1, 2026
Category: Medicaid Eligibility
- Reduction in SNAP Administrative Federal Match
Section 10108
Effective beginning FY27 and each year thereafter, reduces the federal portion of administrative costs from 50% to 25% and therefore increases the state’s share of administrative costs to 75%.
Effective: October 1, 2026
Category: SNAP
- Medicaid Work Requirements for Adult Expansion Population
Section 71119
States must require certain expansion adults to complete 80 hours per month of work, education, or community service as a condition of eligibility. Applies to individuals ages 19-64, with limited exemptions and must be verified through ex parte processes.
Effective: Dec 31, 2026; HHS must issue rule by June 1, 2026; States may request a good faith effort extension through Dec 31, 2028
Category: Medicaid Eligibility
- Eligibility Redeterminations Twice Annually for Adult Expansion Population
Section 77107
Requires Medicaid eligibility redeterminations every six months for adult expansion enrollees or those receiving Minimum Essential Coverage (MEC) through a waiver. Current 12-month requirement remains for all other populations.
Effective: Dec 31, 2026; CMS guidance due by Dec 31, 2025
Category: Medicaid Eligibility
- Limitations of Medicaid Retroactive Coverage
Section 71112
Reduces retroactive coverage in Medicaid from up to three months to one month for expansion adults and two months for all other groups.
Effective: for applications submitted on or after Jan 1, 2027
Category: Medicaid Eligibility
- SNAP State Share Requirement
Section 10105
Establishes that beginning in FY28, state agencies will be required to pay a percentage of SNAP benefit allotments if they have a SNAP Quality Control Payment Error Rate (PER) above 6%. Of note, this language does not alter existing liability and financial penalty requirements for state agencies.
Effective: October 1, 2027
Category: SNAP
- Medicaid Co-Pay Requirements for Adult Expansion Population
Section 71120
Requires states to implement cost-sharing on expansion adults with income above 100% Federal Poverty Level. Caps charges at $35 per service and 5% of income; excludes key services like primary care, behavioral health, and those provided in Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Certified Community Behavioral Health Clinics (CCBHCs).
Effective: October 1, 2028
Category: Medicaid Financing
- State Residency Data Verification for Medicaid
Section 71103
States must implement new systems and processes to:
- Regularly obtain and verify enrollee address information using reliable sources named in the bill.
- Submit monthly enrollee data including Social Security numbers to a new federal system monthly and at each eligibility determination or redetermination to identify individuals enrolled in more that one state.
- Disenroll individuals confirmed to be residing in another state unless they meet a federal exception.
Effective: October 1, 2029
Category: Medicaid Eligibility
- Expanded Definition of Medicaid Payment Error Rate
Section 71106
Beginning in FY 2030, this provision expands the definition of “erroneous excess payments” under Medicaid to include payments made when there is insufficient information to verify a beneficiary’s eligibility or when services are provided to ineligible individuals. It authorizes the Secretary of HHS to use state-conducted audits, in addition to federal audits, to determine whether states exceed the 3% allowable error rate.
Effective: October 1, 2029
Category: Medicaid Financing