On Wednesday, October 15, the national law firm Foley & Lardner hosted a webinar on the new federal budget law, H.R.1, also known as the One Big Beautiful Bill Act, and its impact on Medicaid. The Act, which was enacted on July 4, 2025, makes dramatic changes to the Medicaid program, the law firm stated. The firm advised healthcare providers, plans, patients, and other stakeholders who work with Medicaid populations to prepare for these changes.

Jennifer Walsh, public affairs director at Foley & Lardner, began the webinar by noting that the map from the Congressional Budget Office shows some pretty dramatic projections. Walsh stated, "There's no way that all of these cuts are just targeting waste, fraud, and abuse." She explained that we will see a $911 billion reduction in the Medicaid program over 10 years and anticipate an increase of 10 million uninsured people by 2034. Congress postponed the effects of these cuts, with most not taking effect until 2027. Walsh expressed that she expects to see some of the downstream impacts of this law take effect quickly. “When you cut one part of the health system, it tends to have a ripple effect on the rest of it.”

Anil Shankar, a partner with Foley & Lardner, explained that there are eligibility changes within the new law regarding Medicaid. There will be efforts to reduce the scope of eligibility in the Medicaid program for certain categories of immigrants, he noted. The list, however, will be expanded to immigrants who are not necessarily illegal, including asylees and refugees. “They're going to, depending on how the paperwork works out and what kind of status they have, they're going to be removed from the rules,” Shankar said, “which will have an impact on…the entire delivery system.”

Shankar furthermore pointed out that non-qualified aliens are already ineligible for federal public benefit programs under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWOR), a foundational law in place since the mid-90s. Although, he said, there is a separate effort by the current administration to expand PRWOR's reach to include new programs, benefits such as Medicaid, Medicare, food stamps, or the ACA were already out of reach to non-qualified aliens.