How the "Big Beautiful Bill" Actually Changes Medicaid Funding

Nearly a year after the passage of the One Big Beautiful Bill Act (OBBBA), state officials and observers across the country are working to understand its effect on Medicaid. This tool provides clarity by quantifying how the Act will impact federal Medicaid outlays going forward.

Select your desired state from the maps or dropdown below and the calculator will automatically populate a series of tables and charts illustrating the 10-year Medicaid fiscal outlook projection based on the OBBBA's changes. This tool is derived from research presented in Medi-Cal and One Big Beautiful Bill: Federal Medicaid Reforms and the Fiscal Premise of California's Billionaire Tax Act.

The OBBBA included 22 sections that made substantial alterations to the program, namely the introduction of work and community engagement requirements for able-bodied individuals and new limits to provider taxes. Each is described beneath the tool.

Federal Medicaid Reduction by Expansion Status (10-yr, 2025–2034)

This map shows the projected change in annual federal Medicaid outlays received by each state resulting from the OBBBA. Darker shading indicates larger reductions in federal spending. Click any state to populate the calculator below. Expansion states are green and non-expansion states are blue.

Notes: Projected federal Medicaid spending reductions by state. Green shading indicates Medicaid expansion states; blue shading indicates non-expansion states. Darker shading indicates larger reductions. Authors' calculations based on CBO, KFF, and MACPAC data.

MCO Spending as Share of Total Medicaid Spending (FY 2024)

This map shows the share of each state's Medicaid financing derived from managed care organization (MCO) taxes and provider taxes. Darker shading indicates greater reliance on these tax financing mechanisms, which the OBBBA limits. N/A states (Alabama, Alaska, Connecticut, Idaho, Maine, Montana, South Dakota, Vermont, Wyoming) have no contracts with comprehensive MCOs.

Notes: Share of state Medicaid financing derived from managed care organization (MCO) taxes and provider taxes, by state. Darker shading indicates greater reliance on provider tax financing mechanisms. N/A states (Alabama, Alaska, Connecticut, Idaho, Maine, Montana, South Dakota, Vermont, Wyoming) have no contracts with comprehensive MCOs. KFF State Health Facts, FY 2024.

Federal Reduction as % of Baseline Federal Medicaid Spending (10-yr, 2025–2034)

This map shows each state's projected 10-year federal Medicaid reduction as a percentage of its total baseline federal Medicaid spending over the same period.

Notes: 10-year federal Medicaid reduction as a share of baseline federal Medicaid spending, by state. Darker shading indicates a larger relative reduction. Authors' calculations based on CBO, KFF, and MACPAC data.

Federal Reduction as % of Total Baseline Medicaid Spending (10-yr, 2025–2034)

This map shows each state's projected 10-year federal Medicaid reduction as a percentage of its total baseline Medicaid spending (federal + state) over the same period.

Notes: 10-year federal Medicaid reduction as a share of total baseline Medicaid spending (federal + state), by state. Darker shading indicates a larger relative reduction. Authors' calculations based on CBO, KFF, and MACPAC data.

Use and Interpretation

Upon selecting your desired state, a short dashboard of key projections populate, including the state's 10-year federal budget reduction due to the OBBBA and the impact on the state budget under two scenarios. Scenario (i) projects the budget impact if the state chooses not to backfill the difference to providers, causing a larger loss for providers and patients while resulting in greater savings to the state. Scenario (ii) projects the budget impact if the state chooses to backfill the difference to providers, providing a smaller loss for providers and patients while resulting in greater expenses for the state. The projected range for the budget impact on Medicaid providers and patients is provided as well. Whether the selected state is an “Expansion State” or “Non-Expansion State” is demarcated at the top of the page next to the state name.

“Annual Federal Reductions” lays out the annual breakdown of federal Medicaid reductions by states, with additional columns depicting its cumulative impact over the 10-year outlook period and the share of total funds by year.

“Allocating the Effects” lists the annual breakdown of the OBBBA’s impact on the state budget and Medicaid providers under Scenarios (i) and (ii). Scenario (i) reflects the State Budget Low ($B) and Providers High ($B) results. Scenario (ii) reflects the State Budget High ($B) and Providers Low ($B) results.

Medi-Calculator also populates twin visualizations presenting the OBBBA’s 10-year impact on (1) federal Medicaid spending and (2) total (federal and state) Medicaid spending, relative to the pre-OBBBA baseline.

"Section-by-Section Federal Impact” outlines each section of the One Big Beautiful Bill Act’s impact on the Medicaid program for the selected state and delineates what population it applies to, whether it be All Populations, Long-Term Services and Supports (LTSS) Recipients, Medicaid Expansion Population, Medicare Savings Programs (MSP) Population, or State Directed Payments (SDP) States. It also classifies each section’s effect as resulting either in savings, losses, or having an indeterminate impact. The state share and 10-year federal impact is applied on a section-by-section basis.

This display is complemented by a listing of the OBBBA provision sections sorted by their effect type, which provides an easy reference to what provisions of the OBBBA reduce federal spending (resulting in savings), increase federal costs, or have an indeterminate impact.

The academic content [Medi-Cal and One Big Beautiful Bill: Federal Medicaid Reforms and the Fiscal Premise of California's Billionaire Tax Act], calculator methodology, and associated research are © 2026 Joshua Rauh, Tom Church, Daniel Heil, Benjamin Jaros, and John Doran. For inquiries regarding the research or calculator, please contact: hooverfpi@stanford.edu.