One Year After H.R. 1: Health Fallout
Numerous health policy provisions in H.R. 1 will be rolled out over the next several years – including nearly $1 trillion in cuts to Medicaid. We are beginning to see several of those policies implemented, and the predicted coverage losses and loss of federal dollars to states have only just begun.
More Than 3,000 Kansans with Refugee/Asylee Immigration Status to Lose Coverage
Medicaid coverage losses will occur for more than 3,000 Kansans later this year.
On June 9, the Kansas Department of Health and Environment (KDHE) announced KanCare eligibility changes this fall due to H.R. 1 for certain “refugees or asylees, humanitarian parolees, and immigrants who are survivors of domestic violence or human trafficking.” Those impacted will lose their KanCare coverage on September 30, 2026. No eligibility changes will affect green card holders, Cuban or Haitian immigrants, COFA migrants, or lawful permanent residents from H.R. 1.
Data shared with us by KDHE reveals 3,344 Kansans – including 1,973 children and 76 pregnant or postpartum moms – are impacted by this H.R. 1 change that goes into effect on October 1, 2026. The 76 women are in the middle of their pregnancy or 12-month postpartum coverage period. Normally, coverage wouldn’t be discontinued until the end of the 12-month postpartum period. But for this refugee and asylee population, their insurance coverage will be cut off immediately.
These Kansans will still need medical care – especially the 2,000 kids and pregnant and postpartum women – but most will likely go uninsured. Federally qualified health centers may be an option to continue affordable health care, but it remains to be seen if they’ll be able to fill the gap.
ACA Enrollment Decreases Only Just Beginning
H.R. 1 included restrictions and policy changes for ACA Marketplace plans, while also failing to extend enhanced premium tax credits (EPTCs). Predictions were made that millions would lose health insurance because of these changes. Congress failed to extend the EPTCs, and they expired on December 31, 2025.
Prior to these changes, more than 200,000 Kansans had purchased insurance on the ACA Marketplace in 2025. Analysis from Kansas health foundations last fall projected 108,000 Kansans would lose their marketplace coverage over the next 10 years. Declines in ACA Marketplace enrollment are already occurring. Nearly 193,000 Kansans enrolled in Marketplace plans for 2026, which is a 3.6% decrease from 2025.
Alternative health insurance options are limited for those who previously turned to the ACA Marketplace for insurance coverage, so it’s likely more Kansans will become uninsured, delay preventative medical care, and turn to emergency rooms for last-resort care.
Warning Signs for Children’s Health Insurance Coverage Levels as H.R. 1 Implementation Begins
One argument for the Medicaid cuts in H.R. 1 was that Congress would “protect” the program for traditional Medicaid populations, including children. Yet the Congressional Budget Office (CBO) now predicts that nationally, 3 million fewer children will be enrolled in Medicaid over the next 10 years, attributing those coverage losses mostly to the cuts in H.R. 1.
Before H.R. 1 was even implemented, the number of uninsured children was already headed in the wrong direction. New analysis from the Georgetown University Center for Children and Families determined that for kids under the age of 6, Kansas’s uninsured numbers nearly doubled between 2022 and 2024 to nearly 15,000 kids. Between January 2025 and February 2026, 12,500 fewer Kansas kids enrolled in Medicaid and CHIP. While these decreases are not linked to H.R. 1 since much of this data comes from before H.R. 1 passed, these numbers should raise the alarm for how much more the data is likely to shift in future years.
Rural Health Transformation Program
At the last minute before H.R. 1 passed Congress, a $50 billion fund for rural health was added to placate lawmakers concerned about the Medicaid cuts’ impact on rural hospitals. The fund will be sent out to states over the next five years, as they apply each year for the money. During Fall 2025, federal agencies rapidly spun up the application for this program, states quickly applied, and the first year of funding decisions were announced in late December 2025.
For year one, Kansas received $221.8 million, the sixth most received by any state. KDHE oversees this program and publicly shared information, its application, approved budget, meeting recordings, fund application announcements, and awardees.
Kansas focused its grant on expanding local access to primary care alongside an innovative “food is medicine” program, building a sustainable rural health care workforce, and harnessing data and technology. Nearly $80 million has already been awarded for regional partnerships and rural emergency hospital investments. The next rounds of grants focus on “food is medicine” and emerging technology.
While the program received a lot of positive attention, it will not make up for the billions of dollars lost to rural hospitals. New analysis from the Commonwealth Fund casts doubt on the overall impact of this program. Kansas will have to reapply for year two of the grant this fall, and funding is not guaranteed.
Work Reporting Requirements in Medicaid Expansion States
For the first time ever, H.R. 1 requires Medicaid expansion states to require their expansion population adhere to work reporting requirements every six months to keep their coverage. This includes parents whose youngest child is over the age of 13.
This provision goes into effect on January 1, 2027, but some states (like Nebraska) have already begun to implement these changes. As federal agencies keep changing the rules for how this policy will roll out and impacted states scramble to have their systems and processes ready in time, fear grows among advocates that coverage losses will be catastrophic.
One recent analysis showed that up to 7 million people could lose coverage by 2028 due to the work reporting requirements. Most of the loss will be because people will find it difficult to navigate the new state systems to prove compliance with the requirements, not because they are not working.
While Kansas is not impacted by these new work reporting requirements because the state hasn’t expanded Medicaid, we are surrounded by four Medicaid expansion states and Kansans could experience some confusion in rules compared to our neighbors. There’s also the possibility that this provision could be pursued for certain traditional Medicaid populations in the near future through state policy change or additional congressional action.
State Budgetary Impacts
Modeling last summer from two Kansas health foundations projected that Kansas could see $3.9 billion in reduced federal and state Medicaid funding over the next decade. We continue to wait and see if these funding reductions come to fruition, as federal agencies haven’t finalized the rules for the provisions most likely to impact Kansas.
The H.R. 1 provision expected to have the greatest impact on the Kansas Medicaid budget is a cap on state directed payments (SDP), which require managed care organizations (MCOs) to pay enhanced rates to certain providers, allowing the state to then draw down a federal match on the increased rate.
Though this cap will result in an overall reduction in state Medicaid spending, it will directly reduce the amount going to providers, including behavioral health centers and hospitals, critical access hospitals , public teaching hospitals, and Children’s Mercy Hospital. Based on the content of H.R. 1, RAND estimated that the cap on SDPs would result in $50.4 million less going to Kansas providers. However, recent proposed regulations from the Centers for Medicare and Medicaid Services (CMS) around SDPs extend the changes well beyond what is included in the text of the bill, suggesting that SDP-related cuts will actually be much more significant.
Another repercussion of H.R. 1 is a freeze on provider taxes that began on July 4, 2025, with different provisions in effect for expansion and non-expansion states. Provider taxes allow states to place taxes on health providers (including hospitals) to draw down additional federal dollars that are used to pay providers an increased rate. The 2025 Kansas Legislature passed a bill that would include Critical Access Hospitals and Rural Emergency Hospitals in the tax base. While it is thought that Kansas will be allowed to proceed with this policy change, CMS has not made a final rule on this matter.
When Kansas clearly knows what federal funding cuts are coming from these two provisions, the Kansas Legislature will face tough decisions. With a traditional Medicaid population, the options for budget cuts are limited and painful, with the most likely targets of reducing funding for HCBS waivers (several for which Kansans already face long waiting lists) and reducing already low provider rates.
More Health Impacts to Come
Several health-related policy impacts are still to be determined, yet the early signs point to harm already beginning. We know Medicaid funding cuts are expected, but how much is still unknown. While a significant investment has been made in the Kansas rural health care system, health insurance coverage has already started to decline, especially for children.
The early legacy of H.R. 1 for health care is making it even more unaffordable and inaccessible to more Kansans, and the effects will be felt even more in the years to come.
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