Prepare. Enforce. Protect: Medicaid + ACA Defense

Congress has passed it. The President has signed it. Our work has become even more critical.

The federal budget reconciliation legislation finalized last summer delivers much of the damage we feared: deep cuts and new restrictions on Medicaid and coverage under the ACA. These changes threaten access to life-saving care and disproportionately harm people with low incomes, people of color, immigrants, people with disabilities, and LGBTQ+ communities.

Among the most harmful changes imposed by the so-called “One Big Beautiful Bill” Act are new work requirements, more frequent and burdensome redeterminations, increased cost-sharing, bans on trusted family planning providers, cuts to federal funding to states in the form of reduced provider taxes, the exclusion of immigrants from coverage, and rollbacks to essential services like gender-affirming care and sexual and reproductive health.

Access all of our analysis of the bill and its impacts at www.healthlaw.org/medicaid-defense.

Learn more about our California-specific work defending Medicaid (Medi-Cal) and marketplace coverage (Covered California) at www.healthlaw.org/protect-california-health-care/.

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Our Response: Rapid + Coordinated

As states move toward implementation, NHeLP is advancing a broad, coordinated strategy to confront the law’s threats to Medicaid. Working at both the federal and state levels, we are using legal, policy, and advocacy interventions to protect coverage, limit harm, and hold decision-makers accountable.

At the federal level, we are responding to new CMS policies and regulations while pressing for strong guardrails, oversight, and protections. Our deep knowledge of federal law helps shape implementation strategies that protect coverage and reduce harm.

At the state level, we tailor our approach to each state’s legal, political, and policy landscape, including whether it has expanded Medicaid, supports work requirements, operates its own marketplace, or faces other distinct challenges. We work directly with state advocates to coordinate legal and policy strategies, monitor implementation, identify emerging threats, and prepare for litigation when necessary.

How Our Resources Can Help Advocates

Navigating these changes will be difficult. You do not have to do it alone. NHeLP’s team of legal and policy experts will continue to develop a wide array of materials to help advocates, policymakers, health care providers, and community leaders respond effectively.

These resources explain what the new law means, how it is being implemented, and what you can do to protect the people most at risk. Whether you are drafting comments on a proposed rule, educating communities about their rights, advocating for policy fixes at the state level, or coordinating a media response, our tools are designed to support you.

We will also provide guidance on state-specific challenges, tailored technical assistance, and in-depth analysis to help you navigate uncertainty and make informed decisions. If you are working to keep people covered and connected to care, NHeLP is here to back you up every step of the way.

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