State Policy
States Implement H.R. 1 Medicaid Work Requirements and Rural Health Transformation Programs in July 2026
In July 2026, states responded to H.R. 1 by communicating new Medicaid work reporting requirements and coverage changes for non-citizens to beneficiaries. States announced Rural Health Transformation Program (RHTP) grants and established advisory committees as part of federal rural health initiatives. Delaware enacted legislation expanding hospital financial assistance to patients below 300% FPL and imposing a two-year moratorium on for-profit hospital acquisitions through July 1, 2028. North Carolina established a Healthcare Affordability Commission via executive order to develop cost containment strategies. Multiple states reported Marketplace enrollment declines following expiration of enhanced federal premium tax credits.
Why it mattersState Medicaid agencies must operationalize H.R. 1 work requirements and communicate eligibility changes while simultaneously deploying RHTP funding and managing enrollment volatility from expired federal affordability subsidies.