Recent federal legislation could significantly impact how states and counties administer Medicaid, especially around work eligibility and enrollment verification. These proposed changes are creating understandable concern and uncertainty, particularly for behavioral health providers already stretched thin. As we track these developments, we want to be mindful not only of the policy mechanics but also of the real lives and organizations affected.
What’s in the H.R. 1 Bill?
The proposed legislation is H.R. 1—sometimes referred to as the "One Big Beautiful Bill Act." It passed the U.S. House of Representatives on May 22, 2025, and is currently under review in the Senate. One provision would require able-bodied adults to demonstrate 80 hours per month of employment, education, or community service to keep their Medicaid eligibility. If passed, it would take effect December 31, 2026.
Unlike past proposals, this version would not allow states to opt out via Section 1115 waivers. States would also need to verify compliance regularly, using payroll or other available data, with individuals potentially losing coverage if they don’t meet the new requirements.
Read the full bill text on Congress.gov
Why It Matters
The Congressional Budget Office estimates more than 8 million people could lose coverage under these changes. Behavioral health organizations, FQHCs, counties, and community-based providers may face new operational hurdles in trying to keep people enrolled while continuing to deliver care.
Our team understands that this will present new tracking requirements that impact both individuals and the organizations that serve them. While this blog highlights potential changes to systems and workflows, we want to be clear: technology is not the whole answer, but it can help make hard work a little more manageable.
Areas Where Technology Can Help You Prepare
As states and counties prepare, we’ve seen a rise in interest around case management, outreach, and eligibility systems. The aim isn’t to replace human care with technology—it’s to reduce the manual work that pulls people away from it. Bills such as these impose additional operational and administrative burdens on both those providing care and those receiving care.
Systems like Chorus may be able to support:
- Collecting and storing eligibility and employment verification data
- Alerting teams to redetermination points
- Syncing with employer and agency systems
- Simplifying how beneficiaries report compliance or exemptions
These capabilities won't change policy, but they may help agencies meet new mandates without losing sight of the people at the heart of the work.
Where Funding Could Come From
Separate from H.R. 1, there are active funding streams through the Department of Labor (via the Workforce Innovation and Opportunity Act and the American Rescue Plan). These can help state and local governments strengthen IT systems related to workforce and case management, often in the range of $60M to $400M per state.
What to Watch
The bill’s final outcome is uncertain. But the broader shift toward more frequent eligibility checks and employment-related requirements appears to be gaining momentum.
For providers and agencies serving vulnerable populations, now may be the time to:
- Audit enrollment and outreach systems
- Identify gaps caused by manual processes
- Clarify what new documentation requirements could mean for clients
- Explore tools that help them stay connected and compliant
We’ll continue to monitor the situation and do our part to share what we observe. If you’re trying to make sense of this or just want to trade notes, reach out.
Additional Resources
- H.R.1 Full Text on Congress.gov
- KFF: 5 Key Facts About Medicaid Work Requirements
- Commonwealth Fund Explainer: Work Requirements for Medicaid Enrollees
