FQHC Impact Tracker — Lives, Health & Cost of the 2026 Safety-Net Cuts

Every coverage loss, benefit cut, and cost shift hitting community health — quantified by lives impacted, the individual and population-health consequences, and the dollar cost. Across California, Texas, and every U.S. state, plus federal policy. Every figure primary-sourced.

Last updated: June 8, 2026

146

Tracked Impacts

States Covered

California

Texas

Federal

Already in Effect

What's at Stake — In Verified Figures

~100,000

lawfully present immigrants lose Medicare (Jan 4 2027)

~2M

lose Medi-Cal dental on July 1

$9.5B/yr

H.R. 1 cost shift onto CA counties

~588,000

Texans stuck in the coverage gap

Every figure is primary-sourced and carries a confidence level (confirmed count, modeled projection, or estimate). Figures come from different sources, timeframes, and populations that may overlap — so they are not summed into one grand total.

146 results

ProjectedCoverage LossFederalModeled projection

Medicaid work requirements put 5.6M community health center patients at risk

5.6M

Lives Impacted

—

Cost Estimate

Lives Impacted

Community health center patients in expansion states subject to the 80-hours/month requirement (CA in scope; TX excepted)

Cost Estimate · Who bears it

Patients (lost coverage) + FQHCs (rising uncompensated care)

Individual Health

A working patient who misses a paperwork deadline loses Medicaid mid-treatment and skips a follow-up.

Population Health

Redetermination churn opens coverage gaps across expansion states; FQHC eligibility teams must scale navigation by Jan 1, 2027.

Timeframe: Implement by Jan 1, 2027 (IFR June 1, 2026)Source: American Hospital Association (CMS-2454-IFC) / Commonwealth Fund

In EffectRate CutNorth CarolinaConfirmed count

$319M NC Medicaid Rebase Shortfall Forced Provider Rate Cuts Threatening 3 Million+ Residents

3M+

Lives Impacted

$319M shortfall

Cost Estimate

Lives Impacted

North Carolina Medicaid enrollees whose care access was threatened by FQHC and provider rate cuts in October 2025

Cost Estimate · Who bears it

North Carolina FQHC providers (rate cuts) and Medicaid enrollees (access risk)

Individual Health

An FQHC in rural Bertie County that depends on Medicaid for the majority of its revenue saw reimbursement drop 3-10% in October 2025, threatening staffing levels at the only primary care practice within 30 miles for hundreds of uninsured and low-income patients.

Population Health

A $319M Medicaid rebase funding gap triggered 3% across-the-board and 8-10% selective provider rate cuts effective Oct. 1, 2025, directly hitting FQHC reimbursement. Governor Stein reversed them Dec. 10, 2025, warning Medicaid could exhaust funds before fiscal year end — threatening care for 3M+ residents.

Timeframe: Rate cuts Oct. 1 – Dec. 10, 2025; rates restored but underlying shortfall unresolvedSource: NC Governor's Office / NCDHHS

In EffectRate CutNew YorkConfirmed count

NY Medicaid pays FQHCs only 70% of cost using 1999-era rates; $80M budget win falls $220M short of the fix

~2.5 million

Lives Impacted

$80M increase (vs. $300M needed)

Cost Estimate

Lives Impacted

New Yorkers served at 70+ FQHC organizations at nearly 900 sites, concentrated in NYC, whose health centers operate at a 30% per-visit Medicaid underpayment relative to actual cost

Cost Estimate · Who bears it

NY FQHCs absorb the $220M structural shortfall through cross-subsidy from grants and reserves; patients absorb reduced services if centers cannot close the gap

Individual Health

A health center CEO in the Bronx must subsidize every Medicaid patient visit out of federal grants and reserves because the state still uses 1999-2000 cost data to set rates, spending about 40% more per visit than Medicaid reimburses.

Population Health

Urban Institute analysis: NY Medicaid reimburses health centers ~70% of care cost (centers spend ~40% more per visit than paid); Medicaid is ~42% of CHC revenue. CHCANYS sought $300M for a full fix in FY2027; the enacted budget delivered $80M — leaving the structural gap largely unresolved for 2.5M patients.

Timeframe: FY2027 budget enacted May 2026; structural rate problem persists until A.7560/S.6959 passesSource: CBS6 Albany / WRGB

In EffectBenefit CutCaliforniaEstimate

~2M immigrant adults lose full-scope Medi-Cal dental

~2M

Lives Impacted

$308M

Cost Estimate

Lives Impacted

Immigrant adults ages 19-54 with Unsatisfactory Immigration Status — emergency-only dental thereafter

Cost Estimate · Who bears it

$308M FY26-27 state 'savings' = patients' out-of-pocket cost and forgone care

Individual Health

Untreated decay becomes an abscess; the patient ends up in the ER for pain and loses the tooth.

Population Health

FQHC dental panels shrink and ED dental visits rise — a double hit with the July 1 UIS-PPS cut on the same patients.

Timeframe: Effective July 1, 2026Source: National Health Law Program / Justice in Aging

In EffectRate CutFloridaConfirmed count

FQHC Medicaid PPS Rate Unchanged for 20+ Years Leaves $106 (42.2%) Gap Per Visit in Florida

~1.72M

Lives Impacted

$106/visit gap

Cost Estimate

Lives Impacted

patients served by Florida's ~54 FQHC organizations whose care is underfunded by $106/visit on Medicaid

Cost Estimate · Who bears it

Florida FQHCs absorbing the unreimbursed cost of every Medicaid visit

Individual Health

A Medicaid patient visiting a Jacksonville FQHC for a prenatal check-up generates $106 less in reimbursement than the actual cost of care — a structural gap the health center absorbs on every one of its roughly 1.72 million annual patient visits.

Population Health

FACHC reports current Medicaid PPS rates leave a $106/visit reimbursement gap — about 42.2% below actual cost — across all ~54 FL FQHC organizations serving ~1.72 million patients; FACHC has not requested a rate increase in over 20 years.

Timeframe: Ongoing; FACHC brought rate-increase request to 2026 legislative sessionSource: Florida Association of Community Health Centers (FACHC)

ProjectedCost ShiftCaliforniaNorth StateModeled projection

Rural counties warn H.R. 1 shifts $9.5B/yr onto California and could drop 1.5M from Medi-Cal

~1.5M

Lives Impacted

$9.5B/yr

Cost Estimate

Lives Impacted

Californians who could lose Medi-Cal; rural counties (e.g., Tehama, served by Ampla Health) hit hardest

Cost Estimate · Who bears it

California state + county governments (cost shift)

Individual Health

A rural patient loses the only clinic within driving distance when the county cuts indigent-care wrap-around.

Population Health

Counties absorb new indigent-care obligations without dedicated funding; thin rural safety nets are disproportionately exposed.

Timeframe: FY26-27 → FY27-28Source: Tehama County Board of Supervisors / Action News Now

ProjectedCoverage LossFloridaModeled projection

~1.5 Million Floridians Projected to Lose Coverage as ACA Credits Expire; $5.2B Uncompensated Care

~1.5M

Lives Impacted

$5.2B uncompensated care

Cost Estimate

Lives Impacted

Floridians projected to lose health insurance as enhanced ACA premium tax credits expire, mostly low-income non-expansion adults

Cost Estimate · Who bears it

Florida FQHCs and hospitals absorbing uncompensated care from newly uninsured patients

Individual Health

A 42-year-old restaurant worker in Miami-Dade who paid $60/month for marketplace coverage with enhanced subsidies will see her premium more than double without the credits, leaving the FQHC sliding-fee scale as her only option for the diabetes management she needs every quarter.

Population Health

Florida Policy Institute projects ~1.5M Floridians (range 1.1-1.9M) will lose health insurance — ~1.4M from ACA marketplace changes alone — pushing the uninsured rate from a record-low 10.7% (2023) toward ~16.7%; resulting uncompensated care estimated at $5.2B, highest in the nation.

Timeframe: Enhanced credits expired end of 2025; coverage losses materializing through 2026Source: Florida Policy Institute

ProjectedCoverage LossPuerto RicoConfirmed count

Puerto Rico's Medicaid Block Grant Cliff: FMAP Drops from 76% to 55% After FY2027, Threatening 1.3M Enrollees

~1.3M

Lives Impacted

$3.825B/yr (FY2027 cap)

Cost Estimate

Lives Impacted

Puerto Rico Plan Vital Medicaid enrollees whose federal match rate and funding ceiling revert to far lower levels unless Congress acts before the end of FY2027

Cost Estimate · Who bears it

Puerto Rico territorial government and Plan Vital enrollees if Congress does not act to prevent the cliff

Individual Health

A diabetic patient in Ponce who depends on Plan Vital for insulin and quarterly specialist visits could face benefit cuts or copays overnight if the FMAP cliff triggers service-reduction decisions at the territory's health authority.

Population Health

Puerto Rico funds Plan Vital for roughly 1.3 million enrollees via a capped block grant ($3.825B FY2027). Without Congressional action, after FY2027 the FMAP reverts from 76% to the statutory 55% and the allotment is recalculated off the much lower FY2019 base.

Timeframe: Enhanced FMAP of 76% expires September 30, 2027; cliff takes effect FY2028Source: KFF

In EffectAccess GapLouisianaConfirmed count

Louisiana receives $208M Year-1 Rural Health Transformation award — up to ~$1B over five years for FQHCs

~1.1M

Lives Impacted

$208M/yr-1

Cost Estimate

Lives Impacted

Rural Louisiana residents, including 37% on Medicaid, reached by FQHC, RHC, and rural hospital workforce, telehealth, and infrastructure upgrades funded through the Rural Health Transformation Program

Cost Estimate · Who bears it

Federal government via H.R.1's Rural Health Transformation Program; LDH Office of Rural Health Transformation administers

Individual Health

A patient in a rural Louisiana Delta parish where the nearest specialist is hours away may gain access to a telehealth cardiology consult at their local FQHC once transformation funding upgrades the center's broadband and equipment.

Population Health

Gov. Landry signed an executive order on April 7, 2026 creating the Office of Rural Health Transformation within LDH to deploy a $208,374,448 Year-1 federal award (among the nation's highest), targeting ~1.1M rural residents (37% on Medicaid) through rural hospitals, FQHCs, and RHCs.

Timeframe: Year 1 award April 7, 2026; estimated ~$1B+ over five yearsSource: Louisiana Department of Health

In EffectCoverage LossTexasModeled projection

ACA premium credits expired — ~1M Texans projected to lose coverage by 2034

~1M

Lives Impacted

+$700/yr premiums

Cost Estimate

Lives Impacted

Texans projected to lose marketplace coverage by 2034 (of ~4M enrolled, 95% subsidized)

Cost Estimate · Who bears it

Texas marketplace enrollees (higher premiums)

Individual Health

A self-employed Texan's premium jumps more than $700, so they drop coverage and skip preventive care.

Population Health

In a non-expansion state, marketplace coverage is the main insured path — its erosion drives uncompensated-care pressure onto FQHCs.

Timeframe: Expired Dec 31, 2025Source: Texas Hospital Association

In EffectAccess GapOhioConfirmed count

Medicaid covers ~52% of Ohio's ~1M FQHC patients — largest payer at risk from concurrent federal cuts

~1 million

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served across Ohio's ~59-60 FQHCs at roughly 550 sites in 76 of 88 counties; about 52% insured by Medicaid, making Ohio health centers serve 1 in 7 Ohio Medicaid beneficiaries

Cost Estimate · Who bears it

Ohio FQHCs (majority of revenue from Medicaid and Section 330 federal grants, both at risk); 1 million patients bear access consequences

Individual Health

A rural Appalachian farmworker in Meigs County — one of Ohio's persistent-poverty counties — who relies on a community health center as the only primary-care option within 30 miles faces a double threat: potential Medicaid loss from work requirements and a Section 330 grant cliff at year-end that could force the center to cut services.

Population Health

GW Geiger Gibson factsheet (Jan 2025): Ohio CHCs serve nearly 1M patients statewide across 550+ sites; Medicaid covers ~52% of patients and is the largest revenue source. The combination of H.R.1 work requirements, a $5.13B year-one Medicaid spending cut, and the December 31, 2026 Community Health Center Fund cliff threatens both coverage and FQHC financial viability simultaneously.

Timeframe: Ongoing; compounded by January 2027 work-requirement deadline and December 31, 2026 CHCF cliffSource: GW Geiger Gibson Program in Community Health

ProposedAccess GapPennsylvaniaConfirmed count

PA Safety Net Serves 1M+ Patients With No Dedicated State Budget Line — PACHC Requests $5M

1M+

Lives Impacted

$5M requested

Cost Estimate

Lives Impacted

Patients served annually across Pennsylvania's 450+ FQHC sites, 44% on Medicaid/CHIP, 16% uninsured

Cost Estimate · Who bears it

Pennsylvania state general fund (FY2026-27 budget ask)

Individual Health

A farmworker in Lancaster County with no insurance relies on her FQHC as her only source of primary care; without the modest state investment PACHC is requesting, her center faces hiring freezes that lengthen wait times from days to weeks.

Population Health

Pennsylvania's ~51 FQHC organizations operate 450+ sites serving over 1 million patients per year. PACHC requested just $5 million for FY2026-27 — down from a prior $50M ask — in a state that is one of only four without a dedicated FQHC budget line.

Timeframe: FY2026-27 state budget cycle, alongside Dec. 31, 2026 federal CHCF cliffSource: WESA (90.5, Pittsburgh NPR)

In EffectClinic Closure / Funding CliffColoradoConfirmed count

65% of Colorado's community health centers ran negative margins; 850,000+ patients at risk

850,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Coloradans served by the state's 21 community health centers — disproportionately low-income, rural, and Medicaid-dependent patients

Cost Estimate · Who bears it

—

Individual Health

A migrant farmworker in Weld County whose nearest FQHC is running a negative margin faces the prospect of a longer drive to the next county or no primary care at all if hours or services are cut.

Population Health

CCHN warns 65% of Colorado's 21 CHCs operated at negative financial margins in the past year, driven by inflation, flat federal funding, the Medicaid unwind, and now H.R.1 revenue cuts — threatening services for 850,000+ Coloradans.

Timeframe: Ongoing financial distress as of September 2025; worsening with H.R.1Source: Colorado Community Health Network (CCHN)

ProjectedRate CutIndianaConfirmed count

Indiana ends 340B Medicaid reimbursement July 1, 2026 — HealthNet alone risks $3M/year

~700,000

Lives Impacted

~$63M/yr

Cost Estimate

Lives Impacted

Indiana FQHC patients served by centers whose 340B savings fund expanded medication access and wraparound services

Cost Estimate · Who bears it

Indiana FQHCs and safety-net providers lose ~$63M/year in 340B savings redirected to the state

Individual Health

A low-income diabetic patient at a HealthNet clinic in Indianapolis who receives insulin at a deeply discounted rate through the 340B program will face reduced medication access or higher out-of-pocket costs if the health center can no longer capture those savings.

Population Health

Indiana FSSA plans to stop Medicaid reimbursement for 340B-purchased drugs effective July 1, 2026, capturing ~$63M/year for the state; HealthNet (10 Indianapolis centers) estimates $3M in annual savings at risk; Damien Center estimates $5M.

Timeframe: Effective July 1, 2026Source: WFYI Indianapolis

ProjectedCost ShiftIndianaConfirmed count

Indiana FQHCs received ~$88M in HRSA grants in 2024 — 24% of budgets federally dependent ahead of Dec. 2026 cliff

~700,000

Lives Impacted

~$88M/yr

Cost Estimate

Lives Impacted

Patients of Indiana's ~42 FQHC organizations whose continuity of care depends on HRSA grant reauthorization by December 2026

Cost Estimate · Who bears it

Federal government via HRSA Section 330; Indiana FQHCs bear the shortfall if reauthorization fails

Individual Health

A HealthNet patient in Indianapolis who relies on sliding-scale fees for primary care and behavioral health services may lose access if the center is forced to cut staff or close sites when federal grants expire in December 2026 without a multi-year reauthorization.

Population Health

Indiana's ~42 FQHC organizations serve ~700,000 patients and received ~$88M in HRSA primary care grants in 2024; federal grants represent ~24% of FQHC budgets. A January 2025 freeze briefly locked one-third of Indiana FQHCs out of their grant accounts.

Timeframe: Community Health Center Fund authorization expires December 2026Source: WFYI Indianapolis

In EffectRate CutKentuckyConfirmed count

Kentucky governor orders Medicaid provider reimbursement cuts as H.R.1 federal dollars fall (June 2026)

~700,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients of Kentucky's ~31 FQHC organizations whose providers now receive lower Medicaid reimbursement rates, pressuring health center operating margins ahead of the December 2026 coverage cliff

Cost Estimate · Who bears it

Kentucky FQHCs and other Medicaid providers bear reduced reimbursement rates; patients bear reduced service availability

Individual Health

A Kentucky FQHC patient whose clinic operates on thin margins in rural Appalachia may see shortened appointment slots or reduced specialty services as the center adjusts staffing in response to lower Medicaid reimbursement rates announced in June 2026.

Population Health

On June 4, 2026, Gov. Andy Beshear announced cuts spanning Medicaid provider reimbursement, foster care, and senior meals, signaling that H.R.1 federal funding losses are already translating into concrete state budget pain ahead of December 2026 eligibility changes; Kentucky's ~31 FQHCs serve ~700,000 patients.

Timeframe: Announced June 4, 2026; in effect immediatelySource: Kentucky Lantern

In EffectAccess GapNorth CarolinaConfirmed count

NC Medicaid Expansion Tops 687,000 Enrollees, Sharply Improving FQHC Payer Mix

687,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

North Carolinians newly covered by Medicaid expansion since December 2023

Cost Estimate · Who bears it

Federal government (90% FMAP for expansion population)

Individual Health

At Western NC Community Health Services, a patient previously counted as uninsured became a billable Medicaid visit after December 2023 expansion — part of the payer-mix shift that cut the FQHC's uninsured share from 68% to 37% in three years.

Population Health

More than 687,000 North Carolinians enrolled through Medicaid expansion by Nov. 2025 (~690,000 at two years). At one FQHC, uninsured visits fell from 68% (2022) to 37% (2025) while Medicaid visits rose from 13% to ~31%.

Timeframe: Expansion launched December 1, 2023; two-year enrollment figure as of December 2025Source: NC Governor's Office / NC Medical Journal

ProjectedCoverage LossNorth CarolinaModeled projection

H.R. 1 Work Requirements Could Activate NC Auto-Repeal Clause, Ending Coverage for 671,000+ Expansion Enrollees

671,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

North Carolina Medicaid expansion enrollees whose coverage could end if the state auto-repeal clause activates

Cost Estimate · Who bears it

671,000+ enrolled patients and 43 FQHC organizations relying on improved payer mix

Individual Health

A 52-year-old home health aide in rural Robeson County enrolled through Medicaid expansion would lose her only health coverage if NC's auto-repeal clause fires — not because the 90% FMAP dropped, but because H.R.1 work-requirement administrative costs strain state matching capacity.

Population Health

NC expansion topped 687,000 enrollees by Nov. 2025 (~690,000 at two-year mark); H.R.1 work requirements affect ~732,000 NC expansion adults from Jan. 2027. County social services are ~10% understaffed as recertification work is set to double. NC law auto-repeals expansion if the state cannot fund its share.

Timeframe: Work-requirement reporting begins January 2027; auto-repeal risk ongoingSource: Smith Anderson / NC Health News

ProjectedCoverage LossWashingtonModeled projection

H.R.1 work requirements risk coverage loss for ~620,000 Washington Apple Health adults starting December 2026

~620,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Non-pregnant Apple Health adults ages 19-64 subject to H.R.1 Medicaid work requirements

Cost Estimate · Who bears it

—

Individual Health

A gig-economy rideshare driver in the Seattle suburbs who is enrolled in Apple Health may lose coverage not because they fail to work 80 hours a month, but because Washington's eligibility-automation system will not be ready to verify compliance until June 2027 — creating a paperwork-driven coverage gap.

Population Health

HCA's Medicaid director warns ~620,000 Washington adults risk losing Apple Health coverage under H.R.1 work requirements starting December 2026, primarily from administrative burden; Washington's eligibility system won't be ready until June 2027, so the state is seeking a delay to December 2028.

Timeframe: Work requirements effective December 2026; state seeking delay to December 2028Source: Washington State Health Care Authority

In EffectCost ShiftNew JerseyConfirmed count

NJ holds FQHC uncompensated-care support at $32M and raises Medicaid primary-care rates to 70% of Medicare

600,000+

Lives Impacted

$32M/yr

Cost Estimate

Lives Impacted

Patients served by approximately 25 NJ community health center organizations at 139+ satellite sites statewide

Cost Estimate · Who bears it

New Jersey state General Fund (direct safety-net line item in the Department of Health budget)

Individual Health

An uninsured construction worker in Trenton whose community health center stay financially viable because the $32M state line item offsets costs the federal PPS rate does not fully cover.

Population Health

NJ FY2026 budget maintains $32M in uncompensated-care support for FQHCs and invests ~$45M combined state/federal to raise Medicaid primary-care reimbursement from ~58% to 70% of the Medicare fee schedule.

Timeframe: FY2026 (July 2025-June 2026); rate increase ongoingSource: McCarter & English (NJ FY2026 Dept. of Health Budget Hearing analysis)

ProjectedCoverage LossVirginiaModeled projection

Virginia's Medicaid expansion trigger could strip coverage from 600,000+ if FMAP penalty hits immigrant populations

600,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Virginia Medicaid Cardinal Care expansion adults covered since 2019

Cost Estimate · Who bears it

—

Individual Health

A construction worker in Northern Virginia who gained insurance through Cardinal Care expansion and manages a chronic condition at a community health center could lose all coverage overnight if an FMAP penalty activates the state's automatic disenrollment trigger.

Population Health

More than 600,000 Virginia expansion enrollees face sudden disenrollment if an FMAP penalty — for example covering lawfully residing immigrant children and pregnant people — triggers the state's statutory automatic wind-down provision.

Timeframe: Trigger risk is ongoing; work requirements begin January 2027Source: Voices for Virginia's Children

In EffectCoverage LossTexasConfirmed count

~588,000 Texans are stuck in the Medicaid coverage gap — 42% of the U.S. total

~588,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Uninsured Texas adults who earn too much for Texas Medicaid but too little for marketplace subsidies

Cost Estimate · Who bears it

Patients (no coverage) + FQHCs (sliding-fee + Section 330 reliance)

Individual Health

An adult with no coverage option uses the FQHC sliding fee for everything and avoids the specialist they need.

Population Health

Texas's non-expansion decision is the single largest driver of its nation-leading uninsured rate.

Timeframe: OngoingSource: KFF

In EffectCoverage LossSouth CarolinaConfirmed count

ACA Premiums Rise ~98% in SC After Subsidy Expiry; Marketplace Enrollment Falls 7% to 587,567

587,567

Lives Impacted

—

Cost Estimate

Lives Impacted

South Carolinians enrolled in 2026 ACA Marketplace plans after 44,381 dropped coverage from the prior record; average benchmark premiums up ~98% after enhanced tax credits expired Dec. 31, 2025

Cost Estimate · Who bears it

—

Individual Health

A restaurant cook in Columbia earning $28,000 per year — above the Medicaid gap ceiling in a non-expansion state — saw her monthly premium jump from roughly $50 to over $100 and dropped coverage, making her FQHC the only place she can see a doctor.

Population Health

South Carolina is one of eight states projected to lose more than half of subsidized marketplace enrollment. 2026 plan selections fell ~7% to 587,567 from a record 631,948. Because SC never expanded Medicaid, every dropped enrollee becomes an uninsured or self-pay patient for the state's ~25 FQHCs with no Medicaid backstop.

Timeframe: Effective January 2026; full enrollment impact visible in 2026 plan yearSource: healthinsurance.org (South Carolina ACA Marketplace 2026 Guide)

ProjectedCost ShiftLouisianaConfirmed count

Louisiana's 41 FQHCs serve 503,329 patients — federal CHCF authorization expires December 2026

503,329

Lives Impacted

$4.6B/yr at risk

Cost Estimate

Lives Impacted

Patients of Louisiana's 41 FQHC organizations whose centers depend on Community Health Center Fund authorization expiring December 2026

Cost Estimate · Who bears it

Louisiana FQHCs bear the funding gap if Congress does not reauthorize CHCF before December 2026; national $4.6B program at risk

Individual Health

A Louisiana FQHC patient in a rural Delta parish who relies on her health center for prenatal care, behavioral health, and pharmacy services faces the prospect of reduced hours or staffing cuts if the federal CHCF is not reauthorized before December 2026.

Population Health

The 2026 Consolidated Appropriations Act (enacted Feb. 3, 2026) set the Community Health Center Fund at $4.6B for FY2026 but only extended authorization through December 2026. Louisiana's LPCA-member FQHCs serving 503,329 patients face stalled hiring and construction without multi-year reauthorization.

Timeframe: CHCF authorization expires December 2026Source: NACHC (National Association of Community Health Centers)

ProjectedCoverage LossIllinoisModeled projection

H.R.1 threatens ~500,000 Illinois Medicaid enrollees and $26–51B in lost federal funds over a decade

~500,000

Lives Impacted

$26–51B/decade

Cost Estimate

Lives Impacted

Illinois Medicaid customers projected to lose coverage under H.R.1 work requirements and bi-annual eligibility checks, on top of ~33,000 already lost via HBIA closure

Cost Estimate · Who bears it

Illinois state budget and FQHCs bear rising uncompensated care; federal government withdraws $26–51B over 10 years

Individual Health

An expansion-enrolled adult in Springfield who works part-time and already lost HBIA coverage now faces bi-annual eligibility redeterminations instead of annual ones — any documentation gap triggers disenrollment and an uninsured visit to the FQHC.

Population Health

Illinois HFS projects H.R.1 could cause coverage loss for ~500,000 Medicaid customers and cut between ~$26B and ~$51B in federal funds over a decade; most expansion adults must document 80 hours/month beginning no later than Dec. 31, 2026.

Timeframe: Work requirements begin no later than December 31, 2026; bi-annual checks already enactedSource: Illinois HFS (Healthcare & Family Services)

ProjectedCoverage LossNew YorkModeled projection

H.R.1 Medicaid work requirements hit NY Jan 1, 2027 — up to $13.5B/yr cut and 500,000+ more uninsured

~500,000 by 2029

Lives Impacted

up to $13.5B/yr by 2032

Cost Estimate

Lives Impacted

Medicaid expansion adults ages 19-64 subject to 80-hour/month work requirements; NYSBA projects 500,000 more uninsured by 2029 and over 1 million annually at full implementation

Cost Estimate · Who bears it

New York State Medicaid program; ~$500M additional state administrative costs; patients who lose coverage bear out-of-pocket care costs

Individual Health

A middle-aged unemployed man in Buffalo who receives Medicaid while searching for work and cannot always produce paperwork proving 80 qualifying hours per month risks losing coverage and skipping follow-up care for his hypertension at the local community health center.

Population Health

NYSBA estimates H.R.1 will cut up to $13.5B/yr from NY Medicaid by 2032, raise the uninsured count by ~500,000 by 2029 (1M+ at full implementation), and add ~$500M in state administrative costs for work-requirement verification.

Timeframe: Work requirements effective January 1, 2027; full fiscal impact phased through 2032Source: New York State Bar Association

In EffectAccess GapPuerto RicoEstimate

Puerto Rico Has Only 120.7 Primary-Care Providers per 100,000 vs. 156.7 Mainland — 5,000 Physicians Left Since 2006

474,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served by Puerto Rico's ~22 Section 330 FQHC organizations across ~120 clinics, in a territory with a severe and worsening primary-care physician shortage

Cost Estimate · Who bears it

—

Individual Health

A elderly patient in Mayaguez who finally has Plan Vital coverage may still wait months for a primary-care appointment because the physician her 330 center needs to hire has already matched to a residency in Florida.

Population Health

Puerto Rico has 120.7 primary-care providers per 100,000 vs. 156.7 on the mainland. An estimated 5,000 physicians left between 2006 and 2016, and roughly half of Puerto Rican medical graduates continue matching to mainland residencies.

Timeframe: Ongoing and accelerating; 2025–2026 AAMC dataSource: AAMC

In EffectCoverage LossNew YorkModeled projection

Essential Plan cliff: ~470,000 New Yorkers lose coverage July 1, 2026 as H.R.1 cuts $7.5B from the program

~470,000

Lives Impacted

$7.5B cut from Essential Plan

Cost Estimate

Lives Impacted

Low-income and immigrant Essential Plan enrollees losing coverage when NY lowers the income limit from 250% to 200% FPL July 1, 2026; concentrated in NYC (233,000), Long Island (~70,000), and the Hudson Valley (~47,000)

Cost Estimate · Who bears it

New York State (absorbs the ~$7.5B federal funding cut through program contraction) and patients who shift to uninsured or sliding-scale FQHC care

Individual Health

A Guatemalan home health aide in the Bronx who earns just above 200% of poverty and held Essential Plan coverage through the expanded income limit will lose her insurance on July 1 and likely seek uncompensated care at a community health center where she already gets her primary care.

Population Health

H.R.1 eliminated premium tax credit eligibility for most lawfully present immigrants — cutting ~$7.5B from NY's $14B Essential Plan budget — forcing NY to lower the income ceiling from 250% to 200% FPL July 1, 2026; Fiscal Policy Institute estimates ~470,000 of 1.7M enrollees lose coverage.

Timeframe: Effective July 1, 2026 (income ceiling drops from 250% to 200% FPL)Source: Fiscal Policy Institute

In EffectRate CutConnecticutConfirmed count

Connecticut earmarks $26.4M over 3 years to raise FQHC Medicaid rates from bottom-of-New-England $163/visit

452,000+

Lives Impacted

$26.4M (3-yr state share)

Cost Estimate

Lives Impacted

Patients served by Connecticut's 17 FQHC organizations who benefit from clinics having sustainable reimbursement rates

Cost Estimate · Who bears it

Connecticut state budget (state share); federal Medicaid match adds ~$54M more over 3 years

Individual Health

A diabetic patient at a Hartford FQHC benefits when the clinic can hire a care manager to call patients between visits — a service only possible if the Medicaid rate covers more than the $163.37 per visit Connecticut paid before the 2025 deal.

Population Health

The biennial budget earmarks $26.4M over 3 years ($5M FY2026, $7M FY2027, $14M FY2028) to raise rates from CT's $163.37/visit — lowest in New England vs. NH $297/visit; potentially $80M with federal match by FY2028.

Timeframe: FY2026–FY2028 (3-year phase-in)Source: CT Mirror

ProjectedRate CutHawaiiModeled projection

H.R. 1 Medicaid-to-Medicare Rate Cap Threatens 'State of Non-Viability' for Hawai'i's 429,000 Med-QUEST Enrollees

~429,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Hawai'i Med-QUEST enrollees (~30% of state population) who face coverage and access losses as the rate cap forces Medicaid reimbursement cuts 2028-2030

Cost Estimate · Who bears it

Hawai'i state government and Medicaid enrollees bearing costs of mandated rate reductions

Individual Health

An elderly neighbor-island patient with multiple chronic conditions who sees a physician at a Maui FQHC every six weeks depends on Med-QUEST reimbursement that the state legislature tried to raise but Congress has now banned from exceeding Medicare rates — which are already set without accounting for Hawai'i's cost of living.

Population Health

H.R. 1 bars states from paying Medicaid above Medicare rates, forcing Hawai'i to cut Med-QUEST reimbursements 2028-2030; with ~429,000 residents (30% of state) on Medicaid and Medicare rates set without a Hawaii cost-of-living adjustment, HHPDA's Dr. Jack Lewin warns the system is heading toward 'a state of non-viability.'

Timeframe: Rate cap takes effect 2028-2030 under H.R. 1Source: Honolulu Civil Beat

ProjectedCoverage LossHawaiiConfirmed count

Med-QUEST 80-Hour Work Requirements and 6-Month Renewals Begin Jan 1, 2027 for Expansion Adults

~429,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Hawai'i Med-QUEST expansion adults ages 19-64 subject to new 80-hour/month work requirements and semi-annual renewal burden starting Jan 1, 2027

Cost Estimate · Who bears it

Med-QUEST enrollees at risk of churn; FQHCs absorbing navigation and uncompensated care load

Individual Health

A Native Hawaiian seasonal worker on the Big Island who works 80+ hours some months and fewer others will need to document her hours every month and renew her Med-QUEST eligibility every six months — tasks that FQHC community health workers at Wai'anae will need to help navigate to prevent coverage lapses.

Population Health

Med-QUEST requires non-pregnant expansion adults 19-64 to work/volunteer at least 80 hours/month or earn at least $580/month starting Jan 1, 2027, with eligibility renewals shifting from annual to every six months — creating major navigation and churn risk for FQHC eligibility teams serving Hawai'i's ~429,000 enrollees.

Timeframe: Implementation begins Jan 1, 2027; details expected from Med-QUEST by July 2026Source: Hawai'i Med-QUEST Division

In EffectRate CutOregonConfirmed count

OHA cuts ~$170M in quality-incentive payments to primary care to fund H.R.1 implementation mandates

~429,000

Lives Impacted

~$170M this fiscal year

Cost Estimate

Lives Impacted

Patients at Oregon community health centers, which serve 22% of Oregon Health Plan (Medicaid) beneficiaries; quality-incentive payment cuts flow directly to primary care clinics, family doctors, pediatricians, and OB-GYNs serving low-income Oregonians

Cost Estimate · Who bears it

Oregon primary care clinics and community health centers (lose quality-incentive revenue they planned operational budgets around)

Individual Health

A pediatric patient at a Willamette Valley community health center whose clinic loses a portion of its annual quality-incentive payment — income the center counted on to keep staffing levels stable — may find appointment availability tightening as the clinic absorbs a cut it did not budget for.

Population Health

OHA asked legislators (January 2026) to authorize 27 new state positions while slashing $200M+ in OHP quality-incentive funds; ~85% (~$170M) flows directly to primary care clinics serving low-income Oregonians. Oregon CHCs serve 22% of all Oregon Health Plan members and are directly exposed to these payment reductions.

Timeframe: January 2026 OHA request to legislature; cuts flow through the current fiscal yearSource: OPB

In EffectBenefit CutVirginiaConfirmed count

2025 federal funding freeze locked 16 of Virginia's 31 FQHCs out of grant payments; centers serve 400,000 Virginians

~400,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Virginians served annually across the state's 31 community health centers

Cost Estimate · Who bears it

—

Individual Health

A patient at Capital Area Health Network in Richmond arrived for a scheduled appointment only to find the clinic had been forced to consolidate locations after being locked out of federal grant funds needed to cover payroll — illustrating how a payment-system disruption translates directly to reduced clinical access.

Population Health

16 of Virginia's 31 community health centers were unable to draw down federal grant funds during the January 2025 OMB freeze; collectively the centers serve roughly 400,000 Virginians annually.

Timeframe: January–February 2025 freeze episode; ongoing federal funding cliff risk through December 2026Source: VPM (Virginia Public Media)

ProjectedAccess GapOklahomaEstimate

Community Health Center Fund cliff: ~70% of OK health-center base funding at risk, 350,000+ patients exposed

350,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Oklahomans served by 22 CHC organizations at 170+ sites who depend on Section 330 base grants, which supply roughly 70% of federal health-center funding

Cost Estimate · Who bears it

Oklahoma FQHCs (lose ~70% of federal Section 330 base grant revenue without reauthorization); patients absorb reduced services or clinic closures

Individual Health

A diabetic patient in rural Sequoyah County whose only nearby clinic is a community health center faces the prospect of that clinic freezing hiring and cutting hours if Congress lets the Community Health Center Fund lapse, turning a 30-minute wait into a 90-mile drive.

Population Health

CHCF mandatory funding lapsed at the January 30, 2026 deadline without long-term reauthorization. The CHCF supplies ~70% of federal Section 330 base funding for Oklahoma's 22 CHC organizations (350,000+ patients, 170+ sites); without reauthorization, centers face hiring freezes, paused expansions, and service cuts.

Timeframe: CHCF mandatory funding authorized only through December 31, 2026; lapse risk ongoingSource: NACHC

ProjectedCost ShiftMissouriModeled projection

Missouri Foundation for Health Estimates ~$23 Billion in Federal Medicaid Losses Over the Decade

340,000+

Lives Impacted

~$23B over 10 years

Cost Estimate

Lives Impacted

Missouri Medicaid expansion enrollees (constitutionally protected) whose provider rates and services face pressure as ~$23 billion in federal funding drains over the decade

Cost Estimate · Who bears it

Missouri state general revenue and FQHCs serving 665,000 patients in a state where all 99 rural counties carry health-professional-shortage designations

Individual Health

A 50-year-old uninsured farmworker in rural Stoddard County who only recently gained Medicaid through Amendment 2 expansion will face a November 2026 ballot measure that could attach work requirements to her constitutionally protected coverage — paperwork she cannot complete during harvest season.

Population Health

The Missouri Foundation for Health estimates H.R. 1 will cost Missouri ~$23 billion in federal Medicaid funding over the decade. Expansion reserve funds are projected to run out as soon as late 2026, threatening provider rates for the ~340,000+ constitutionally mandated expansion enrollees.

Timeframe: Federal cuts phase in through 2027-2035; expansion reserve funds projected to run dry as soon as late 2026Source: Missouri Independent

ProjectedCoverage LossOhioModeled projection

H.R.1 work requirements projected to strip 337,000+ Ohioans of Medicaid and cut $5.13B in year one

~337,000

Lives Impacted

$5.13B year-one Medicaid cut

Cost Estimate

Lives Impacted

Ohio Medicaid expansion adults ages 19-64 who lose coverage when 80-hour/month community-engagement requirements take effect no later than January 1, 2027; Urban Institute estimates the range at 261,000-412,000

Cost Estimate · Who bears it

Ohio Medicaid program ($5.13B year-one decline); Ohio FQHCs lose half-patient Medicaid revenue stream; patients bear cost of uninsured care or forgo it

Individual Health

A 35-year-old warehouse temp worker in Columbus who moves between short-term contracts and has stretches without paycheck documentation could lose the Medicaid coverage that keeps her diabetes managed at her community health center.

Population Health

Center for Community Solutions modeling: ~337,000 Ohioans (10.7% enrollment drop, range 261,000-412,000) lose Medicaid in year one under H.R.1; first-year Medicaid spending declines $5.13B ($53.3B over a decade). Medicaid covers ~half of Ohio's ~1M FQHC patients.

Timeframe: State 1115 waiver eligibility review begins January 2026; federal H.R.1 work requirements enforceable no later than January 1, 2027Source: The Center for Community Solutions

In EffectCoverage LossAlabamaEstimate

~300,000 Alabamians remain uninsured in the Medicaid coverage gap; state forgoes $619M/yr in federal funds

~300,000

Lives Impacted

$619M/yr

Cost Estimate

Lives Impacted

Adults earning too much for traditional Medicaid but too little for marketplace subsidies — the coverage gap created by Alabama's refusal to expand

Cost Estimate · Who bears it

Federal government (forgone funds); FQHCs absorb uncompensated care demand

Individual Health

A 38-year-old home-health aide in rural Sumter County earns $14,000 a year — above Alabama's Medicaid cutoff of 18% FPL for parents, below the marketplace subsidy floor — and has no affordable coverage option.

Population Health

Alabama covers parents only at ~18% FPL and excludes childless adults entirely, leaving roughly 300,000 residents in the coverage gap while forgoing an estimated $619 million annually in federal matching funds.

Timeframe: Ongoing; no expansion vote scheduled as of March 2026Source: Fox 10 News (WALA)

ProjectedCoverage LossArizonaModeled projection

300,000+ Arizonans projected to lose AHCCCS under H.R.1 work requirements and twice-yearly renewals

300,000+

Lives Impacted

$700M+/yr

Cost Estimate

Lives Impacted

AHCCCS expansion adults ages 19-64 at up to 133% FPL who must verify 80 hours/month of work, school, or volunteering starting January 2027

Cost Estimate · Who bears it

Arizona FQHCs (Medicaid revenue at risk); patients lose coverage access

Individual Health

A seasonal farm worker in Yuma County who picks crops eight months a year faces a coverage gap in the off-season unless she can document exempt status through AHCCCS's new twice-yearly renewal portal.

Population Health

Arizona's 24 FQHCs serve ~870,000 patients — 43% on AHCCCS — generating over $700 million a year (~two-thirds of patient revenue); AACHC warns every 1% coverage drop costs a clinic ~$1M/year, and 300,000+ are projected to lose coverage.

Timeframe: Work requirements begin January 2027; twice-yearly renewals also January 2027Source: Arizona Center for Investigative Reporting (AZCIR)

ProjectedCoverage LossMarylandConfirmed count

H.R. 1 Work Requirements and Six-Month Renewals Hit ~300,000 Maryland Medicaid Enrollees

~300,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Maryland HealthChoice adult enrollees ages 19-54 subject to 80-hours-per-month work/community-engagement requirement beginning January 1, 2027

Cost Estimate · Who bears it

FQHCs absorbing increased eligibility-navigation workload and potential uncompensated care from disenrolled patients

Individual Health

A 38-year-old home health aide in Prince George's County whose seasonal work hours fluctuate will face a six-month renewal deadline alongside a new monthly work-log requirement — a paperwork burden that could strip her HealthChoice coverage even if she remains eligible.

Population Health

The Maryland Department of Health confirms that under H.R. 1 (signed July 2025), about 300,000 Marylanders ages 19-64 must document 80 hours/month of qualifying work or community engagement starting January 1, 2027, and HealthChoice renewals shift from annual to every six months.

Timeframe: Work requirements effective January 1, 2027; outreach must begin well before year-end 2026Source: Maryland Department of Health

ProjectedCoverage LossNew JerseyModeled projection

Up to 300,000 NJ FamilyCare enrollees projected to lose coverage under H.R.1 work rules

up to 300,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Medicaid expansion adults ages 19-64 in NJ FamilyCare, including some non-citizen immigrants losing eligibility as early as October 1, 2026

Cost Estimate · Who bears it

State (state officials warn the federal changes could cost NJ roughly $3.3 billion annually in hospital aid)

Individual Health

A 42-year-old home health aide in Newark who works part-time and struggles to document 80 hours per month of qualifying activity could lose her NJ FamilyCare coverage and face no-cost-sharing primary care disappearing at her community health center.

Population Health

NJ DHS projects 300,000 enrollees (range 165,000-300,000 depending on system performance) lose NJ FamilyCare when 80-hour/month work requirements and six-month renewals take effect January 1, 2027; ~30% of beneficiaries face the new rules.

Timeframe: Work requirements effective January 1, 2027; non-citizen eligibility cuts beginning October 1, 2026Source: NJ Division of Medical Assistance and Health Services (DMAHS)

ProjectedBenefit CutWisconsinConfirmed count

Federal CHC Fund cliff threatens Wisconsin's ~17 FQHCs serving nearly 300,000 patients at 200+ sites

~300,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served across Wisconsin's approximately 17 FQHC organizations at 200+ sites

Cost Estimate · Who bears it

—

Individual Health

A patient at a Milwaukee community health center where ~60% of patients rely on Medicaid faces the prospect of reduced hours or closed specialty services if the Section 330 base grant is not reauthorized after December 2026 — just as BadgerCare work-requirement losses push more patients to show up uninsured.

Population Health

Wisconsin's ~17 FQHC organizations serve nearly 300,000 patients at 200+ sites; the Community Health Center Fund ($4.6B) is authorized only through December 2026, and NACHC warns 1-in-4 CHCs nationally could close without stable funding.

Timeframe: Community Health Center Fund expires December 2026Source: NACHC

ProposedRate CutWashingtonEstimate

Gov. Ferguson's pharmacy carve-out would strip 340B savings from WA health centers — $100M+ annual loss

~298,000

Lives Impacted

$100M+/yr

Cost Estimate

Lives Impacted

Patients served by Sea Mar Community Health Centers alone across 18 Western Washington counties (plus all other WA CHC patients served by 340B-funded programs)

Cost Estimate · Who bears it

Washington community health centers losing 340B drug pricing savings

Individual Health

A Sea Mar patient in a rural Clark County community who receives low-cost medications through the 340B program could face drug costs their family cannot afford if the pharmacy carve-out eliminates the center's ability to generate 340B savings used to cross-subsidize care.

Population Health

Washington community health centers would lose $100M+ annually while the state saves only ~$7.5M; Sea Mar serves ~298,000 patients across 18 counties and warns of service cuts and layoffs.

Timeframe: Proposed in 2025-27 budget; pending legislative decisionSource: The Columbian / Washington Association for Community Health

In EffectCoverage LossMississippiConfirmed count

~271,000 Mississippi Marketplace Enrollees Did Not Renew for 2026 After ACA Subsidy Expiry

~271,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Mississippians who enrolled in 2025 marketplace coverage but did not renew for 2026 after premium spikes

Cost Estimate · Who bears it

Uninsured patients and FQHCs absorbing uncompensated care

Individual Health

A 45-year-old self-employed farm worker in the Mississippi Delta who paid roughly $130/month under enhanced subsidies now faces a $746/month premium — a 474% increase — making marketplace coverage unaffordable and pushing them to seek care at an FQHC on a sliding-scale basis.

Population Health

Only about 67,000 of the 338,159 Mississippians enrolled for 2025 had renewed for 2026; 95% of enrollees had relied on subsidies averaging $718/month. KFF estimates net payments are ~114% higher after subsidy expiry.

Timeframe: Effective January 2026; enrollment collapse documented December 2025Source: Mississippi Public Broadcasting

ProjectedCoverage LossIowaModeled projection

Iowa Medicaid work requirements target Dec. 1, 2026 — ~254,000 CHC patients exposed

~254,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Iowa community health center patients whose Medicaid coverage depends on documenting 80+ hours/month of qualifying activity

Cost Estimate · Who bears it

Iowa FQHCs absorb uncompensated care for patients who lose Medicaid and cannot pay

Individual Health

An adult CHC patient in a rural Iowa county who works seasonal farm labor must gather pay stubs or supervisor letters every month and submit them on time — missing one reporting window means losing the Medicaid coverage that pays for prescriptions and prenatal visits.

Population Health

Iowa's ~14 FQHC organizations serve ~254,000 patients; nearly all fall within the Iowa Health and Wellness Plan's expansion population subject to the Dec. 1, 2026 80-hour community-engagement requirement.

Timeframe: Effective December 1, 2026 (Iowa's self-imposed deadline, ahead of federal H.R.1 mandate)Source: Iowa Health & Human Services

ProjectedCost ShiftDelawareModeled projection

H.R. 1 Medicaid Cuts Threaten $200M/yr in Federal Funding for Delaware's 250,000 Enrollees

~250,000

Lives Impacted

~$200M/yr

Cost Estimate

Lives Impacted

Delaware Medicaid enrollees at risk of coverage loss or reduced benefits if $200M/yr in federal funding is cut

Cost Estimate · Who bears it

Delaware state government and Medicaid enrollees absorbing federal funding reductions

Individual Health

A poultry-processing worker in Sussex County who relies on Medicaid for preventive care at La Red Health Center could lose access to the visits and prescriptions that keep a chronic condition managed, with no practical alternative in a county with limited transportation.

Population Health

H.R. 1 puts Delaware at risk of losing ~$200M in annual federal Medicaid funding, threatening coverage for roughly 250,000 Delawareans; rural Sussex and Kent county FQHCs face disproportionate patient-access risk if Medicaid rolls contract.

Timeframe: Ongoing under H.R. 1 Medicaid cuts enacted 2025-2026Source: WHYY

ProjectedCoverage LossMassachusettsModeled projection

H.R. 1 Threatens Coverage for 250,000+ Massachusetts Residents

250,000+

Lives Impacted

~$1.75B/yr

Cost Estimate

Lives Impacted

MassHealth and Health Connector enrollees projected to lose coverage under H.R. 1 federal Medicaid cuts

Cost Estimate · Who bears it

Massachusetts state budget (MassHealth and Health Connector programs) absorbing lost federal matching funds

Individual Health

A 42-year-old home health aide in Worcester who earns just above the Medicaid threshold will face a documentation deadline she cannot meet while working two jobs — and will lose the MassHealth coverage she relies on for her diabetes management.

Population Health

Massachusetts officials estimate H.R. 1 will cut roughly $1.75 billion in federal MassHealth and Connector funding and cause 250,000+ residents to lose coverage; work/community-engagement requirements for adults 19-64 begin January 1, 2027.

Timeframe: First immigrant-member changes Fall 2026; work requirements begin January 1, 2027Source: Massachusetts Executive Office of Health and Human Services (Mass.gov)

ProjectedCoverage LossWashingtonModeled projection

WACH projects 250,000+ Washingtonians will lose Medicaid under H.R.1

250,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Washington Medicaid enrollees projected to lose coverage under H.R.1 cuts and work requirements

Cost Estimate · Who bears it

—

Individual Health

A low-income agricultural worker in Eastern Washington who depends on Medicaid for diabetes management at a community health center faces losing coverage if H.R.1 coverage losses materialize, with no local safety-net alternative in rural areas where Apple Health was the only payer.

Population Health

The Washington Association for Community Health projects 250,000+ Washingtonians will lose Medicaid under H.R.1 and warns the law will strain community health centers; it also eliminates federal AHEC workforce development funding.

Timeframe: H.R.1 enacted July 2025; coverage changes phase in through 2027Source: Washington Association for Community Health

In EffectCost ShiftIdahoConfirmed count

Idaho awarded up to $930M over five years through Rural Health Transformation Program

~241,000

Lives Impacted

~$930M/5yr

Cost Estimate

Lives Impacted

Patients served by Idaho's ~14 FQHC organizations, rural hospitals, and tribal health programs that can access Rural Health Transformation funding

Cost Estimate · Who bears it

Federal government via H.R.1's Rural Health Transformation Program; Idaho Department of Health and Welfare administers

Individual Health

A Native American patient in rural northern Idaho whose tribal health partnership receives ~$32.5M in transformation funding gains access to expanded telehealth and workforce services that were previously unfunded.

Population Health

CMS awarded Idaho ~$930M over five years (~$186M/year) on Dec. 30, 2025, including ~$32.5M for tribal partnerships, for telehealth, workforce recruitment, and innovative care models.

Timeframe: Five-year program beginning Dec. 30, 2025; first ~$186M must be awarded by Oct. 30 deadlineSource: Idaho Department of Health and Welfare

ProjectedCoverage LossTexasSouth TexasEstimate

San Antonio: ACA subsidy loss could hit 234,000 Bexar County residents

234,000

Lives Impacted

$75M

Cost Estimate

Lives Impacted

Bexar County residents whose ACA tax credits are at risk as enhanced subsidies lapse

Cost Estimate · Who bears it

University Health (San Antonio) safety-net system

Individual Health

A San Antonio family loses subsidies, becomes uninsured, and turns to an already-stretched safety net.

Population Health

University Health's ED visits are up 77% since 2014; the CFO warns of up to $75M in lost payments as insured patients become uninsured.

Timeframe: FY2026Source: San Antonio Report / University Health

ProposedCoverage LossOklahomaConfirmed count

November 2026 ballot measure would strip constitutional protection from 233,500 Medicaid expansion enrollees

~233,500

Lives Impacted

—

Cost Estimate

Lives Impacted

Oklahoma Medicaid expansion adults (ages 19-64, at or below 138% FPL) currently protected by the state constitution; if SJR 50 passes in November 2026 and the federal match drops, the legislature could amend or repeal coverage

Cost Estimate · Who bears it

If expansion is repealed: the state would lose federal match revenue; patients would bear full cost of uninsured care; Oklahoma FQHCs would lose a major payer segment

Individual Health

A Cherokee Nation member in Tahlequah who gained coverage under the 2021 expansion and receives primary care at the Cherokee Nation Health Service could see her constitutional protection stripped in November 2026, leaving her coverage subject to annual legislative budget fights.

Population Health

OK House passed SJR 50 (69-18) to put a November 2026 ballot measure asking voters to move Medicaid expansion from the state constitution to statute, allowing the legislature to amend or repeal coverage if the 90% federal match drops — directly threatening the ~233,530 expansion enrollees FQHCs depend on.

Timeframe: SJR 50 pending Senate; ballot measure November 2026Source: KGOU (Oklahoma NPR)

ProjectedCoverage LossArkansasConfirmed count

225,000 ARHOME enrollees face work-requirement enforcement starting January 2027

~225,000

Lives Impacted

—

Cost Estimate

Lives Impacted

ARHOME expansion adults ages 19-64 in Arkansas who must verify 80 hours/month of work or community engagement to retain coverage

Cost Estimate · Who bears it

—

Individual Health

A gig-economy driver in Jonesboro who works irregular hours across two platforms must document compliance each month or risk losing the coverage that pays for his insulin.

Population Health

Arkansas will begin checking work status of ~225,000 ARHOME expansion enrollees July 1, 2026, with disenrollment starting January 1, 2027; the state program costs $2–2.5 billion a year.

Timeframe: Soft launch July 1, 2026; enforcement begins January 1, 2027Source: Arkansas Department of Human Services

In EffectCoverage LossTennesseeModeled projection

ACA Credit Expiry Threatens 142,000–203,000 Tennesseans as Marketplace Premiums More Than Double

142,000–203,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Tennesseans projected to forgo ACA Marketplace coverage after enhanced premium tax credits expired December 31, 2025, with average premiums set to more than double in a non-expansion state with no Medicaid backstop

Cost Estimate · Who bears it

—

Individual Health

A warehouse worker in Memphis earning $26,000 per year who relied on a $12/month subsidized plan now faces a premium above her food budget; she dropped coverage and will seek primary care at a Nashville-area FQHC that is already absorbing rural hospital closure patients.

Population Health

The Sycamore Institute projects 142,000–203,000 Tennesseans will forgo coverage as premiums more than double after enhanced ACA credits expired end of 2025. Almost 643,000 were enrolled in 2025 — more than double 2020 — with enrollment among 100-150% FPL up nearly 460%. Because TN is a non-expansion state, losses land on FQHCs with no Medicaid backstop.

Timeframe: Enhanced credits expired December 31, 2025; coverage losses materializing in 2026 plan yearSource: The Sycamore Institute

In EffectCoverage LossFloridaConfirmed count

Florida ACA Marketplace Lost 196,643 Selections in 2026 Open Enrollment — Early Warning of Larger Erosion

~196,600

Lives Impacted

—

Cost Estimate

Lives Impacted

Florida ACA marketplace enrollees who dropped coverage in 2026 open enrollment before the full credit expiration impact

Cost Estimate · Who bears it

newly uninsured patients and FQHCs absorbing sliding-fee and uncompensated care

Individual Health

A 28-year-old agricultural worker in the Panhandle who dropped his marketplace plan when the premium crept up in 2026 now goes without coverage, likely turning to the nearest FQHC when a work injury or illness requires care.

Population Health

KFF data shows Florida dropped from 4,735,415 to 4,538,772 marketplace plan selections in 2026 open enrollment (−4.2%, −196,643), the largest absolute loss of any state — a leading indicator of the larger uninsured surge as enhanced credits fully expire.

Timeframe: 2026 open enrollment period; full impact materializing through 2026Source: KFF (Kaiser Family Foundation) State Health Facts

ProjectedBenefit CutUtahConfirmed count

Federal Community Health Center Fund cliff threatens Section 330 base for 180,000+ Utah patients

180,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served by Utah's 14 federally funded health centers

Cost Estimate · Who bears it

—

Individual Health

A farmworker family in rural Utah whose local health center depends on Section 330 grants for dental and behavioral health services could lose access to those programs if Congress fails to reauthorize the Community Health Center Fund past December 2026.

Population Health

More than 180,000 Utahns receive care underwritten by Section 330 / Community Health Center Fund grants at Utah's 14 federally funded health centers, with no long-term reauthorization past December 2026.

Timeframe: Community Health Center Fund authorized only through December 2026Source: NACHC

ProjectedCoverage LossKentuckyModeled projection

H.R.1 work requirements threaten ~149,000 Kentuckians with coverage loss starting Dec. 31, 2026

~149,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Kentucky Medicaid expansion enrollees projected to lose coverage — mostly from paperwork errors, not from actually not working — when the 80-hour/month reporting requirement takes effect December 31, 2026

Cost Estimate · Who bears it

Kentucky FQHCs absorb uncompensated care for ~149,000 newly uninsured; the state faces a multi-billion-dollar Medicaid shortfall

Individual Health

An Appalachian Kentucky coal-country worker who already meets the 80-hour threshold through informal day labor risks losing Medicaid because they have no pay stubs to document it — a paperwork failure, not a work failure, that triggers disenrollment and uninsured visits to their FQHC.

Population Health

The Kentucky Center for Economic Policy projects ~149,000 Kentuckians will lose coverage (based on Arkansas's experience) and ~210,000 will become uninsured overall; nearly 500,000 Kentucky expansion enrollees must prove 80 hours/month of qualifying activity starting December 31, 2026.

Timeframe: Work-reporting requirement effective December 31, 2026Source: Kentucky Center for Economic Policy

ProjectedCoverage LossMinnesotaModeled projection

H.R. 1 Projected to Cost Up to 140,000 Minnesotans Medicaid Coverage and $200M/Year in Federal Funding

up to 140,000

Lives Impacted

~$200M/yr federal lost

Cost Estimate

Lives Impacted

Minnesota Medical Assistance expansion adults projected to lose coverage under H.R. 1 work/community-engagement requirements

Cost Estimate · Who bears it

Minnesota state, county, and Tribal governments absorbing ~$165M/yr in new administrative costs; FQHCs absorbing uncompensated care from disenrolled patients

Individual Health

A 33-year-old non-disabled, childless adult in St. Cloud who works part-time at a seasonal warehouse must now document every qualifying hour monthly or lose the Medical Assistance that covers his mental health medications — and the documentation portal may only be available in English.

Population Health

Minnesota DHS projects H.R. 1 will eventually cause up to 140,000 Minnesotans to lose Medical Assistance coverage, with ~$200 million in lost federal funding annually plus ~$165 million/year in new state, county, and Tribal administrative costs.

Timeframe: Work requirements effective under H.R. 1 (signed July 4, 2025); implementation timeline through 2027Source: Minnesota Department of Human Services

ProjectedCoverage LossLouisianaModeled projection

Louisiana projects ~21,000 will lose Medicaid under Jan. 2027 work requirements; outside estimates reach 132,000

21,000–132,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Louisiana Medicaid expansion adults aged 19–64 who must document 80 hours/month of community engagement starting January 1, 2027 — with LDH projecting 21,000 at minimum and the Urban Institute estimating up to 132,000 losing coverage

Cost Estimate · Who bears it

Louisiana FQHCs absorb uncompensated care for newly uninsured patients; 503,329 FQHC patients at PPS revenue risk

Individual Health

A Louisiana home-care worker in a rural Delta parish who informally cares for an elderly neighbor may count those hours toward the 80-hour requirement — but only if she navigates the renewal packet arriving in November 2026 in time, or she loses the Medicaid coverage that pays for her own diabetes management at the FQHC.

Population Health

LDH projects ~21,000 Healthy Louisiana enrollees will lose coverage when the Jan. 1, 2027 work requirement takes effect; the Urban Institute estimates up to 132,000 adults at risk. Louisiana's 41 FQHCs serve 503,329 patients and face direct PPS revenue loss for each newly uninsured patient.

Timeframe: Notices to affected members: May 2026; renewal packets: November 2026; effective: January 1, 2027Source: NOLA.com / The Times-Picayune

In EffectAccess GapSouth DakotaModeled projection

38% of South Dakota Native Americans Remain Uninsured; State Ranks Last on Native Health Outcomes Nationally

124,433

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served by South Dakota's four FQHC organizations across frontier and reservation communities, including urban Native American patients served by South Dakota Urban Indian Health, against a backdrop where 38% of Native Americans in the state remain uninsured

Cost Estimate · Who bears it

—

Individual Health

A Lakota elder on the Rosebud Reservation who gained Medicaid in 2023 may be among the 38% who still lack coverage — or risk losing it in 2027 — meaning a preventable complication like diabetic foot ulcer goes untreated until it requires hospitalization.

Population Health

Approximately 38% of Native Americans in South Dakota remain uninsured despite 2023 Medicaid expansion. Native Americans die from avoidable causes at 1,089 per 100,000 — five times the white rate — and half die before age 58. South Dakota ranks last nationally on Native American health outcomes.

Timeframe: Ongoing; Commonwealth Fund data as of May 2026Source: South Dakota Searchlight

In EffectCoverage LossMississippiModeled projection

123,000 Low-Income Adults Remain in Mississippi Coverage Gap as Medicaid Expansion Fails Again

~123,000

Lives Impacted

~$73.8M/yr

Cost Estimate

Lives Impacted

low-income adults in Mississippi with no affordable coverage option

Cost Estimate · Who bears it

Mississippi state (foregone federal matching funds)

Individual Health

An uninsured adult in the Mississippi Delta earning $14,000 a year earns too much for traditional Medicaid but too little to qualify for marketplace subsidies, leaving a working parent with no affordable path to primary care except sliding-scale visits at an FQHC.

Population Health

Roughly 123,000 low-income Mississippi adults remain in the coverage gap; Families USA estimates the state is forgoing ~$73.8 million in federal Medicaid matching in 2026 by not expanding.

Timeframe: 2026 legislative session; expansion bills never taken up in committeeSource: Mississippi Today

ProjectedCoverage LossFederalModeled projection

H.R. 1 strips Medicare from ~100,000 lawfully present immigrants

~100,000

Lives Impacted

$1.1B/yr

Cost Estimate

Lives Impacted

Lawfully present immigrants — refugees, asylees, TPS holders, DV/trafficking survivors, some work-visa holders

Cost Estimate · Who bears it

California declines to backfill ~200,000 affected residents (~$1.1B/yr); the rest become uninsured/self-pay

Individual Health

An elderly refugee who paid into Medicare for years loses Part B and must self-pay or delay care for chronic conditions.

Population Health

Adds insured, often-elderly patients to FQHC self-pay panels nationwide starting January 2027 — California, with the most immigrant seniors, is the most exposed.

Timeframe: Disenrollment Jan 4, 2027Source: KFF Health News

ProjectedCoverage LossConnecticutModeled projection

100,000+ CT residents projected to lose HUSKY Medicaid under H.R.1 work requirements

100,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

HUSKY Part D (Medicaid expansion) adults ages 19-64 who must verify 80 hours/month of work or community engagement starting January 1, 2027

Cost Estimate · Who bears it

—

Individual Health

A home health aide in New Haven who works 20 hours a week for two elderly clients — below the 80-hour threshold — must find and document approved volunteer hours or lose the HUSKY coverage that pays for her asthma medication.

Population Health

Connecticut DSS confirms 80-hour/month work requirements take effect January 1, 2027; state analyses estimate over 100,000 residents could lose coverage due to reporting and system failures despite remaining eligible.

Timeframe: Effective January 1, 2027; twice-yearly renewals also begin January 2027Source: Connecticut Department of Social Services

In EffectAccess GapGeorgiaConfirmed count

Georgia Pathways to Coverage Enrolled Only ~8,000 of 100,000+ Eligible Adults in Two Years

100,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

low-income uninsured Georgia adults eligible for Pathways but not enrolled, left in the coverage gap

Cost Estimate · Who bears it

uninsured low-income Georgians bearing out-of-pocket costs; FQHCs absorbing uncompensated care

Individual Health

A 45-year-old warehouse worker in Columbus earning $15,000/year is technically eligible for Pathways to Coverage but navigated the 80-hour documentation requirement incorrectly and was never enrolled, leaving the FQHC as his only source of care on a sliding-fee scale.

Population Health

Georgia's partial-expansion alternative enrolled just over 8,000 people — ~7% of eligible adults — after two years; GAO found two-thirds of spending went to administration (largely Deloitte), not care; state now projects only ~18,301 active enrollees by Dec 2026.

Timeframe: Two years of Pathways program operation through Dec 2025; extension to Dec 2026Source: Georgetown Center for Children and Families

ProjectedCoverage LossIndianaModeled projection

Indiana SB 1 (2026) could push 100,000+ Hoosiers off Medicaid; ~400,000 at risk by 2034

100,000+

Lives Impacted

$400M+ projected state savings

Cost Estimate

Lives Impacted

Indiana Medicaid expansion adults who face stricter work requirements and more frequent eligibility checks under SB 1, layered on top of federal H.R.1 requirements

Cost Estimate · Who bears it

Indiana FQHCs and uninsured patients bear the cost of lost coverage; FSSA projected $400M+ in savings via population reductions

Individual Health

A Hoosier adult working part-time retail in Indianapolis must document both state and federal hours requirements — any gap in documentation during a redetermination cycle triggers disenrollment and an uninsured visit to an FQHC that cannot turn them away.

Population Health

Advocacy group Hoosier Action estimates over 100,000 additional people could lose coverage from Indiana SB 1 state changes alone; combined with federal H.R.1 cuts, nearly 400,000 by 2034 — the majority from the Medicaid expansion population that drives more than half of FQHC patient volume.

Timeframe: SB 1 passed in 2026 session; federal H.R.1 work requirements begin January 1, 2027Source: WFYI Indianapolis

ProjectedCoverage LossOregonModeled projection

Healthier Oregon covers 100,000+ undocumented residents at ~$1.5B/biennium — now exposed to H.R.1 FMAP penalties

100,000+

Lives Impacted

~$1.5B/biennium

Cost Estimate

Lives Impacted

Oregon residents of all ages enrolled in Healthier Oregon regardless of immigration status; primarily immigrants who could not access the Oregon Health Plan before July 2023

Cost Estimate · Who bears it

Oregon General Fund (overwhelmingly state-funded with no federal match for undocumented residents); FMAP penalty risk could force program restructuring

Individual Health

A Mexican-born farmworker in the Willamette Valley who gained full Oregon Health Plan benefits through Healthier Oregon in 2023 and now manages her asthma at a community health center faces the risk that H.R.1 FMAP penalties prompt the legislature to cut or restructure the program in the 2026 budget reckoning.

Population Health

Healthier Oregon (full OHP benefits regardless of immigration status since July 2023) covers 100,000+ enrollees at ~$1.5B/biennium, predominantly state General Fund. H.R.1 imposes FMAP penalties on states that cover undocumented residents — a direct threat to the program's state-funded model and a major share of FQHC patient revenue.

Timeframe: Program under 2026 budget review; FMAP penalty risk ongoing under H.R.1Source: Oregon Legislature (OLIS) — OHA 2025-27 Budget Review

In EffectCost ShiftNevadaModeled projection

ACA credit expiration: 94,500 Nevadans face premiums rising 75%+ as Nevada Health Link costs surge 26%

~94,500

Lives Impacted

—

Cost Estimate

Lives Impacted

Nevadans on Health Link Marketplace plans who received enhanced ACA subsidies in 2025; estimated 87% of the 110,000 enrollees relied on the enhanced credit

Cost Estimate · Who bears it

Individual enrollees (average monthly premium cost rises 75%+ for those who lose the enhanced subsidy)

Individual Health

A part-time blackjack dealer at a Strip casino who does not receive employer benefits and relied on the enhanced subsidy to keep her premium under $50/month now faces a jump of more than 75% in her monthly cost, likely driving her to drop coverage and use Nevada Health Centers as an uninsured patient.

Population Health

Nevada insurance regulators approved a 26% premium increase for 2026 Nevada Health Link plans after enhanced ACA credits expired December 31, 2025; KFF estimated 94,500 lose the enhanced credit, with average premiums rising 75%+ for those reliant solely on the enhanced portion.

Timeframe: In effect since January 1, 2026 (enhanced credits expired December 31, 2025)Source: Nevada Current

ProjectedCoverage LossNew MexicoModeled projection

NM projects 88,530 residents losing Medicaid and $8.5B in lost federal funds from H.R.1 over a decade

88,530

Lives Impacted

$8.5B over 2028-2037

Cost Estimate

Lives Impacted

New Mexico Medicaid enrollees permanently losing coverage, plus ~10,000 lawfully present non-citizens losing eligibility starting October 2026; an additional ~254,000 subject to 80-hour/month work reporting

Cost Estimate · Who bears it

New Mexico state (must backfill or absorb $8.5B in lost federal Medicaid funds over the decade, plus wind down the ~$1.5B Healthcare Delivery and Access provider-tax program)

Individual Health

A farmworker in Dona Ana County near the border who already cycles in and out of seasonal employment would be required to document 80 hours of qualifying activity every month or lose the Medicaid coverage that makes her community health center visits cost-free.

Population Health

NM Health Care Authority estimates at least 88,530 New Mexicans permanently lose Medicaid; the federal changes also cost the state ~$8.5 billion in Medicaid funds from 2028 through 2037, with 6-8 hospitals at closure risk.

Timeframe: Non-citizen eligibility cuts October 2026; work requirements begin January 2027; full fiscal impact 2028-2037Source: New Mexico Health Care Authority

In EffectCoverage LossCaliforniaConfirmed count

86,000+ undocumented Californians dropped or denied Medi-Cal in two months

86,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Undocumented Californians dropped or denied Medi-Cal, Jan–Feb 2026, after the enrollment freeze

Cost Estimate · Who bears it

Patients (lost coverage) + FQHCs (more uninsured visits)

Individual Health

A diabetic loses coverage and starts rationing insulin between paychecks.

Population Health

Exits ran at roughly 6x the normal rate; ~1.3M coverage loss is projected over four years.

Timeframe: Jan–Feb 2026 (ongoing)Source: KVPR / Public Health Watch

In EffectCoverage LossNew HampshireConfirmed count

ACA Premium Credit Expiry Hits NH's 80,000 Marketplace Enrollees With 17% Average Rate Increase

~80,000

Lives Impacted

—

Cost Estimate

Lives Impacted

New Hampshire individual marketplace enrollees affected by the 17.3% weighted-average gross premium increase after enhanced ACA tax credits expired December 31, 2025

Cost Estimate · Who bears it

NH marketplace enrollees facing premium spikes and FQHCs absorbing new uninsured patients

Individual Health

A self-employed IT consultant in Concord, NH who relied on enhanced ACA subsidies for family coverage faces a 17% or more premium spike in 2026, pushing them toward sliding-scale care at a nearby FQHC as the out-of-pocket cost of private insurance exceeds their budget.

Population Health

Enhanced ACA premium tax credits expired December 31, 2025, triggering a weighted average 17.3% gross premium increase across NH's individual marketplace affecting ~80,000 enrollees. More than 30% of NH marketplace enrollees are self-employed or small-business owners who relied heavily on the enhanced credits. CBO projects nationwide credit expiry will push millions into the uninsured pool.

Timeframe: Effective January 2026; credits expired December 31, 2025Source: ACA Signups / NH market filings

ProjectedCoverage LossMontanaConfirmed count

Montana Imposes Medicaid Work Requirements July 2026 — First Disenrollments Dec. 31 for 75,000 Expansion Adults

~75,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Montana Medicaid expansion adults ages 19-64 subject to 80-hour-per-month work or training documentation

Cost Estimate · Who bears it

Patients losing coverage and FQHCs bearing added enrollment-navigation burden

Individual Health

A 38-year-old seasonal farm worker in the Flathead Valley who is enrolled in Medicaid expansion must now document 80 hours of work each month or risk losing coverage on December 31 — a bureaucratic hurdle difficult to meet during off-season months when gig work is irregular.

Population Health

Montana is implementing H.R.1 work requirements ahead of the federal Jan. 2027 deadline; 75,000 expansion adults face 80-hrs/month documentation starting July 1, 2026, with first disenrollments Dec. 31, 2026. Redeterminations also shift from annual to every 6 months.

Timeframe: Work requirements effective July 1, 2026; first coverage terminations Dec. 31, 2026Source: Montana Department of Public Health and Human Services (DPHHS)

ProposedCoverage LossUtahEstimate

Utah seeks July 2026 Medicaid work requirement, threatening ~75,000 expansion enrollees

~75,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Medicaid expansion adults enrolled in Utah's expansion program

Cost Estimate · Who bears it

—

Individual Health

A part-time warehouse worker in rural Utah who gained Medicaid through the 2018 ballot initiative could lose coverage if they cannot document 80 hours of qualifying activity each month, even when irregular seasonal work makes consistent verification impossible.

Population Health

Roughly 75,000 Utahns enrolled in Medicaid expansion face coverage risk under the proposed 80-hour/month work requirement waiver targeting a July 2026 start.

Timeframe: Work requirement targeting July 2026; federal mandate January 2027Source: Utah DHHS Medicaid

ProjectedCoverage LossWest VirginiaModeled projection

Study: H.R.1 work requirements will cost 40,000-75,000 West Virginians their Medicaid coverage

40,000-75,000

Lives Impacted

—

Cost Estimate

Lives Impacted

West Virginia Medicaid expansion adults ages 19-64, out of ~161,000 total expansion enrollees

Cost Estimate · Who bears it

—

Individual Health

A coal miner's family in McDowell County enrolled in Medicaid expansion who relies on a community health center for all primary care could lose coverage under work requirements despite living in a county where documented formal employment is scarce and broadband access to online reporting portals is unreliable.

Population Health

A study models WV Medicaid expansion enrollment falling by 40,000 (high mitigation) to 75,000 (low mitigation) — out of ~161,000 expansion enrollees — due to H.R.1 work requirements and six-month redeterminations starting December 31, 2026; ~55% of WV recipients were unaware of the coming requirements as of May 2026.

Timeframe: Redeterminations begin December 31, 2026; work requirement enforcement January 1, 2027Source: West Virginia Watch

ProjectedCost ShiftSouth CarolinaModeled projection

H.R. 1 Projects ~$5B Medicaid Loss and Up to 60,000 Fewer Enrollees in SC Over a Decade

up to 60,000

Lives Impacted

~$5B over 10 yrs

Cost Estimate

Lives Impacted

South Carolina Medicaid enrollees projected to lose coverage over 10 years as H.R. 1 phases down state-directed payment programs 10% per year beginning January 2028

Cost Estimate · Who bears it

South Carolina state budget and Medicaid-dependent rural hospitals and FQHCs

Individual Health

A Medicaid-enrolled patient in rural Allendale County, home to a near-zero-margin hospital that has been in survival planning, may find the county hospital closed within a few years and the local FQHC as the only remaining care option.

Population Health

SC is projected to lose roughly $5 billion in Medicaid funding and up to 60,000 enrollees over ten years as H.R. 1 phases down the state-directed payment program (which boosted hospital Medicaid payments ~70% since 2023) by 10%/year starting January 2028.

Timeframe: State-directed payment cuts begin January 2028; 10% per year for a decadeSource: South Carolina Public Radio

ProjectedCoverage LossVermontModeled projection

~55,000 Vermont Medicaid recipients face 80-hour/month work requirements starting January 2027

~55,000

Lives Impacted

~$1M/yr in state admin costs

Cost Estimate

Lives Impacted

Vermont Medicaid recipients — roughly one-third of all state enrollees — subject to the H.R.1 work requirement

Cost Estimate · Who bears it

Vermont state government / Department of Vermont Health Access

Individual Health

A self-employed maple farmer in rural Vermont who relies on Medicaid for treatment of a chronic back injury could lose coverage if erratic seasonal income and irregular hours make it impossible to consistently document 80 qualifying hours each month.

Population Health

Nearly 55,000 Vermont Medicaid recipients — about one-third of all enrollees — must document 80 hours/month of work, volunteering, or education starting January 2027; Vermont will need 12 new administrative positions and ~$1M in additional spending plus $300K just for printing notices.

Timeframe: New applicants January 1, 2027; renewals March 1, 2027Source: Department of Vermont Health Access / VTDigger

ProjectedCoverage LossMichiganModeled projection

~52,000 Michigan Health-Center Patients to Lose Medicaid; Centers Face $38.3M Annual Revenue Loss

~52,000

Lives Impacted

$38.3M/yr

Cost Estimate

Lives Impacted

Community health center patients statewide projected to lose Medicaid coverage under H.R. 1 work requirements (effective January 1, 2027)

Cost Estimate · Who bears it

Michigan community health centers absorbing lost Medicaid reimbursement as covered patients become uninsured

Individual Health

A part-time warehouse worker in Wayne County who cycles between gig work and UI will find it nearly impossible to document a consistent 80 qualifying hours every month — and will lose the Healthy Michigan Plan coverage that pays for her asthma inhalers.

Population Health

A May 2025 MDHHS report found ~52,000 health-center patients statewide could lose Medicaid coverage, cutting ~$38.3 million in annual health-center revenue — nearly 30% of the federal Health Center Program grant funding Michigan receives. Medicaid covers 51% of Michigan health-center patients and 63% of service revenue.

Timeframe: Work requirements effective January 1, 2027; MDHHS outreach must begin by September 30, 2026Source: Michigan Department of Health & Human Services (via MPCA)

In EffectCost ShiftNew MexicoConfirmed count

NM HB 4 allocates $366M to protect coverage for up to 46,600 residents as federal ACA credits expire

up to 46,600

Lives Impacted

$366M/yr

Cost Estimate

Lives Impacted

New Mexicans on Marketplace plans who would have lost coverage when enhanced ACA premium tax credits expired; up to 122,000 see lower costs under the state fund

Cost Estimate · Who bears it

New Mexico insurers (via surcharge financing the state Health Care Affordability Fund); passed to policyholders through premiums

Individual Health

A self-employed home-care worker in Albuquerque whose Marketplace premium would have jumped unaffordably after the federal credits expired can stay insured because the state Health Care Affordability Fund now bridges the subsidy gap.

Population Health

NM FY27 budget allocates $366M for the Health Care Affordability Fund (financed by insurer surcharge) to protect coverage for up to 46,600 residents and lower costs for up to 122,000 — making NM the only state with a comprehensive plan for the ACA-credit expiration.

Timeframe: FY2027 (beginning July 2026); applications through Marketplace open enrollmentSource: New Mexico Health Care Authority

In EffectRate CutWyomingConfirmed count

Wyoming community health centers see 14.8% Medicaid revenue decline in 2024 — among steepest nationally

34,666

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served by Wyoming's five federally qualified health centers statewide

Cost Estimate · Who bears it

—

Individual Health

A patient at one of Wyoming's five FQHCs in a frontier county faces reduced clinic hours or deferred capital investment as the health center absorbs a 14.8% Medicaid revenue drop — with no expansion population to anchor a stable payer base and no state income tax revenue to fund a backstop.

Population Health

Wyoming community health centers experienced a 14.8% Medicaid revenue decline in 2024 — one of the steepest nationally — while serving 34,666 patients in a non-expansion state with an estimated 9,000-19,000 residents caught in the coverage gap.

Timeframe: FY2024 (calendar year); projected to worsen under H.R.1Source: NACHC

ProjectedCost ShiftDistrict of ColumbiaModeled projection

Federal Medicaid Cuts Threaten $58M in FQHC Revenue and Care for 34,000 DC Patients

~34,000

Lives Impacted

~$58M

Cost Estimate

Lives Impacted

DC FQHC patients at risk as H.R. 1 Medicaid cuts reduce health center revenue

Cost Estimate · Who bears it

DC community health centers absorbing Medicaid revenue reductions

Individual Health

A Community of Hope patient with diabetes who depends on Medicaid for quarterly visits and medication management faces reduced clinic capacity if the center loses a share of the projected $58M revenue cut.

Population Health

H.R. 1 Medicaid cuts could cost DC's nine community health centers ~$58M in projected revenue, threatening care for 34,000+ FQHC patients; centers reported losing over $90,000/day during the Jan 2025 federal funding freeze.

Timeframe: Projected under H.R. 1 Medicaid cuts enacted 2025-2026Source: 51st News / DC Primary Care Association

ProjectedCoverage LossIdahoModeled projection

Idaho HB 913: Medicaid work requirements with 3-month lookback — up to 34,000 could lose coverage

~34,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Idaho Medicaid expansion enrollees (of ~80,000 total) who may be dropped under the 44% estimated attrition from the three-month pre-enrollment compliance lookback

Cost Estimate · Who bears it

Idaho FQHCs absorb uncompensated care for newly uninsured patients; ~241,000 CHC patients at revenue risk

Individual Health

A rural Idaho patient who works part-time at a seasonal job and is between coverage periods must now prove three full months of qualifying hours before being allowed to enroll in Medicaid — meaning a gap in care during that window where they cannot fill prescriptions or see a provider.

Population Health

Gov. Brad Little signed HB 913 on April 10, 2026; analysts estimate up to 34,000 of ~80,000 expansion enrollees (44%) could lose coverage under the three-month pre-enrollment lookback — the longest the federal law allows.

Timeframe: Effective January 1, 2027 (federal implementation date under H.R.1)Source: Idaho Capital Sun

ProjectedCoverage LossRhode IslandModeled projection

H.R. 1 Work Requirements Threaten 24,500–33,500 RI Residents; Medicaid Payments to Drop $32.5M by FY2029

24,500–33,500

Lives Impacted

$32.5M/yr by FY2029

Cost Estimate

Lives Impacted

Rhode Islanders projected to lose Medicaid coverage due to H.R. 1 work requirements (80 hrs/month) and eligibility changes, beginning January 1, 2027

Cost Estimate · Who bears it

Rhode Island Medicaid program and FQHCs absorbing uncompensated care for newly uninsured patients

Individual Health

A part-time retail worker in Woonsocket who qualifies for Medicaid but whose gig hours fluctuate week to week may fail the 80-hour monthly threshold in any given month and face a gap in coverage that interrupts her asthma medications.

Population Health

Rhode Island analysts project 33,000–50,000 residents losing Medicaid coverage overall; 24,500 specifically due to work requirements. Medicaid provider payments will drop $32.5M in FY2029, nearly doubling to $61.8M by FY2030, directly threatening the eight FQHCs serving 220,000+ patients.

Timeframe: Work requirements effective January 1, 2027; payment cuts begin FY2029Source: Rhode Island Current

In EffectCoverage LossIllinoisConfirmed count

Illinois ends immigrant adult coverage (HBIA) July 2025 — ~33,000 routed to FQHCs uninsured

~33,000

Lives Impacted

~$330M/yr state savings

Cost Estimate

Lives Impacted

Non-citizen adults aged 42–64 who lost Medicaid-equivalent coverage when Illinois closed HBIA on June 30, 2025 and were directed to FQHCs as uninsured patients

Cost Estimate · Who bears it

Illinois FQHCs bear the uncompensated care cost; the state captured ~$330M in annual savings by eliminating HBIA for ages 42–64

Individual Health

A 55-year-old immigrant woman in Chicago who previously had full Medicaid coverage through HBIA now presents at her FQHC without insurance — her hypertension medications and follow-up labs become uncompensated care the health center must absorb.

Population Health

Illinois closed HBIA (aged 42–64) effective June 30, 2025 — a ~$330M state savings (HFS spent $487M on HBIA in FY24); the April 2025 provider notice explicitly redirected ~33,000 former enrollees to FQHCs and free clinics regardless of immigration status.

Timeframe: In effect since July 1, 2025; ongoing uncompensated care burden for Illinois FQHCsSource: Illinois HFS (Healthcare & Family Services)

In EffectBenefit CutColoradoConfirmed count

Colorado caps immigrant health coverage: Cover All Coloradans limited to 25,000 kids; OmniSalud cut to ~6,700

~31,700 (25,000 kids + ~6,700 adults)

Lives Impacted

—

Cost Estimate

Lives Impacted

Undocumented children capped at enrollment of 25,000 and undocumented adults in the OmniSalud lottery limited to ~6,700, down from an 11,000 cap

Cost Estimate · Who bears it

—

Individual Health

A farmworker family in the San Luis Valley whose two children had continuous coverage through Cover All Coloradans now faces a waiting list after the state capped enrollment at 25,000 due to the billion-dollar budget gap.

Population Health

Facing a ~$1 billion budget gap, HB26-1411 capped Cover All Coloradans at 25,000 children and cut OmniSalud subsidies for undocumented adults to ~6,700 (down from 11,000), allocated by lottery.

Timeframe: Coverage caps effective FY2026-27 (dental cap July 1, 2026; BH to fee-for-service January 1, 2027)Source: Colorado General Assembly

ProjectedCoverage LossMaineModeled projection

31,000+ Maine Residents Projected to Lose MaineCare Under H.R. 1 Work Requirements

31,000+

Lives Impacted

~$8M one-time

Cost Estimate

Lives Impacted

MaineCare expansion adults projected to lose coverage in year one due to documentation hurdles under the 80-hours-per-month work requirement beginning December 31, 2026

Cost Estimate · Who bears it

Maine state budget absorbing technology and staffing costs to administer the new work-requirement verification system

Individual Health

A lobsterman in Downeast Maine whose work is intensely seasonal — long stretches of unpaid winter idleness between fishing seasons — will struggle to document 80 qualifying hours every single month and could lose the MaineCare coverage that manages his hypertension.

Population Health

Maine DHHS projects 31,000+ disenrollments in year one from the 80-hours-per-month requirement (effective Dec. 31, 2026) affecting ~90,000 expansion adults; the state also projects ~$8M in one-time FY2027 tech/staffing costs (~$5.5M annually after).

Timeframe: Work requirement effective December 31, 2026; DHHS outreach and system build through 2026Source: Maine DHHS

ProjectedCoverage LossNew HampshireModeled projection

14,000–29,000 NH Residents Projected to Lose Medicaid Under One Big Beautiful Bill Act

14,000–29,000

Lives Impacted

—

Cost Estimate

Lives Impacted

New Hampshire Granite Advantage Medicaid expansion enrollees projected to lose coverage under the One Big Beautiful Bill Act

Cost Estimate · Who bears it

Patients losing Granite Advantage coverage and 10 NH FQHCs absorbing uncompensated care

Individual Health

A 42-year-old uninsured construction worker in Coos County who relies on Granite Advantage Medicaid for his only access to primary care and medication-assisted opioid treatment faces losing that coverage under combined federal and potential state work requirements — with no other affordable option in a rural region with very limited providers.

Population Health

A national analysis (April 2026) estimates 14,000-29,000 NH Granite Advantage enrollees could lose Medicaid under the One Big Beautiful Bill Act. NH has prior experience: a 2018 work-requirement attempt left 16,000 at risk of losing coverage before a court injunction. Losses would fall on 10 FQHCs already operating with margins thin enough to have forced site closures.

Timeframe: Federal work requirements effective January 2027; state-level requirements potentially earlierSource: NH Public Radio

In EffectAccess GapKansasConfirmed count

Kansas still has not expanded Medicaid — ~28,000 adults stuck in the coverage gap

~28,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Low-income Kansas adults who earn too little for ACA marketplace subsidies but do not qualify for KanCare (non-expansion Medicaid) — left entirely uninsured with FQHCs as their only safety-net option

Cost Estimate · Who bears it

Kansas FQHCs bear structural uncompensated care burden for ~28,000 coverage-gap adults; state forgoes ~$1B+/year in federal Medicaid match

Individual Health

A 38-year-old Kansas farm worker earning $18,000 a year falls into the coverage gap — too poor for marketplace subsidies and too 'rich' for KanCare — so every primary care visit and prescription is either out-of-pocket or absorbed as uncompensated care by the FQHC.

Population Health

Kansas is one of only 10 non-expansion states; an estimated 28,000 low-income adults remain in the coverage gap, with Gov. Kelly's seventh expansion attempt (the HAWK Act) again failing in 2026.

Timeframe: Ongoing as of 2026; HAWK Act failed again in 2026 legislative sessionSource: KFF / Kansas Reflector

ProjectedAccess GapAmerican SamoaEstimate

American Samoa's sole FQHC serves 26,000+ patients under a federally capped block grant threatened by H.R.1

26,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Low-income Pacific Islander residents of American Samoa with no alternative safety-net provider if the sole FQHC loses operating funds

Cost Estimate · Who bears it

—

Individual Health

A diabetic elder in Pago Pago relies on the territory's single FQHC for insulin management; any cut to the Medicaid block grant or HRSA grant that closes a clinic day means a trip to the emergency room.

Population Health

American Samoa operates Medicaid under a federal block-grant cap rather than standard FFP matching; expiry of pandemic-era enhanced allotments and potential H.R.1 reductions directly threaten the operating budget of the territory's only FQHC.

Timeframe: Ongoing risk as pandemic-era allotment enhancements expireSource: Kaiser Family Foundation

In EffectCoverage LossDistrict of ColumbiaModeled projection

DC Healthcare Alliance Phase-Out Strips Coverage from 23,000 Residents, Costs FQHCs $12.4M/yr

~23,000/mo

Lives Impacted

$12.4M/yr

Cost Estimate

Lives Impacted

uninsured and undocumented adults losing DC Healthcare Alliance coverage by FY 2028

Cost Estimate · Who bears it

DC FQHCs absorbing lost Alliance reimbursement as uncompensated care

Individual Health

A patient who relied on the Alliance for insulin and primary care visits now faces a sliding-fee bill or goes without, as the income cutoff dropped from 210% to 138% FPL and will phase out entirely for adults over 20 by FY 2028.

Population Health

~2,200 residents lost coverage immediately when eligibility dropped Oct 1, 2025; a further 6,000 did not recertify due to ICE activity; full phase-out by FY 2028 threatens $12.4M in annual FQHC revenue.

Timeframe: Phase-out began Oct 1, 2025; adults over 20 fully excluded by FY 2028Source: DC Fiscal Policy Institute

ProposedBenefit CutConnecticutConfirmed count

CT's state-funded immigrant coverage: 15,600 kids and 3,200 postpartum women (~$41M/yr) threatened by federal penalties

~18,800 (15,600 kids + 3,200 women)

Lives Impacted

~$41M/yr

Cost Estimate

Lives Impacted

Income-eligible undocumented children under 15 and postpartum women in Connecticut covered by state-only 'HUSKY for immigrants' at 100% state cost

Cost Estimate · Who bears it

Connecticut state general fund at 100% — federal bill threatens added financial penalties on top

Individual Health

A 7-year-old Guatemalan child in Bridgeport — covered through HUSKY for immigrants and cared for almost entirely at a local FQHC — could lose preventive and dental care if federal penalties force Connecticut to end the program.

Population Health

About 15,600 children and 3,200 postpartum women are covered at 100% state cost (~$30M children + ~$11M postpartum = ~$41M/yr); the federal budget bill threatens to financially penalize states for this coverage even though no federal dollars fund it.

Timeframe: Ongoing state program; federal penalty threat as of June 2025Source: CT Mirror

In EffectCoverage LossArkansasConfirmed count

2018 precedent: 18,000 Arkansans lost Medicaid in 7 months — 97% while compliant or exempt

~18,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Medicaid expansion enrollees subject to work-reporting rules — removed largely due to online portal failures and administrative errors, not non-compliance

Cost Estimate · Who bears it

—

Individual Health

A Delta farmworker who worked seasonal harvest hours couldn't navigate the state's online reporting portal and lost Medicaid coverage for three months before a community health worker helped him re-enroll.

Population Health

CBPP documents that roughly 18,000 people — 1 in 4 of those subject to the rule — lost coverage in just 7 months in 2018, with ~97% removed despite being compliant or exempt, after Arkansas became the first state to enforce Medicaid work requirements.

Timeframe: Historical (2018); cited as 2026 predictive baselineSource: Center on Budget and Policy Priorities

In EffectCoverage LossMinnesotaConfirmed count

Minnesota Ends MinnesotaCare for Undocumented Adults — 16,500 Lose Coverage December 31, 2025

~16,500

Lives Impacted

$56.9M/biennium saved by state

Cost Estimate

Lives Impacted

Undocumented adults age 18+ in Minnesota who lost MinnesotaCare eligibility on December 31, 2025; undocumented children remain eligible

Cost Estimate · Who bears it

Minnesota FQHCs absorbing uncompensated care from the newly uninsured adults; state saves $56.9M biennially

Individual Health

A 45-year-old Somali-born restaurant worker in Minneapolis who had been covered by MinnesotaCare lost her insurance on New Year's Day 2026 — and must now choose between paying out of pocket at a clinic or skipping the follow-up for the hypertension first diagnosed there.

Population Health

The June 2025 special-session repeal (HF1; House 68-65, Senate 37-30) ended MinnesotaCare for undocumented adults; an estimated 16,500 adults lost coverage. The rollback saves the state ~$56.9 million in the 2026-27 biennium but shifts uninsured volume onto FQHCs.

Timeframe: Coverage ended December 31, 2025; patients uninsured beginning January 1, 2026Source: Minnesota House of Representatives — Session Daily

In EffectCoverage LossRhode IslandConfirmed count

16,000 Rhode Islanders Drop ACA Plans After Subsidy Expiry; Uninsured Share at Health Centers Could Double

~16,000

Lives Impacted

~$60M gap/yr

Cost Estimate

Lives Impacted

Rhode Islanders who dropped HealthSource RI marketplace plans for 2026 after enhanced premium tax credits expired December 31, 2025, causing premiums to roughly double

Cost Estimate · Who bears it

Rhode Island state budget and uninsured patients absorbing higher out-of-pocket costs

Individual Health

A home-care aide in Providence who lost her ACA subsidy saw her monthly premium jump from $45 to over $200; she dropped coverage and now relies on the local FQHC as her only source of care for a hypertension diagnosis.

Population Health

Approximately 16,000 Rhode Islanders dropped HealthSource RI plans — a 20% net decline — after enhanced premium tax credits expired. RIHCA CEO projects FQHC uninsured patient share could rise from ~9% to 18-20% at all eight centers. The state faces an estimated $60M gap to offset lost federal subsidies.

Timeframe: Effective January 2026; ongoing through at least end of 2026Source: Ocean State Media

In EffectCoverage LossNebraskaEstimate

15,000+ Nebraskans at Risk of Losing Marketplace Coverage After ACA Premium Credit Expiry — 434% Premium Spike in Rural Districts

15,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Nebraskans who relied on enhanced ACA marketplace subsidies that expired December 2025

Cost Estimate · Who bears it

Uninsured patients and Nebraska FQHCs absorbing uncompensated care volume

Individual Health

A 60-year-old couple of meatpacking supervisors in Lexington, Nebraska earning $85,000 a year saw their monthly marketplace premium jump from $602 to $3,216 — a 434% increase — making continued coverage unaffordable and pushing them to seek primary care at a federally qualified health center on a sliding-scale basis.

Population Health

Nebraska Public Media reported 15,000+ Nebraskans at risk of losing marketplace coverage in 2026 after enhanced ACA premium tax credits expired. Rural Nebraska's 3rd Congressional District faced the steepest increases, with some couples seeing 434% premium spikes. Coverage loss is expected to increase FQHC uninsured patient volume at the same moment Medicaid revenue is falling.

Timeframe: Effective January 2026; credits expired December 31, 2025Source: Nebraska Public Media

In EffectAccess GapU.S. Virgin IslandsConfirmed count

USVI FQHCs serve 15,000+ patients under a block-grant Medicaid structure that caps federal contributions below mainland parity

15,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served by the two FQHCs across St. Thomas, St. Croix, and St. John

Cost Estimate · Who bears it

—

Individual Health

A St. Croix resident still rebuilding after the 2017 hurricanes who relies on the island's FQHC for primary care has no alternative safety-net provider; any reduction to the territory's Medicaid block grant ceiling would directly cut operating budgets with no state general-fund backstop.

Population Health

The U.S. Virgin Islands' two FQHCs serve over 15,000 patients across three islands under a Medicaid block-grant structure; any federal block-grant reduction has no state-fund backstop.

Timeframe: Ongoing; risk increases with any federal budget reconciliation reducing the block grant ceilingSource: Kaiser Family Foundation

ProjectedCoverage LossAlaskaModeled projection

9,400–13,600 Alaskans projected to lose Medicaid under H.R.1 work requirements

9,400–13,600

Lives Impacted

—

Cost Estimate

Lives Impacted

Medicaid expansion enrollees without automatic exemptions — many working Alaskans in remote and rural areas facing paperwork barriers

Cost Estimate · Who bears it

—

Individual Health

A Yup'ik subsistence worker on the Yukon delta who lacks reliable internet cannot upload the monthly verification form and loses coverage despite being exempt under the rural high-unemployment rule.

Population Health

A Manatt analysis projects 9,400–13,600 of the roughly 61,000 affected expansion enrollees will lose Medicaid, with 50–72% of the ~19,000 needing manual exemption removed due to paperwork failures.

Timeframe: Effective by December 31, 2026 under H.R.1Source: Anchorage Daily News

ProjectedCoverage LossNevadaModeled projection

H.R.1 Medicaid work rules projected to strip 13,000 FQHC patients and $17M/yr from Nevada's 8-center network

~13,000

Lives Impacted

$17M/yr

Cost Estimate

Lives Impacted

FQHC patients who would lose Medicaid coverage when 80-hour/month work requirements take effect January 1, 2027; Nevada Medicaid administrator separately estimates 70,000 total Nevadans lose Medicaid statewide

Cost Estimate · Who bears it

Nevada FQHCs (operating revenue loss) and patients who shift to uninsured sliding-scale care

Individual Health

A part-time casino housekeeper in Las Vegas who works irregular call shifts cannot reliably document 80 qualifying hours every month, putting her at risk of losing the Medicaid card that makes her FQHC visits free.

Population Health

NVPCA testimony (May 2026): H.R.1 work requirements would strip Nevada's 8 FQHCs of ~$17M/yr (11% of operating revenue) and eliminate ~107 full-time jobs; 13,000 FQHC patients lose Medicaid.

Timeframe: Effective January 1, 2027 under H.R.1 federal mandateSource: Nevada Current / This Is Reno

In EffectAccess GapPalauEstimate

Palau's sole FQHC serves 13,000+ under the 2023 Compact (through 2044), not Medicaid

13,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients at Palau's single FQHC — the only community health center for the nation

Cost Estimate · Who bears it

HRSA Section 330 appropriations + Compact of Free Association (renewed 2023, through 2044)

Individual Health

For a Palauan family the community health center is the only primary-care option, and its budget still hinges on annual HRSA appropriations even with the 2023 Compact.

Population Health

Palau operates outside U.S. Medicaid; the 2023 Compact renewal (through 2044) provides relative funding stability, but the FQHC still depends on annual HRSA Section 330 appropriations and U.S. Pacific policy.

Timeframe: Compact through 2044 (annual HRSA appropriations)Source: U.S. Department of Interior — Office of Insular Affairs

ProjectedCoverage LossWyomingModeled projection

H.R.1 Medicaid cuts projected to cost 12,000 Wyoming residents their coverage and shrink state economy by $140M over five years

12,000

Lives Impacted

$140M economic contraction over 5 years

Cost Estimate

Lives Impacted

Wyoming residents projected to lose health coverage under H.R.1 Medicaid cuts (2026-2030)

Cost Estimate · Who bears it

Wyoming economy and residents — 192 jobs/yr lost, $14.6M/yr less in disposable income

Individual Health

A low-income resident in Natrona County who loses Medicaid under H.R.1 cuts will join the roughly 9,000 to 19,000 Wyomingites already caught in the non-expansion coverage gap — the state's five FQHCs being their only primary care option, regardless of ability to pay.

Population Health

A REMI economic modeling study found H.R.1 Medicaid cuts will cause at least 12,000 Wyoming residents to lose coverage, shrink Wyoming's economy by $140M over 2026-2030, eliminate ~192 jobs/year, and reduce disposable personal income by $14.6M annually.

Timeframe: 2026-2030 (five-year modeling window)Source: WyoFile

In EffectClinic Closure / Funding CliffMicronesiaEstimate

Micronesia's 4 FQHCs serve 11,000+ patients on HRSA + Compact funding, not Medicaid

11,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients across Pohnpei, Chuuk, Yap and Kosrae served by FSM's four FQHCs — often the only source of care on remote islands

Cost Estimate · Who bears it

HRSA Section 330 appropriations + Compact of Free Association

Individual Health

On a remote Micronesian island the FQHC is frequently the only primary-care option; if HRSA funding lapses, that patient has nowhere else to go.

Population Health

FSM operates outside U.S. Medicaid, so its FQHCs depend entirely on HRSA Section 330 grants and Compact of Free Association health provisions — the risk is federal appropriations and Compact stability, not Medicaid work rules.

Timeframe: Ongoing (Compact/appropriations-dependent)Source: HRSA Health Center Program

ProjectedCost ShiftNebraskaModeled projection

H.R. 1 Projected to Cut Nebraska FQHCs $33 Million and 10,000 Patients

~10,000

Lives Impacted

$33M+ projected

Cost Estimate

Lives Impacted

patients projected to be dropped from Nebraska FQHC panels due to H.R.1 Medicaid cuts

Cost Estimate · Who bears it

Nebraska FQHCs (revenue loss) and rural patients losing access

Individual Health

A farmworker family in Lexington, Nebraska insured through Medicaid and cared for at a rural FQHC faces losing that coverage entirely as the clinic projects a $33 million statewide revenue cut — threatening staffing and hours at the only primary care provider in their county.

Population Health

HCAN estimated H.R.1 Medicaid reductions will cut 10,000 patients from Nebraska FQHC panels and eliminate more than $33 million in FQHC revenue. 88 of Nebraska's 93 counties are rural, with 30 classified as frontier; no alternative primary care providers exist in most affected areas. Bluestem Health has already operated at a loss for two consecutive years.

Timeframe: Phased under H.R.1; full impact backloaded after FY2030Source: UNMC Center for Health Policy / Nebraska Examiner

In EffectCoverage LossVermontConfirmed count

ACA enhanced tax credit expiry hits Vermont hardest: 9,272 fewer subsidized residents, $72M in lost federal funds

9,272

Lives Impacted

$72M in lost federal funds to Vermonters

Cost Estimate

Lives Impacted

Vermont residents who lost federal marketplace premium subsidies after enhanced ACA tax credits expired

Cost Estimate · Who bears it

Vermont marketplace enrollees losing subsidies; Vermont FQHCs absorbing uncompensated care

Individual Health

An unsubsidized Vermont farmer who faces over $10,000 in additional annual premium costs after losing their enhanced ACA credit is likely to go uninsured and turn to their local FQHC as a sliding-fee payer, compounding the health center's uncompensated care load.

Population Health

Vermont lost 9,272 subsidized residents and $72M in total federal funds after enhanced ACA premium tax credits expired; 6,216 Vermont Health Connect members now receive zero subsidy, up from ~1,600 the prior year.

Timeframe: Effective end of 2025; ongoing for 2026 plan yearSource: VTDigger

In EffectAccess GapGuamEstimate

Guam FQHC Block Grant Cap Constrains Care for ~8,600 Patients as Pandemic Allotments End

~8,600

Lives Impacted

—

Cost Estimate

Lives Impacted

patients served by Guam's single FQHC under a federal Medicaid block grant that caps funding unlike the open-ended match available to states

Cost Estimate · Who bears it

Guam FQHC and uninsured patients bearing costs above the block grant ceiling

Individual Health

A Filipino-American family on Guam relying on the territory's only FQHC for pediatric and preventive care faces service constraints when the block grant cap is reached, with no secondary safety-net clinic to absorb overflow.

Population Health

Guam's FQHC serves nearly 8,600 patients under a Medicaid block grant cap rather than open-ended federal matching; the end of pandemic-era enhanced allotments and potential reconciliation cuts further constrain the center's ability to expand services despite growing demand.

Timeframe: Ongoing structural constraint; pandemic allotments ended 2023-2025Source: Kaiser Family Foundation

In EffectCoverage LossWyomingModeled projection

Mountain Health CO-OP exit drops Wyoming marketplace to two insurers; 7,600+ lose coverage as premiums rise 25.9%

~7,600

Lives Impacted

—

Cost Estimate

Lives Impacted

Wyoming marketplace enrollees projected to drop out as premiums rise 25.9% — from 46,643 to an estimated 39,000

Cost Estimate · Who bears it

—

Individual Health

An uninsured Wyoming resident who dropped marketplace coverage when Mountain Health CO-OP exited and premiums jumped 25.9% will now rely on one of the state's five FQHCs as a self-pay sliding-fee patient — adding uncompensated volume to centers already seeing a 14.8% Medicaid revenue decline.

Population Health

Mountain Health CO-OP exit and 25.9% premium increases are projected to drop Wyoming marketplace enrollment ~16%, from 46,643 to ~39,000 — adding ~7,600 newly uninsured who will flow to Wyoming's five FQHCs as self-pay patients. CO-OP had insured 11,000+ residents.

Timeframe: Effective January 2026 plan yearSource: Cowboy State Daily / acasignups.net

In EffectAccess GapMarshall IslandsEstimate

Marshall Islands' sole FQHC serves 5,000+ amid the Pacific's highest diabetes rates

5,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients at RMI's single FQHC; Marshallese face among the highest type-2 diabetes and cancer rates in the Pacific (nuclear-testing legacy)

Cost Estimate · Who bears it

HRSA Section 330 appropriations + Compact of Free Association

Individual Health

A Marshallese patient with diabetes relies on the one community health center for insulin and monitoring; losing it leaves no local alternative.

Population Health

RMI operates outside U.S. Medicaid, relying on HRSA Section 330 grants and Compact health provisions; the exceptional chronic-disease burden makes that preventive care disproportionately critical and Compact/appropriations stability the key risk.

Timeframe: Ongoing (Compact/appropriations-dependent)Source: HRSA Health Center Program

ProjectedCoverage LossNorth DakotaModeled projection

3,000–5,000 ND Medicaid Expansion Enrollees Projected to Face Work Requirement Compliance Burden from Jan. 2027

3,000–5,000

Lives Impacted

—

Cost Estimate

Lives Impacted

North Dakota Medicaid expansion enrollees (ages 19-64) subject to H.R.1 80-hour-per-month work documentation, out of ~23,000 total expansion adults

Cost Estimate · Who bears it

Patients subject to compliance and FQHCs absorbing navigation burden

Individual Health

A 29-year-old seasonal oil field contractor in Williston who is enrolled in Medicaid expansion must begin documenting 80 hours of work monthly starting Jan. 2027 — even if exempt for part of the year, administrative complexity flagged by Georgetown CCF could cause paperwork-driven loss of coverage.

Population Health

ND HHS projects 3,000-5,000 (~5%) of ~23,000 expansion enrollees are subject to work requirements under H.R.1, effective Jan. 1, 2027. Georgetown CCF flagged North Dakota with six implementation red flags, raising risk of inappropriate coverage losses even among exempt patients.

Timeframe: Federal work requirements effective January 1, 2027; FQHC navigation burden starts mid-2026Source: North Dakota Monitor / Georgetown CCF

In EffectCost ShiftNorthern Mariana IslandsEstimate

CNMI Block-Grant Cap Limits Medicaid Matching for Sole FQHC

~3,800

Lives Impacted

—

Cost Estimate

Lives Impacted

patients served by the CNMI's single community health center

Cost Estimate · Who bears it

CNMI territory government and patients

Individual Health

A low-income patient in Saipan cannot access expanded services because the territory's block-grant cap, unlike open-ended federal matching, cannot automatically scale with enrollment need.

Population Health

The CNMI's single FQHC serves nearly 3,800 patients under a block-grant Medicaid structure that caps federal contributions regardless of enrollment growth.

Timeframe: Ongoing; worsened after end of pandemic-era enhanced territory allotmentsSource: Kaiser Family Foundation

ProjectedRate CutCaliforniaCentral CoastConfirmed count

Santa Cruz Community Health: ~$2.3M/yr lost to the UIS-PPS cut

2,000

Lives Impacted

$2.3M/yr

Cost Estimate

Lives Impacted

2,000 patients / ~12,000 visits at one FQHC — the first named-clinic figure on the July 1 cut

Cost Estimate · Who bears it

The FQHC's operating budget

Individual Health

A farmworker's medical home loses the reimbursement that keeps its doors open for everyone who relies on it.

Population Health

Puts a concrete per-clinic dollar figure on the statewide $1.6B+ UIS-PPS hit FQHCs absorb July 1.

Timeframe: Effective July 1, 2026Source: Santa Cruz Community Health / National Today

In EffectClinic Closure / Funding CliffNew HampshireConfirmed count

Ammonoosuc FQHC Closes Franconia Site, Displacing 1,400 Patients Due to Medicaid Reimbursement Pressure

~1,400

Lives Impacted

$500K shortfall

Cost Estimate

Lives Impacted

mostly elderly and chronically ill rural patients displaced from the Franconia FQHC site, now traveling at least 10 miles on mountain roads to reach the nearest health center

Cost Estimate · Who bears it

Ammonoosuc FQHC (site closure) and 1,400 displaced rural patients

Individual Health

An elderly patient with diabetes in Franconia, NH who relied on the local FQHC for medication management and regular lab draws must now arrange transportation along icy mountain routes in winter to reach care 10-plus miles away — a barrier that deters follow-up and worsens chronic disease control.

Population Health

Ammonoosuc Community Health Services closed its Franconia site November 2025 after projecting a $500,000 network-wide shortfall driven by Medicaid funding cuts. The closure displaced ~1,400 patients — the first documented NH FQHC site loss directly attributed to Medicaid reimbursement pressure — despite the organization receiving $2M+ annually in Section 330 federal grants out of a $12M total budget.

Timeframe: Site closed November 2025Source: AP / EMS1

ProjectedCoverage LossSouth DakotaConfirmed count

Federal Work Requirements Could Disenroll 1,213 Newly Insured South Dakotans Starting January 2027

~1,213

Lives Impacted

—

Cost Estimate

Lives Impacted

South Dakota Medicaid expansion enrollees (about 4% of the ~28,000 expansion population) estimated to be disenrolled when CMS 80-hours/month work requirements take effect

Cost Estimate · Who bears it

—

Individual Health

A Native American construction worker in Sioux Falls who first gained Medicaid coverage in 2023 may lose it in a month when a seasonal layoff drops his hours below 80 — returning him to the uninsured status he held before Amendment D passed.

Population Health

South Dakota's Department of Social Services estimates 1,213 people — about 4% of the state's expansion population — could be disenrolled when federal Medicaid work requirements (CMS-2454-IFC, 80 hours/month) take effect in January 2027. The state withdrew its own state-level work requirement waiver application after H.R. 1 was signed, deferring entirely to the federal mandate.

Timeframe: CMS work requirements effective January 2027Source: South Dakota Searchlight

In EffectWorkforce LossHawaiiConfirmed count

Hawai'i Physician Shortage Worsens to 833 FTE Gaps, Hitting Neighbor Islands and Primary Care Hardest

833 FTE gap

Lives Impacted

—

Cost Estimate

Lives Impacted

positions unfilled across Hawai'i's physician workforce in 2025, primarily in primary care and neighbor-island communities

Cost Estimate · Who bears it

neighbor-island and rural patients bearing access gaps; FQHCs and NPs absorbing displaced primary care demand

Individual Health

A patient on Moloka'i who needs a specialist referral may wait months or travel to O'ahu because the island has no resident physician — the shortage leaves the island's FQHC and its full-practice NPs as the de facto entire healthcare system.

Population Health

UH JABSOM reports Hawai'i was short 833 FTE physicians in 2025 (up from 768 in 2024), with primary care short 152 FTEs; 88+ physicians left and 81+ retired in 2025; 80% of physicians concentrated on O'ahu and under 4% NHPI (vs ~25% of population).

Timeframe: 2025 assessment; shortage worsening year-over-yearSource: Honolulu Civil Beat

In EffectClinic Closure / Funding CliffKansasConfirmed count

Kansas has the most at-risk rural hospitals in the U.S. — 68 at risk, 30 at immediate risk of closing

68 hospitals

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients of rural Kansas hospitals that are financially distressed, with ~87% operating in the red and 30 at immediate closure risk — once closed, these patients shift to FQHCs

Cost Estimate · Who bears it

Rural Kansas patients and FQHCs bear increased access burden and uncompensated care when rural hospitals close

Individual Health

A rural Kansas patient whose county hospital closes its emergency department must drive 60 or more miles for urgent care, and chronic-condition management and follow-up falls entirely to the FQHC — a demand spike the center may not have staff or exam rooms to absorb.

Population Health

A January 2026 Center for Healthcare Quality & Payment Reform analysis found Kansas has 68 rural hospitals at risk and 30 at immediate closure risk — the most of any U.S. state — with ~87% operating in the red, driven by inadequate reimbursement and looming H.R.1 Medicaid cuts (est. ~15% reduction in Kansas).

Timeframe: As of January 2026; risk increases if H.R.1 Medicaid cuts (~15% reduction) take full effectSource: KCUR / Center for Healthcare Quality & Payment Reform

In EffectClinic Closure / Funding CliffIowaConfirmed count

Iowa leads the U.S. in rural OB closures — only 54 hospitals still deliver babies

41 closed

Lives Impacted

—

Cost Estimate

Lives Impacted

Iowa community hospitals that have closed OB units since 2000, leaving rural pregnant patients with no local delivery option

Cost Estimate · Who bears it

Rural pregnant patients bear travel costs and risk; FQHCs absorb rising uncompensated prenatal care demand

Individual Health

A low-income pregnant patient in a rural Iowa county where the nearest OB unit closed must drive 45 or more minutes for prenatal monitoring and delivery — a risk that pushes more complex maternal cases onto FQHCs already stretched thin.

Population Health

As of December 1, 2025 only 54 of Iowa's facilities still operate OB units; 41 community hospitals have closed OB units since 2000, the largest rural labor-and-delivery access decline in the U.S.

Timeframe: Ongoing trend as of January 2026 legislative report; H.R.1 Medicaid cuts risk further closuresSource: Iowa Legislature (Legislative Services Agency)

ProjectedCost ShiftKentuckyModeled projection

H.R.1 will cut $12.3B from rural Kentucky Medicaid over 10 years — 35 rural hospitals at elevated closure risk

35 hospitals

Lives Impacted

$12.3B/decade

Cost Estimate

Lives Impacted

Patients of Kentucky's 35 rural hospitals at elevated closure risk from H.R.1 Medicaid cuts — in Appalachian counties where roughly half the population is enrolled in Medicaid

Cost Estimate · Who bears it

Rural Kentucky patients, FQHCs, and communities bear the access loss; $12.3B exits the rural Medicaid system over 10 years

Individual Health

A rural Appalachian Kentucky patient with opioid use disorder whose county hospital closes loses access to the MAT program and the specialist referral network — care gaps that fall entirely on the FQHC, which is already among the largest employers in the county.

Population Health

H.R.1 will cut an estimated $12.3 billion from rural Kentucky Medicaid over 10 years — the largest rural loss of any U.S. state per the Kentucky Center for Economic Policy — putting 35 rural hospitals at elevated closure risk.

Timeframe: Projected over 10 years from H.R.1 enactment (July 4, 2025); hospital closures accelerate as cuts phase inSource: Kentucky Center for Economic Policy

In EffectClinic Closure / Funding CliffGeorgiaEstimate

Up to 22 Rural Georgia Hospitals at Risk of Closure, 9 at Immediate Risk, Pushing Demand Onto FQHCs

22 hospitals

Lives Impacted

—

Cost Estimate

Lives Impacted

rural Georgians who will lose hospital services and shift to FQHCs as their primary care source

Cost Estimate · Who bears it

rural Georgians and FQHCs absorbing displaced hospital patients

Individual Health

A pregnant woman in Lavonia lost access to her local labor-and-delivery unit when Sacred Heart Hospital closed it in 2025, now required to travel nearly an hour to Athens for prenatal and delivery care — with no FQHC maternity services to fill the gap.

Population Health

Chartis Center for Rural Health flagged ~22 rural Georgia hospitals at risk of closure (9 at immediate risk); 9 rural hospitals have already closed since 2010; instability shifts primary, dental, and behavioral health demand onto Georgia's 30+ FQHCs.

Timeframe: Ongoing closures since 2010; accelerating under 2025-2026 Medicaid cutsSource: Georgia Recorder

ProjectedCost ShiftCaliforniaLos AngelesConfirmed count

LA County DHS: $700M federal revenue decline by 2029 + 3 health centers consolidated

3 centers

Lives Impacted

$700M by 2029

Cost Estimate

Lives Impacted

Patients of the Antelope Valley, Torrance, and East LA county health centers being consolidated

Cost Estimate · Who bears it

LA County Health Services (federal revenue decline)

Individual Health

A patient who used the East LA county center now travels farther and waits longer for the same visit.

Population Health

LA's public safety net contracts under a hiring freeze as federal revenue falls — displaced patients flow to nearby FQHCs.

Timeframe: FY26-27 → 2029Source: Los Angeles County

ProposedCost ShiftCaliforniaLos AngelesEstimate

LA's Measure ER — a ~$1B/yr safety-net tax — is a coin flip

LA safety net

Lives Impacted

$1B/yr

Cost Estimate

Lives Impacted

Los Angeles County safety-net patients who would benefit from the local backstop

Cost Estimate · Who bears it

Proposed local sales tax (revenue, if it passes)

Individual Health

Whether LA has any local cushion for the July 1 cuts comes down to ~11,500 votes.

Population Health

A half-cent sales tax would raise ~$1B/yr to backfill the safety net; too close to call, county certifies by July 2.

Timeframe: Certifies ~July 2, 2026Source: LAist / LA County Registrar-Recorder

ProjectedCost ShiftCaliforniaModeled projection

MCO-tax June 30 CMS cliff threatens the Medi-Cal rate floor (~$1.1B GF)

Medi-Cal rate floor

Lives Impacted

$1.1B GF

Cost Estimate

Lives Impacted

Medi-Cal primary-care, maternal-care, and behavioral-health rate floors FQHCs rely on

Cost Estimate · Who bears it

California General Fund (if CMS withholds the extension)

Individual Health

If the rate floor lapses, the supplemental payments that keep specialty and BH access viable shrink.

Population Health

CMS approved the current MCO tax only through June 30; the budget merely assumes a Dec-31 extension.

Timeframe: Transition expires June 30, 2026Source: California Legislative Analyst's Office

In EffectAccess GapCaliforniaConfirmed count

Only 16% of California's Medi-Cal kids got an eye exam

16% screened

Lives Impacted

$47 rate (frozen 25 yrs)

Cost Estimate

Lives Impacted

Children on Medi-Cal — only 16% received an eye exam (2022-24), down from 19%

Cost Estimate · Who bears it

Optometrists (frozen rate) → access denied to kids

Individual Health

A child's undiagnosed vision problem goes uncorrected, hurting reading and classroom learning.

Population Health

Pediatric eye-exam rates fell as the ~$47 Medi-Cal exam rate stayed frozen 25 years and the May Revision excluded optometry.

Timeframe: 2022–2024 dataSource: CalMatters / California Optometric Association

In EffectAccess GapCaliforniaConfirmed count

Fewer than 6,000 of ~15M Medi-Cal members used the CHW benefit

<6,000

Lives Impacted

<$1M reimbursed

Cost Estimate

Lives Impacted

Medi-Cal beneficiaries who actually accessed the Community Health Worker benefit since 2022

Cost Estimate · Who bears it

An underused funded benefit (foregone navigation capacity)

Individual Health

Patients miss the trusted-messenger navigation that keeps them enrolled and in care.

Population Health

A funded benefit reaching under 0.04% of those eligible — exactly when navigation demand is spiking. AB 403 would force public reporting from July 2027.

Timeframe: Since July 2022Source: California Legislature (AB 403) / Latino Coalition for a Healthy California

In EffectAccess GapCaliforniaLos AngelesConfirmed count

Koreatown patients are delaying or dropping care after losing coverage

Koreatown patients

Lives Impacted

—

Cost Estimate

Lives Impacted

Immigrant patients at a Los Angeles FQHC reporting they now skip or postpone needed care

Cost Estimate · Who bears it

Patients (delayed care) + FQHCs (sicker patients, later)

Individual Health

A patient who lost Medi-Cal puts off a needed visit until a manageable problem becomes an emergency.

Population Health

Coverage loss is translating into measurable care-avoidance in immigrant communities — the demand-side mirror of the enrollment freeze.

Timeframe: May 2026 (ongoing)Source: American Community Media

In EffectCost ShiftTexasConfirmed count

Texas loses $600M+ in federal public-health funds as OBBBA + pandemic streams expire

Public-health programs

Lives Impacted

$600M+

Cost Estimate

Lives Impacted

Texans served by immunization, HIV/STI prevention, and infectious-disease programs FQHCs refer to

Cost Estimate · Who bears it

Texas public-health system

Individual Health

Cuts to immunization and HIV/STI programs reach the same low-income patients FQHCs serve and refer.

Population Health

Immunization funds more than halved; ~$90M off HIV/STI prevention; Dallas County laid off 21 public-health staff and Bell County closed a clinic.

Timeframe: 2025–2026Source: Texas Medical Association

ProjectedClinic Closure / Funding CliffTexasConfirmed count

Community Health Center Fund extended only through Dec 2026 — Texas's 71 grantees on a short clock

71 grantees

Lives Impacted

$4.6B (through Dec 2026)

Cost Estimate

Lives Impacted

Patients of Texas's 71 Section 330 grantee health centers facing repeated short-term funding cliffs

Cost Estimate · Who bears it

Federal Section 330 grant base (Texas's 71 grantees)

Individual Health

Short-term cliffs force slower hiring and paused construction, so a patient waits longer for an appointment or a new site.

Population Health

The CHCF was set at $4.6B for FY2026 (largest increase in a decade) but extended only through December 2026 — the same Dec-2026 cliff window as California.

Timeframe: Expires Dec 2026Source: NACHC

In EffectCost ShiftAlaskaConfirmed count

Alaska receives $272M first-year Rural Health Transformation award for FQHC and Tribal clinics

—

Lives Impacted

$272M (yr 1)

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Federal CMS Rural Health Transformation Program; state distributes to eligible providers

Individual Health

A CHC in rural western Alaska can finally fund a telehealth expansion that lets a diabetic patient in a village 400 miles from Anchorage see a specialist without a medevac.

Population Health

Alaska received $272,174,856 in first-year CMS Rural Health Transformation funding; nearly 1,800 letters of interest were received from 864 organizations, with awards expected mid-July 2026.

Timeframe: First grant period; awards expected mid-July 2026Source: Alaska Department of Health

In EffectCoverage LossAlabamaModeled projection

Enhanced ACA premium tax credits expired — 91% of Alabama marketplace enrollees lose subsidies averaging $678/mo

—

Lives Impacted

~$1,016/yr per enrollee

Cost Estimate

Lives Impacted

91% of Alabama Marketplace enrollees who relied on enhanced premium tax credits averaging ~$678/month

Cost Estimate · Who bears it

Individual marketplace enrollees absorb the premium increase

Individual Health

A 52-year-old machine operator in Montgomery who lost her job earned $28,000 last year and saw her monthly premium jump by more than $800 when enhanced subsidies expired, pricing her out of coverage.

Population Health

The enhanced credits' expiry is projected to raise marketplace premiums by ~114% (~$1,016/year); Alabama is among the seven non-expansion states with the most projected job losses from the expiry.

Timeframe: Effective January 2026 (credits expired end of 2025)Source: Commonwealth Fund

ProjectedBenefit CutArizonaConfirmed count

Refugees and asylees lose full AHCCCS coverage in October 2026 under H.R.1 immigrant-eligibility cuts

—

Lives Impacted

—

Cost Estimate

Lives Impacted

Refugees, asylees, and humanitarian immigrants in Arizona who previously qualified for full AHCCCS and will be cut to emergency-only services

Cost Estimate · Who bears it

—

Individual Health

An Afghan refugee family resettled in Phoenix who relied on AHCCCS for prenatal care will lose all non-emergency coverage in October 2026, facing the choice of foregoing care or driving an uninsured medical bill.

Population Health

H.R.1 limits Medicaid to lawful permanent residents and certain immigrant categories effective October 2026; in a large border state, FQHCs will absorb the resulting uninsured demand while their Medicaid revenue erodes.

Timeframe: Effective October 2026Source: Arizona Health Care Cost Containment System (AHCCCS)

ProjectedCost ShiftArizonaEstimate

Arizona estimates $71.4M to build H.R.1 work-reporting and renewal systems — state general fund absorbs $18.8M

—

Lives Impacted

$71.4M (FY2027)

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Arizona state general fund ($18.78M) and federal administrative funds

Individual Health

A small rural FQHC near Nogales must now dedicate a full-time eligibility worker to guiding patients through AHCCCS's new twice-yearly renewal portal — cost the clinic has no new revenue to cover.

Population Health

AHCCCS estimates $71.4M in FY2027 to implement H.R.1 systems, including $18.78M from the state general fund and ~$18M in contracted IT; Arizona expects only ~$4M of the $200M national implementation fund.

Timeframe: FY2027 implementation costsSource: Arizona Capitol Times

ProjectedCost ShiftColoradoEstimate

Colorado Medicaid work requirements cost $45.8M to implement in FY2026-27; enforcement starts January 2027

—

Lives Impacted

$45.8M (FY2026-27)

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Colorado state budget (implementation administrative costs)

Individual Health

A CHC in rural Pueblo must absorb the cost of adding eligibility navigation staff to help patients complete twice-yearly renewals and 80-hour monthly work verification — unfunded administrative overhead.

Population Health

Health First Colorado will require 80-hour/month work verification for adults 19-64; the state estimates $5.4M in FY2025-26 and $45.8M in FY2026-27 to build the systems, with impacted members receiving letters in August 2026.

Timeframe: $5.4M in FY2025-26; $45.8M in FY2026-27; enforcement January 2027Source: Colorado Department of Health Care Policy & Financing (HCPF)

ProposedCost ShiftDistrict of ColumbiaModeled projection

H.R. 1 Would Cut DC Medicaid Match from 70% to 50%, Costing Up to $1.1B/yr

—

Lives Impacted

up to $1.1B/yr

Cost Estimate

Lives Impacted

all DC Medicaid enrollees and FQHC patients affected by potential program contraction

Cost Estimate · Who bears it

DC government and Medicaid enrollees if federal match is cut

Individual Health

Without the 70% federal match, a DC resident enrolled in Medicaid for chronic care management could face coverage gaps if the District is forced to cut enrollment or services to absorb a $1.1B annual funding hole.

Population Health

Urban Institute found DC would need to increase its own Medicaid spending by 63.2% to maintain current program levels if the FMAP drops from 70% to 50% — a $800M to $1.1B annual federal reduction.

Timeframe: Proposed under H.R. 1; outcome subject to final legislationSource: Medical Society of DC / Urban Institute

In EffectCoverage LossDelawareConfirmed count

Enhanced ACA Credits Expire, Causing 16% Drop in Delaware Marketplace Enrollment

—

Lives Impacted

—

Cost Estimate

Lives Impacted

Delaware marketplace enrollees who lost coverage or face premium increases after enhanced ACA credits expired end of 2025

Cost Estimate · Who bears it

newly uninsured patients and FQHCs absorbing uncompensated care

Individual Health

A single parent in Kent County who bought marketplace coverage with enhanced subsidies now faces premiums rising sharply without the credits, pushing them toward the FQHC sliding-fee scale as their only affordable option.

Population Health

Delaware saw a 16% year-over-year decline in marketplace plan selections after enhanced ACA premium tax credits expired, one of the largest drops nationally, directly increasing uninsured patient volume at rural FQHCs.

Timeframe: Credits expired end of 2025; 16% enrollment drop observed in 2026 open enrollmentSource: State of Delaware / KFF

In EffectCoverage LossGeorgiaModeled projection

ACA Enhanced Credits Expire — Georgia Marketplace Premiums More Than Double for Low-Income Enrollees

—

Lives Impacted

—

Cost Estimate

Lives Impacted

Georgia ACA marketplace enrollees facing premium increases of ~114% on average after enhanced credits expired Jan 1, 2026

Cost Estimate · Who bears it

low-income Georgia enrollees losing affordability; FQHCs absorbing newly uninsured patients

Individual Health

A part-time retail worker in Savannah who paid roughly $74/month with enhanced subsidies will now owe nearly $160/month for the same plan — a $1,032/year increase that makes dropping coverage the most likely outcome.

Population Health

KFF estimates subsidized enrollees' out-of-pocket premiums more than double on average in Georgia (~114% jump, ~$888 to ~$1,904/year); national effectuated enrollment projected to fall from 22.3M toward ~17.5M as credits fully expire.

Timeframe: Enhanced credits expired Jan 1, 2026; premium increases in effect for plan year 2026Source: KFF

In EffectCost ShiftIowaConfirmed count

Iowa wins first-in-nation Rural Health Transformation award — $209M for FY2026

—

Lives Impacted

$209M/yr-1

Cost Estimate

Lives Impacted

Rural Iowa residents and FQHC patients who benefit from co-located CHW services and telehealth expansion

Cost Estimate · Who bears it

Federal government via H.R.1's Rural Health Transformation Program; Iowa HHS administers

Individual Health

A rural Iowa patient who previously had no behavioral health provider within 60 miles may gain access to a co-located licensed counselor at their FQHC site as a result of 'Healthy Hometowns' infrastructure investments.

Population Health

Iowa awarded $209M for FY2026 (first-in-nation; up to ~$1B over five years) under H.R.1's Rural Health Transformation Program for CHW co-location, telehealth, and workforce investments.

Timeframe: FY2026 (announced Jan. 30, 2026); up to ~$1B over five yearsSource: Iowa Health & Human Services

In EffectAccess GapIllinoisConfirmed count

Illinois launches $50M FQHC capital grant program — up to $3M per center

—

Lives Impacted

$50M total

Cost Estimate

Lives Impacted

Patients in underserved and rural Illinois communities whose FQHCs can expand or renovate facilities with state capital grants

Cost Estimate · Who bears it

Illinois state budget; up to $3M per FQHC or look-alike applicant

Individual Health

A patient at a small downstate FQHC whose clinic has operated from a deteriorating building for years may finally get a renovated exam room and updated equipment as the center uses a state capital grant to replace infrastructure it could not otherwise fund.

Population Health

In January 2026 Illinois opened a $50M program — up to $3M per provider — for FQHCs and look-alikes to fund construction and renovation, prioritizing underserved and rural areas amid federal reimbursement cuts.

Timeframe: Opened January 2026; one-time capital allocationSource: WSIU Public Radio (Illinois)

In EffectCost ShiftKansasConfirmed count

Kansas 2026 ACA benchmark premiums jump 28.9% as enhanced tax credits expire

—

Lives Impacted

$533/mo increase

Cost Estimate

Lives Impacted

Kansas marketplace enrollees — the only subsidized coverage option in a non-expansion state — facing a 28.9% premium spike and fewer insurer choices after enhanced tax credits expired January 1, 2026

Cost Estimate · Who bears it

Kansas marketplace enrollees bear the premium increase; Kansas FQHCs absorb uncompensated care from coverage dropouts

Individual Health

A Kansas family of four whose silver-plan monthly premium jumped from $1,848 to $2,381 may drop marketplace coverage entirely, becoming uninsured and defaulting to the FQHC for all primary and preventive care.

Population Health

The benchmark silver-plan premium for a Kansas family of four rose from $1,848 to $2,381/month for 2026 — a 28.9% increase, the largest since 2019 — after enhanced ACA premium tax credits expired Jan. 1, 2026; insurer participation fell from 81 to 64 plans, leaving 14 southwestern counties with one insurer.

Timeframe: Effective January 1, 2026 (2026 plan year)Source: Kansas Health Institute

ProposedCost ShiftMassachusettsConfirmed count

340B Rebate Pilot Creates ~$1M/Month Cash Drain at Single Massachusetts Health Center

—

Lives Impacted

~$1M/month

Cost Estimate

Lives Impacted

Patients at Massachusetts community health centers serving ~1 million people statewide (43% on Medicaid, 15% uninsured)

Cost Estimate · Who bears it

Individual health center (Greater Lawrence Family Health Center) absorbing the upfront drug-payment cash-flow burden

Individual Health

A pharmacist at Greater Lawrence Family Health Center who must divert roughly $1 million a month to prepay for 10 common drugs before receiving manufacturer rebates — cash that would otherwise fund clinical staffing for the patients waiting in the lobby.

Population Health

The 340B rebate-model pilot (January 2026) requires Massachusetts health centers to pay upfront for 10 common drugs before receiving rebates; Greater Lawrence Family Health Center estimated a ~$1 million monthly cash drain. A federal court later paused the pilot.

Timeframe: Began January 2026; paused by federal court pending litigationSource: GBH News

ProjectedCost ShiftMarylandModeled projection

Maryland Health Secretary Warns Future Federal Medicaid Cuts Could Cost State Up to $2.7 Billion

—

Lives Impacted

up to $2.7B

Cost Estimate

Lives Impacted

Maryland's ~375,000 FQHC patients and broader Medicaid population of ~2.1 million residents statewide

Cost Estimate · Who bears it

Maryland state budget and downstream FQHC provider rates, if federal Medicaid funding is further reduced

Individual Health

A clinic administrator at a Montgomery County FQHC who must draft a contingency budget knowing that up to $2.7 billion in federal Medicaid funding could be stripped from the state — squeezing the provider rates her center depends on for roughly half its revenue.

Population Health

Maryland officials warned during the 2026 legislative session that future federal Medicaid cuts (beyond H.R. 1) could cost the state up to $2.7 billion; a $1.4 billion FY2026 state deficit, partly driven by $778 million in over-forecast Medicaid spending, compounds the pressure.

Timeframe: Risk builds through 2027 and beyond; state deficit pressure immediate in FY2026Source: Maryland Matters

ProjectedClinic Closure / Funding CliffMaineModeled projection

14 of 24 Maine Rural Hospitals at Closure Risk; H.R. 1 Cuts to Cost Hospitals ~$700M

—

Lives Impacted

~$700M

Cost Estimate

Lives Impacted

Patients served by Maine's 24 rural hospitals, of which 14 are at closure risk, redirecting complex and uninsured cases to already-stretched FQHCs

Cost Estimate · Who bears it

Maine rural hospitals absorbing projected Medicaid revenue loss from H.R. 1 cuts

Individual Health

A diabetic patient in rural Aroostook County who relies on a rural Critical Access Hospital for specialist referrals will have nowhere to turn if the hospital closes — and will show up at the nearest FQHC for care the center was never funded to deliver.

Population Health

~40% of Maine hospitals are losing money; H.R. 1 Medicaid cuts projected to cost Maine hospitals ~$700M in revenue and $66M/year; Northern Light Health alone faces a $27.3M two-year hit. The Center for Healthcare Quality and Payment Reform projects 14 of 24 rural hospitals at closure risk.

Timeframe: Cuts mostly begin 2027; hospital financial strain already acute in early 2026Source: Portland Press Herald

ProposedCost ShiftMissouriEstimate

Missouri Confronts ~$294M Administrative Price Tag to Implement Federal Medicaid Work Requirements

—

Lives Impacted

~$294M one-time

Cost Estimate

Lives Impacted

Missouri MO HealthNet enrollees subject to work/community-engagement verification beginning December 2026

Cost Estimate · Who bears it

Missouri state taxpayers funding the eligibility-verification infrastructure required by federal H.R. 1 work requirements

Individual Health

A Medicaid eligibility worker at a Springfield FQHC who already handles enrollment assistance will absorb a surge of patients needing help with the new monthly work-log — at the same moment the state is spending $294 million just to build the verification machinery to process those logs.

Population Health

Missouri lawmakers confront a ~$294 million administrative cost just to build the eligibility-verification machinery for H.R. 1 work requirements, even before any constitutional amendment. The FY2026 supplemental budget already includes technology update funding.

Timeframe: Administrative system must be built by December 2026; work requirements effective December 2026Source: Missouri Independent

In EffectClinic Closure / Funding CliffMississippiConfirmed count

42% of Mississippi Rural Hospitals Vulnerable to Closure, 11+ Communities Already Lost Inpatient Care

—

Lives Impacted

—

Cost Estimate

Lives Impacted

rural Mississippians in communities that have lost or may lose inpatient hospital access

Cost Estimate · Who bears it

Rural Mississippians and state FQHCs as last-resort providers

Individual Health

A pregnant woman in a rural Mississippi county where the hospital has closed its labor-and-delivery unit must now drive an hour or more for prenatal care and delivery in a state with the nation's highest infant mortality rate.

Population Health

About 42% of Mississippi's rural hospitals are vulnerable to closure (down from 49% prior year); 11+ communities have lost inpatient care since 2010 and 68% of rural hospitals no longer offer labor and delivery. FQHCs are absorbing the resulting access gap.

Timeframe: Ongoing trend since 2010; 2026 Chartis analysisSource: Chartis

ProjectedCost ShiftMontanaModeled projection

Montana's $233M Rural Health Windfall Is Temporary — Federal CHCF Cliff Still Looms in Dec. 2026

—

Lives Impacted

$233M one-time (RHTP)

Cost Estimate

Lives Impacted

patients of Montana's 13 FQHCs and look-alike operating 90+ mostly-rural sites

Cost Estimate · Who bears it

Federal government (RHTP grant); CHCF cliff falls on FQHCs if not reauthorized

Individual Health

A frontier FQHC in a rural Montana county can use the RHTP windfall for short-term capital improvements, but if Congress does not reauthorize the CHCF the same health center faces losing ~70% of its Section 330 base grant in December 2026 — a structural funding cut the one-time rural award does not offset.

Population Health

Montana receives ~$233M from H.R.1's Rural Health Transformation Program, but the federal Community Health Center Fund — ~70% of Section 330 grant dollars — expires December 2026. NACHC warns that without reauthorization, 2,800 national site closures and 51,000 provider layoffs are possible.

Timeframe: RHTP funds arriving 2026; CHCF cliff December 2026Source: Montana Free Press

In EffectAccess GapNorth DakotaConfirmed count

North Dakota Receives $198.9M Federal Rural Health Transformation Grant — Largest Rural Health Investment in State History

—

Lives Impacted

$198.9M (FY2026)

Cost Estimate

Lives Impacted

North Dakota and South Dakota residents: health centers serve 1 in 11 residents across 50 communities in both states combined

Cost Estimate · Who bears it

Federal government (RHTP grant)

Individual Health

A frontier FQHC patient in a remote North Dakota county could benefit from telehealth hub deployment and workforce pipeline investments funded through the RHTP — improving access to specialty care that currently requires hundreds of miles of travel.

Population Health

CMS awarded North Dakota $198.9M for FY2026 through H.R.1's Rural Health Transformation Program, the largest rural health investment in the state's history. A special legislative session was called Jan. 21, 2026 to appropriate the funds. CHAD notes health centers serve 1 in 11 residents across 50 communities in both Dakotas.

Timeframe: FY2026 award; subaward grant opportunities expected Q1 2026Source: ND Office of the Governor / North Dakota Monitor

In EffectCoverage LossNebraskaModeled projection

Nebraska First State to Enforce Medicaid Work Requirements — 10-15% of FQHC Medicaid Patients at Risk

~840–1,260 at one FQHC

Lives Impacted

$400K–$600K/yr at one FQHC

Cost Estimate

Lives Impacted

Heritage Health Adult Medicaid expansion enrollees ages 19-64 subject to 80-hour-per-month work documentation — state enforcing 7 months ahead of the federal Jan. 2027 deadline

Cost Estimate · Who bears it

Nebraska FQHCs (lost Medicaid revenue) and patients losing coverage

Individual Health

A Somali-American meatpacking worker in Grand Island enrolled in Medicaid expansion who changes jobs or works irregular hours must now file monthly work documentation or lose health coverage starting July 31, 2026 — even though no new DHHS staff were hired to assist with verification.

Population Health

Effective May 1, 2026, Nebraska enforces 80-hour/month work requirements for Heritage Health Adult enrollees. Bluestem Health CEO projected 10-15% of its 8,400 Medicaid patients could lose coverage, costing the Lincoln FQHC $400,000-$600,000 annually. First coverage checks begin for renewals on or after July 31, 2026.

Timeframe: Effective May 1, 2026; first coverage terminations July 31, 2026Source: Nebraska Public Media

ProjectedCost ShiftPennsylvaniaModeled projection

H.R. 1 Could Strip ~$20B in Federal Medicaid Funding from Pennsylvania Over a Decade

—

Lives Impacted

~$20B over 10 yrs

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Pennsylvania state budget and Medicaid-dependent FQHCs, hospitals, and providers

Individual Health

A Medicaid patient in Harrisburg whose managed-care plan is cut may lose access to the specialist referral her FQHC arranged, leaving her to manage a chronic condition without the follow-up care her physician ordered.

Population Health

State officials estimate Pennsylvania could lose roughly $20 billion in federal Medicaid funding over the next decade beginning in 2028, threatening reimbursement for the 44% of FQHC patients on Medicaid/CHIP.

Timeframe: Federal match reductions begin 2028; work requirements effective January 2027Source: KFF

ProjectedClinic Closure / Funding CliffTennesseeModeled projection

61% of Tennessee Rural Hospitals Now Vulnerable to Closure — 27 at Risk, 14 at Immediate Risk Within 2-3 Years

—

Lives Impacted

—

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

—

Individual Health

A pregnant woman in rural Haywood County whose county hospital lost its labor and delivery unit may drive 40 miles to deliver at a regional center; if that hospital closes, her only prenatal care option becomes the local FQHC.

Population Health

Chartis's 2026 Rural Health State of the State found 61% of Tennessee rural hospitals vulnerable to closure (up from 44% in 2025), with 27 at risk and 14 at immediate risk of closing within 2-3 years. Tennessee has lost inpatient care at 18 hospitals since 2010, second only to Texas. The collapse of rural inpatient capacity drives uninsured demand onto the state's ~100 rural FQHCs and 326 rural health clinics.

Timeframe: 2026 data; closures projected within 2-3 years for 14 facilities at immediate riskSource: Chartis

ProjectedCost ShiftVirginiaModeled projection

Virginia's Medicaid forecast requires an extra $2.8B in general funds over the 2026-2028 biennium

—

Lives Impacted

$2.8B over FY2026-2028 biennium

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Virginia general-fund taxpayers / state Medicaid budget

Individual Health

A state Medicaid director managing tightening general-fund headroom must weigh managed-care rate increases for FQHCs against $591 million in savings strategies — meaning community health centers face harder rate negotiations even as work requirements and six-month redeterminations drive more coverage losses.

Population Health

Virginia's Medicaid forecast requires an additional $410.3M GF in FY2026 and roughly $2.8B GF over the FY2026-2028 biennium, compressing state headroom for FQHC rate support just as work requirements begin.

Timeframe: FY2026-FY2028 biennium; work requirements begin January 2027Source: Virginia House Appropriations Committee

In EffectClinic Closure / Funding CliffVermontConfirmed count

Vermont's 11 FQHCs post $8.5M combined operating deficit on a $65/visit Medicaid reimbursement gap; two sites closed

—

Lives Impacted

$8.5M combined operating deficit

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Vermont community health centers absorbing structural Medicaid underpayment

Individual Health

A patient at Little Rivers Health Center — which has operated with zero to five days of cash on hand since 2022 — faces the prospect of their health center closing if the structural $65-per-visit Medicaid shortfall is not addressed, leaving them with no other primary care provider in their rural county.

Population Health

Vermont's 11 FQHCs posted a combined $8.5M operating deficit on roughly $264M in combined budgets; North Star Health closed its Rockingham site after a $1.5M FY2023 loss, and Lamoille Health Partners closed its Stowe practice in February 2025.

Timeframe: As of early 2025; ongoing structural shortfallSource: VTDigger

ProjectedCoverage LossWisconsinConfirmed count

H.R.1 work requirements hit Wisconsin's BadgerCare childless-adult waiver population — unique among non-expansion states — starting January 2027

—

Lives Impacted

—

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

—

Individual Health

A Milwaukee resident enrolled in BadgerCare Plus who works part-time cleaning offices could lose coverage if they cannot consistently document 80 qualifying hours each month — despite having had stable public coverage under a waiver that predates ACA expansion by decades.

Population Health

Wisconsin is one of only two partial-expansion-waiver states (with Georgia) whose BadgerCare childless-adult waiver enrollees are subject to H.R.1 work requirements beginning January 2027 — an unusually direct hit on FQHC patients who otherwise had stable coverage.

Timeframe: January 1, 2027; six-month eligibility rechecksSource: KFF (Medicaid Work Requirements Tracker)

ProjectedClinic Closure / Funding CliffWest VirginiaModeled projection

H.R.1 to strip $1B+ a year from WV hospitals; 13 rural hospitals at risk of closure — shifting demand to FQHCs

—

Lives Impacted

$1B+/yr

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

West Virginia hospitals losing Medicaid matching funds and provider-tax revenue under H.R.1

Individual Health

A stroke patient in a rural West Virginia county where the only hospital is among the 13 at risk of closure under H.R.1 cuts would have to travel two or more hours for emergency care — and their community health center, already the last primary care provider in the county, would absorb all acute follow-up.

Population Health

WV hospitals will lose $1B+ per year when H.R.1 is fully in effect; 13 rural hospitals are at risk of closure (5 at immediate risk within 2-3 years), with every closure shifting acute and chronic-care demand onto remaining FQHCs — often the only providers left in a county.

Timeframe: Provider-tax caps begin 2028; full effect by 2032 ($533.6M cumulative hospital cuts)Source: West Virginia Watch

ProjectedCost ShiftWest VirginiaConfirmed count

WV Medicaid commissioner warns H.R.1 will cut enrollment, raise admin costs, and strip $533.6M cumulatively from hospital funds by 2032

—

Lives Impacted

$533.6M cumulative by 2032

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

West Virginia hospitals and their patients, with knock-on pressure on FQHCs

Individual Health

A West Virginia FQHC CFO planning next year's budget must account for both lower insured-patient volume as Medicaid enrollment falls and weaker hospital referral capacity as provider-tax cuts cascade — a compounding fiscal stress with no state backstop large enough to offset the federal losses.

Population Health

WV Medicaid commissioner testified that provider-tax restrictions will cut federally matched hospital funds by $35.6M starting 2028, rising to $178M/yr by 2032 ($533.6M cumulative); WV's 3.43% payment error rate (above the 3% penalty threshold) could trigger additional federal reductions.

Timeframe: $35.6M/yr starting 2028; $178M/yr by 2032Source: Charleston Gazette-Mail

Why We Built This

The layoff tracker counts displaced workers. This tracker counts patients. Behind every 2026 funding cliff are real people losing coverage, delaying care, and paying more — and health centers absorbing the cost. Every entry links to its primary source so you can verify it.

Related Intelligence

Layoff Tracker

3,477+ community health workers displaced

Funding Impact

H.R. 1 policy timeline + revenue strategies

Texas Intelligence

Texas on its own terms — non-expansion, ACA credits

This strategic report is analysis compiled from public sources (HRSA UDS, CMS, WARN Act filings, news coverage, public Glassdoor reviews). Claims about workforce stability, financial positioning, or operational resilience are informational only and may not reflect current operations. For authoritative information, contact the organization directly.

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National FQHC policy with a California lens — funding cliffs, 340B, workforce, AI — plus the weekly jobs snapshot. Primary sources only.

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