After reviewing the Maryland Department of Health’s “Impact of Potential Medicaid Proposals to Maryland Medicaid” (May 2025), Maryland Department of Human Services’ “Impact of Proposed Federal Fiscal Year 2026 Budget Cuts on Marylanders” (June 6, 2025), and Congressional Budget Office projections, the scope of H.R. 1’s – “One Big Beautiful Bill” – impact on Maryland’s healthcare system represents the most significant federal policy shift affecting state health programs in decades.
State agencies project that:
- Over 420,000 Marylanders could lose health coverage, resulting in $2 billion in annual shifted costs across Medicaid, food assistance, and private insurance programs in Maryland.
One Big Beautiful Bill Numbers: Maryland State Agency Projections and Federal Estimates
Maryland state agencies have completed impact analyses based on H.R. 1‘s enacted provisions, though officials acknowledge these are projections that depend on implementation details still being developed by federal agencies:
Maryland Medicaid Coverage Changes Are Coming
- Work Requirements: Maryland Department of Health projects 56,000 adults could lose coverage, resulting in $316.7 million annually in reduced federal funding. (Source: “Impact of Potential Medicaid Proposals,” Table 1, May 2025.)
- Semi-Annual Redeterminations: The state projects 130,111 adults could lose coverage, with $864 million annually in reduced federal funding and $22.6 million in additional state administrative costs
Maryland Food Assistance Changes
Maryland Department of Human Services analysis shows 684,000 Marylanders rely on SNAP benefits.
H.R. 1’s restructuring requires Maryland to pay $572.5 million annually in costs previously covered by federal funding.
(Source: “Impact of Proposed Federal Fiscal Year 2026 Budget Cuts,” June 6, 2025.)
Changes Coming to Maryland’s Private Insurance Market
The Maryland Insurance Administration reports that carriers are requesting an average rate increase of 17.1% for 2026, while the Maryland Health Benefit Exchange projects that “over 70,000 people could lose private coverage with a $160 million reduction in federal assistance due to the expiration of enhanced tax credits.”
(Source: “Health Carriers Propose Affordable Care Act Premium Rates for 2026,” June 3, 2025.)
Note: These figures represent projections from state agencies based on current legislative text. Actual impacts may vary depending on federal implementation guidance and state policy responses.
Supporters’ Perspective: Fiscal Responsibility and Work Incentives
Supporters of H.R. 1 argue the changes promote fiscal responsibility and encourage workforce participation.
Congressional Republicans who support the legislation argue that work requirements will help individuals achieve economic independence while reducing federal spending that contributes to deficit growth.
The Congressional Budget Office’s dynamic economic analysis projects that H.R. 1 will increase the labor supply by 0.6% over the 2025-2034 period, boosting economic growth.
However, the agency notes that coverage losses and reduced public investment partially offset this growth.
Understanding the One Big Beautiful Bill’s Structure and Verification
My independent verification of H.R. 1, conducted through congressional records and CBO analyses, confirms the legislation’s core framework:
- Approximately $4.5 trillion in tax cuts over a decade, financed primarily by $1.2 trillion in reductions to Medicaid and food assistance programs.
- The Congressional Budget Office projects the legislation will add $3.4 trillion to the federal deficit, even with these program reductions.
Key provisions verified through official congressional sources:
- Section 44141 establishes 80-hour monthly work requirements for adults enrolled in Medicaid expansion.
- Implementation deadline of December 31, 2026.
- Semi-annual eligibility redeterminations replacing annual reviews.
- CBO projection of 11.8 million more Americans without health coverage by 2034.
The $50 billion rural hospital funding over five years was confirmed through both House Rules Committee documents and final legislative text, representing a significant amendment during Senate negotiations.
The Broader Impact: Food Assistance and Private Insurance Changes
Maryland state agencies report H.R. 1’s effects extend beyond Medicaid to food assistance and private insurance markets:
SNAP (Food Assistance) Restructuring
Over 684,000 Marylanders rely on SNAP benefits, receiving an average of $180 per month.
H.R. 1 restructures SNAP funding, requiring Maryland to pay 25% of all benefits and 75% of administrative costs, compared to the current structure where the federal government pays 100% of benefits and 50% of administrative expenses.
This creates an annual burden of $572.5 million on Maryland taxpayers to maintain current SNAP service levels.
Private Insurance Market Changes
The expiration of enhanced federal tax credits for health coverage has a significant impact on Maryland’s individual insurance market.
The Maryland Insurance Administration reports insurance carriers are requesting an average 17.1% rate increase for 2026, the highest since Maryland’s reinsurance program began in 2019.
Without enhanced tax credits, over 70,000 Marylanders could lose their private insurance coverage, resulting in a loss of approximately $160 million in federal assistance for purchasing health coverage in Maryland.
For the 240,000 Marylanders who buy insurance through Maryland Health Connection, including an estimated 25% who are small business owners, the changes create new enrollment barriers and reduce federal assistance.
Maryland Health Benefit Exchange estimates these changes could cost the state $28 million to implement the new federal requirements, plus $6 million in ongoing annual costs.
Maryland’s Defensive Preparations
Maryland’s 2025 budget already includes a “trigger provision” that requires the governor to engage the Maryland General Assembly on solutions if federal funding decreases by more than $1 billion in a fiscal year.
That threshold will almost certainly be met.
The state has also increased hospital assessments to help cover Medicaid costs and established new funds for healthcare delivery innovations.
However, these state-led efforts pale compared to the scale of federal funding withdrawal mandated by H.R. 1.
Maryland Hospital System Financial Impact Analysis
For Maryland’s hospital systems, including Johns Hopkins, University of Maryland Medical System, MedStar, and others, state projections suggest significant operational changes are ahead.
- According to a Kaiser Family Foundation analysis, roughly 160,000 Marylanders could lose health coverage under the One Big Beautiful Bill Act.
- Separately, the Maryland Department of Human Services projects that over 684,000 Marylanders who rely on SNAP benefits would face service disruptions, with the state shouldering an additional $572.5 million in costs.
- The legislation includes significant support for rural hospitals, with $50 billion allocated nationally over five years, or $10 billion annually, according to the Kaiser Family Foundation.
- This provision, confirmed through congressional documents, was a crucial Senate amendment that helped secure the bill’s narrow passage by a margin of 51-50.
For Maryland’s rural facilities in Western Maryland and the Eastern Shore, this could provide operational support.
However, policy analysts note that rural hospital funding represents roughly 4-5% of the total projected Medicaid reductions nationwide.
Urban and suburban Maryland hospitals may experience a significant shift in their financial position as the uninsured population continues to grow.
However, the exact impact will depend on the actual number of people who lose coverage versus state projections.
Timeline for Implementation
- December 31, 2026: Work requirements take effect. Maryland must have tracking systems operational.
- 2027: Semi-annual redeterminations begin. Expect significant administrative chaos and disruptions to coverage.
- 2028-2030: Full implementation of enhanced verification systems and cross-state enrollment checking.
Healthcare administrators should begin modeling scenarios now.
Impact on Maryland’s Older Adults and Long-Term Care
While the work requirements primarily affect adults aged 19-64, older Marylanders will feel the broader fiscal pressure.
- With the state losing over $1 billion annually in federal Medicaid funds, difficult decisions about nursing home reimbursement rates, home and community-based services, and other eldercare programs become inevitable.
- Maryland nursing homes, which receive almost 80% of their revenue from Medicaid according to state data, face potential operational impacts as the state loses over $1 billion in federal Medicaid funds.
- State officials project that providers will be forced to cut costs and limit patient access, though specific impacts on reimbursement rates and service levels remain to be determined.
Adult children of aging Maryland parents should initiate long-term care planning conversations immediately, as the landscape is about to undergo a significant shift.
Comprehensive Preparation Guide for Maryland Healthcare Professionals
Maryland Primary Care Providers and Practice Administrators
- Begin documenting medical exemptions for work requirements now.
- Establish protocols for completing exemption paperwork and consider designating staff to become experts in the new requirements.
- Prepare for an increase in uninsured patients by reviewing sliding fee scales and charity care policies to ensure you are adequately equipped to handle the influx of patients.
Patients with chronic conditions, disabilities, or caregiver responsibilities may qualify for exemptions; however, they will need to provide detailed medical documentation.
Maryland Specialists Serving Medicaid Populations
Analyze your current patient mix to identify those at risk of losing coverage.
Cardiology, oncology, nephrology, and other specialty practices that serve patients with chronic conditions should prepare exemption documentation for those whose medical needs would qualify them for work requirement waivers.
Consider establishing payment plans for patients who lose coverage mid-treatment.
Maryland Food Assistance and Social Services Staff
- Prepare for the state’s transition to paying 25% of SNAP benefits and 75% of administrative costs, creating a $572.5 million annual burden on Maryland taxpayers.
- Over 684,000 Marylanders rely on SNAP benefits, with 59% being families with children and 32% being households with older adults and adults with disabilities.
- Document the critical health connections between nutrition and medical outcomes to advocate for continued state support.
Maryland Insurance Brokers and Health Benefit Exchange Staff
- Prepare for a massive disruption in the private insurance market.
- With enhanced tax credits expiring, expect an average rate increase of 17.1%, and over 70,000 Marylanders may potentially lose private coverage.
- Small business owners, who represent 25% of Maryland Health Connection enrollees, will be particularly affected.
- Develop expertise in the new enrollment restrictions and verification requirements that take effect January 1, 2026.
Maryland Healthcare Financial Counselors
- Update protocols for helping patients navigate work requirement exemptions.
- The legislation includes exemptions for parents with children under 14, people with disabilities, and those with qualifying medical conditions, but documentation requirements will be complex.
- Train staff on the verification process and establish relationships with social services to help patients access workforce development programs.
Maryland Mental Health and Behavioral Health Providers
- These providers note that many patients with mental health and addiction issues may qualify for work requirement exemptions, but will need current clinical documentation.
- Providers are establishing protocols for exemption letters while maintaining patient confidentiality and preparing for potential increased demand for sliding-fee services.
Maryland Community Health Centers
- As federally qualified health centers, these facilities expect to serve newly uninsured patients.
- Centers are reviewing 340B drug pricing programs and training staff on work requirement exemptions while preparing for potential increases in uninsured patient volume.
Maryland Hospital Emergency Departments
Hospital emergency departments are modeling scenarios for potential increases in uninsured patients, with coverage losses expected to be concentrated among working-age adults who may delay care until emergencies occur.
Maryland Case Managers and Social Workers
Case managers and social workers will likely become experts in work requirement exemption criteria and building resource lists for workforce development programs, food assistance, and other safety-net services.
Maryland Healthcare IT and Compliance Staff
Maryland healthcare organizations are preparing systems for increased data reporting requirements and potential integration with state workforce development databases, while ensuring compliance with enhanced federal oversight provisions.
The Maryland Hospital Association and Maryland Medical Society have not yet issued formal guidance to their members, with officials stating that they are awaiting details on federal implementation, which are expected to be released in the fall of 2025.
Critical Need for Healthcare-Social Services Coordination
The state agency analyses reveal how interconnected Maryland’s health and social safety nets have become.
Healthcare professionals must now coordinate with social services staff managing the SNAP crisis and insurance brokers handling disruptions in the private market.
For Healthcare-Social Services Partnerships
- Over 59% of SNAP recipients are families with children, and 32% are households with older adults or disabilities -populations heavily represented in healthcare settings.
- As Maryland taxpayers absorb $572.5 million in additional SNAP costs, healthcare providers should prepare for an increase in food insecurity among patients and strengthen their partnerships with food assistance programs.
- The Maryland Department of Human Services operates through local departments across all 24 jurisdictions, serving over one million Marylanders with a budget that’s 70% federally funded.
- As this federal support erodes, healthcare providers will need stronger connections to community-based social services.
Cross-System Patient Navigation
Patients who lose Medicaid coverage may qualify for private insurance through Maryland Health Connection; however, with 17.1% rate increases and reduced federal assistance, affordability becomes a significant barrier to accessing this coverage.
Healthcare navigators should prepare for complex insurance transitions and establish protocols for helping patients access emergency coverage options.
Analysis: Policy Trade-offs and Implementation Challenges
The Maryland Department of Health’s analysis indicates the new mandates create systems where eligible individuals may lose coverage due to procedural challenges rather than changes in their underlying eligibility.
This “administrative burden” effect appears designed to achieve the bill’s federal savings targets through reduced program enrollment.
State budget officials are analyzing how federal restrictions on provider taxes and assessments, mechanisms Maryland has used to help fund its Medicaid program, might affect the state’s ability to maintain current provider payment rates.
These restrictions could force difficult decisions about nursing home reimbursement rates, home and community-based services, and other programs that primarily serve older adults.
Looking Ahead: Preparation and Uncertainty
The state agency analyses reveal significant changes ahead for Maryland’s healthcare and social services systems.
The combined $2 billion annual impact across Medicaid, SNAP, and private insurance represents what officials describe as the most significant shift in federal support for Maryland’s social programs in decades.
Maryland’s healthcare community will need to coordinate across healthcare institutions, social services, state government, and community organizations in ways that previous policy changes haven’t required.
The state’s trigger provision and defensive budget measures indicate Maryland officials are treating these projections seriously.
Implementation success will depend on factors still being determined:
- Federal guidance clarity;
- State administrative capacity;
- How effectively organizations can help beneficiaries navigate new requirements.
Healthcare professionals serving vulnerable populations will need to balance preparation for projected impacts with recognition that actual outcomes may differ from current estimates.
The patients served by Maryland’s healthcare system will depend on provider preparedness and effective coordination between healthcare and social services as these federal policy changes take effect over the next 18 months.
This analysis is based on Maryland Department of Health “Impact of Potential Medicaid Proposals to Maryland Medicaid” (May 2025), Maryland Department of Human Services “Impact of Proposed Federal Fiscal Year 2026 Budget Cuts on Marylanders” (June 6, 2025), Maryland Insurance Administration rate filings (June 3, 2025), Congressional Budget Office reports, and review of enacted H.R. 1 legislation.
State projections are estimates that may vary based on federal implementation and actual enrollment patterns.
Ryan Miner, MBA | Co-Founder and Podcast Host | The Senior Soup
Hi, I'm Ryan!
I co-founded The Senior Soup Soup with Raquel Micit in September 2022. Together, we host The Senior Soup Podcast.
I am a community relations manager for Ennoble Care in Maryland, where I am responsible for marketing our home-based primary care healthcare practice.
I have over 15 years experience in healthcare, senior services, senior care, marketing, public policy, and search engine optimization.
I have a MBA from Mount St. Mary's University and a BA from Duquesne University.