Many families and staff have been wondering what the One Big Beautiful Bill (OBBB) might mean for the people we serve and the agency in the upcoming years. The Iowa Developmental Disability Council shared information that helped sort out some of the possible challenges.
Currently, more than 700,000 Iowans rely on Medicaid for their health care and daily support, including 90,000 people with disabilities. Here’s how the bill could impact people with disabilities.
- Increases the number of eligibility redeterminations to at least 2 per year. This means Medicaid members will have to fill out more paperwork more frequently to prove that they need Medicaid. It also creates an opportunity for more “churn,” which is when people lose Medicaid and have to start the enrollment process again. Right now, eligibility is determined annually. This change could result in service interruptions and hit those with fluctuating incomes or complex documentation needs the most. It also adds a lot more administrative cost to Medicaid agencies, money that could be used to support more people in their communities. The change from annual to six-month redetermination evaluations will begin on December 31, 2026.
- Adds new 80-hour/month work requirements to some people on Medicaid (expansion population). This does not include people on waiver programs or receiving regular Medicaid. Iowa passed a similar requirement for people getting health care through the Iowa Health and Wellness Plan, which is what Iowa calls the program for the expansion population. Iowa’s work requirement law is stricter than the federal one, since the federal law allows for going to school or volunteering in the community to count toward “work.” The federal bill also changes cost-sharing, meaning people in this Medicaid population may have to pay more for their services. States must meet this new requirement by December 31, 2026 (but they can start it earlier).
- Adds restrictions to home and community-based services (HCBS), which help people live in the community or at home, instead of institutions. The wording in this section is unclear, but states could start limiting the number of waiver slots (and increasing waiting lists). States could also narrow the scope of services (including fewer hours for personal care or cuts to employment supports). The federal match rates could be reduced (currently a 63/37 split), requiring states to cover a larger share of these costs. These changes could make it harder for people with mild to moderate disabilities to receive supports that help them live independently.
- Less flexibility for states applying for demonstration waivers. Rules on Medicaid waiver “demonstration projects” (formally called section 1115 waivers) were tightened in the bill. These demonstration projects let states try out new approaches to service delivery but require a lot of reporting to make sure there is a focus on outcomes. For instance, if Iowa were to try out a new “Work Without Worry” program, they might use this type of waiver to try it out. The OBBB is actually against trying new ways to improve services for people with disabilities, so this could make it harder to enact creative new approaches to supporting Iowans with disabilities.
- Makes it harder for people to receive food assistance under the Supplemental Nutrition Assistance Program, or SNAP. This program helps lower-income people and seniors pay for important programs. The SNAP cuts will not happen until October 1, 2026 (one year away).
While these are predicted outcomes due to the OBBB, it is still unclear how this will all play out in Iowa.
To learn more, visit the Iowa DD Council HERE.
