The enactment of H.R. 1, the Budget Reconciliation Bill, supported by all four members of West Virginia’s Congressional Delegation, cements the largest cuts to Medicaid and Supplemental Nutrition Assistance Program (SNAP) food assistance in our nation’s history. While the legislation was federal, the effects will be hyper-local, impacting families, food pantries, and health care clinics, as well as state economies and budgets, though many of the provisions are phased in over a long period.
More than $1 trillion in cuts to health care and food assistance barely made a dent in the cost of extending tax cuts, primarily for the nation’s wealthiest households. Eighty percent of the benefits of the legislation go to the wealthiest 10 percent of Americans. Overall, the package still adds more than $3 trillion to the national debt.
While the WVCBP and our partners are still working to analyze the coming impacts of this massive legislative package, this piece will preview key upcoming changes to health care and food assistance and, where possible, their fiscal and human impacts. It is not inclusive of all provisions. We will follow up in more detail in the coming months.
Expands harsh, ineffective time limits and work reporting rules (effective upon passage, however states are not implementing until guidance is established). Under prior law, adults between the ages of 18-55 without dependents in the home were subject to a strict time limit for SNAP eligibility. They could only receive SNAP benefits for three months in any three year period, unless they document 80 hours of work per month or an exemption.
H.R. 1 expands those harsh work reporting requirements to include older adults up to the age of 65 and households with children 14 and above. This change will put 13,000 older West Virginians and thousands of households with older children at risk of losing SNAP. Because SNAP benefits are loaded onto one card for the family, a parent losing their assistance results in less food for children in the household.
For households who think they may be impacted by this provision, nothing has changed with your food benefits for now. Await updates from the SNAP agency about steps to take.
Changes eligibility such that most immigrants with humanitarian protections will lose SNAP (effective upon passage, however states are not implementing until guidance is established). While undocumented immigrants have never been eligible for SNAP, H.R. 1 ended SNAP eligibility for the narrow category of immigrants eligible for the program: those with humanitarian protections including refugees, individuals granted asylum, and victims of domestic violence and labor and sex trafficking. It is unclear how many West Virginia residents may be impacted.
For households who think they may be impacted by this provision, nothing has changed with your food benefits for now. Await updates from the SNAP agency about steps to take.
Saddles West Virginia with huge new costs (administrative costs increase October 1, 2026 and benefit cost share begins October 1, 2027). H.R. 1 ended the longstanding commitment of 100 percent federal funding for SNAP food assistance benefits, shifting massive costs onto state budgets just as the economy is slowing. States will now have to pay a share of SNAP food benefits, determined by the state’s SNAP error rate (errors are not fraud but over- or under-payments based on human error). The state’s cost share is likely to range from 5 to 15 percent of benefits, which would represent between $28-84 million annually in new costs to West Virginia’s state budget. After several years of state tax cuts and flat budgets, it is likely that state lawmakers will have difficulty coming up with the state match without raising taxes, cutting other state services, or cutting SNAP.
The package also increases the state’s share of the cost to administer SNAP from 50 percent to 75 percent. This will cost the state at least $9 million more per year, likely putting pressure on state lawmakers to cut the SNAP administrative budget. If they do, the state agency will have fewer staff and slower service for families and will experience challenges decreasing its error rate just as that becomes critical to the state’s share of SNAP benefits.
Eliminates SNAP Nutrition Program (effective October 1, 2025). H.R. 1 eliminates funding for the nutrition education and obesity prevention grant program, SNAP-Ed. In West Virginia this program is known as the West Virginia Family Nutrition Program. Its defunding eliminates the $4.1 million West Virginia was anticipated to receive annually and an estimated 60 jobs in West Virginia. The West Virginia Family Nutrition Program operated Grow This! and a number of state programs that promoted healthy eating and food access.
Additional changes will shrink benefits, negatively impact children. Cuts to SNAP also negatively impact other nutrition programs. Because SNAP receipt automatically makes children eligible for free and reduced-price school meals and summer EBT, children will be at risk of losing eligibility for those programs, as well. H.R. 1 also limits benefits by stopping future updates to how SNAP benefits are calculated and restricting utility deductions for SNAP eligibility. This is expected to reduce SNAP benefits by about $15 per person per month by 2034.
Requires many enrollees to document work or an exemption or lose health care coverage (effective by January 2027). For the first time in program history, Medicaid will nationally implement work reporting requirements (or job loss penalties) for many enrollees, including parents of children over the age of 14 and those recently laid off. While the majority of Medicaid recipients already work or meet an exemption, proving those things over and over is often a confusing and challenging multi-step process. The state will also have to build a complex bureaucratic system for capturing this information from enrollees, and no funding to do so was included in the package.
An estimated 50,000 to 110,000 West Virginians will lose their health coverage as a result of these new requirements, not because they are ineligible but because they will have difficulty complying with new bureaucratic red tape. Research shows there is no relationship between work reporting requirements and employment; when a similar program was implemented in Arkansas, researchers found that 95 percent of those who lost coverage were working or met an exemption but lost coverage because the paperwork was confusing, burdensome, and difficult to comply with.
These provisions will not go into effect for at least a year, so families who think they might be impacted should not worry now. Your coverage will remain in place.
Doubles eligibility redeterminations (effective by January 2027). Medicaid enrollees in the Medicaid expansion population will face more frequent eligibility redeterminations to maintain their eligibility. This change puts thousands of West Virginians at risk of losing their health care via increased red tape and paperwork barriers. During the Medicaid unwinding from the COVID-19 public health emergency, when Medicaid transitioned from continuous coverage protections back to regular redeterminations, three-fourths of West Virginians who lost their coverage experienced those losses through procedural denials—meaning that they failed to fill out paperwork or filled it out incorrectly rather than no longer being income-eligible for Medicaid.
Increases costs for enrollees (effective by October 2028). For the first time, many Medicaid enrollees will face increased costs to accessing necessary care, with a requirement that states implement copays on a sliding scale up to $35 per service. These additional fees will put health care out of reach for many families, resulting in more residents forgoing care until a health issue is far more serious and costly. Research has found that even premiums of one dollar had a negative relationship with acquisition of care.
Changes eligibility such that most immigrants with humanitarian protections will lose Medicaid (effective October 2026). While undocumented immigrants are already ineligible for Medicaid and the ACA, H.R. 1 ends eligibility for those with humanitarian protections including refugees, individuals granted asylum, and victims of domestic violence and labor and sex trafficking. It is unclear how many West Virginia residents may be impacted.
Limits West Virginia’s options for funding state share of Medicaid. H.R. 1 significantly limits flexibility in funding state Medicaid costs by immediately prohibiting new or increased provider taxes and winding them down over time. It also limits state directed payments. With state lawmakers enacting significant tax cuts and insisting the budget stay flat, the provider tax has represented a key source of funding for the state’s Medicaid growth. Freezing this will put more pressure on state lawmakers to increase general revenue funding for Medicaid or, more likely, reduce Medicaid spending via reducing provider reimbursement rates and cutting optional services, which includes home- and community-based services and substance use treatment. These changes alone are expected to result in a federal funding loss of nearly $400 million per year in West Virginia that will no longer go to health care providers and hospitals.[1]
Affordable Care Act (ACA) Marketplace Changes
Allows enhanced ACA tax credits to expire (expiring December 31, 2025). Congress increased the subsidies that families who do not get health insurance through a job, Medicare, or Medicaid receive to help pay for the cost of health insurance on the Marketplace, but those tax credits expire at the end of this year. If not extended, 67,000 West Virginians will see their health insurance premiums increase by an average of 133 percent or $1,400 annually. This is expected to result in 15,000 losing their health coverage as they will no longer be able to afford it.
Combined, the cuts to Medicaid and the ACA are expected to result in West Virginia losing $1 billion/year in federal funds. This will cost the state thousands of health care jobs as well as indirect job losses and will result in hospitals and providers reducing services or even closing their doors. With that said, it is important to know many of the most harmful provisions are delayed and nothing changes now for families and workers who might be impacted.
[1] WVCBP analysis of Kaiser Family Foundation research.
