By reducing eligibility and funding for SNAP and Medicaid/CHIP, this legislation heightens food insecurity, impairs access to health care, and shifts a greater burden to states, thereby exacerbating health inequities. Low-income households, rural populations, older adults, people with disabilities, and immigrants will bear the brunt. For example, the legislation would cut gross federal Medicaid/CHIP spending by nearly $1 trillion over ten years. Additionally, ripple effects may see hospitals and healthcare centers unable to keep doors open, particularly in more rural areas and low-income neighborhoods. While H.R. 1 provides some funding to rural health care, it is unlikely that it will be enough to offset the losses. This has impacts on job security (economic stability), healthcare access, and other social determinants of health.
Summary
This law enacts deep cuts and eligibility restrictions across major federal safety-net programs, especially the Supplemental Nutrition Assistance Program (SNAP) and Medicaid/Children’s Health Insurance Program (CHIP), shifting costs to states and narrowing access for low-income individuals and immigrants, with disproportionate impacts on historically marginalized communities.
Impact Analysis
Legal Challenges
COMMONWEALTH OF MASSACHUSETTS et. al. v. UNITED STATES DEPARTMENT OF AGRICULTURE; et. al.: https://oag.ca.gov/system/files/attachments/press-docs/2025.10.28%20Complaint.pdf
PLANNED PARENTHOOD ET AL v. KENNEDY ET AL
STATE OF CALIFORNIA v. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Take Institutional Action
- Health systems, public agencies, and community-based organizations can respond to H.R. 1 through coordinated advocacy and action. Under policy advocacy and public engagement, institutions should work with state and local leaders to preserve access to SNAP and Medicaid, elevate community voices, and communicate how cuts to safety-net programs worsen food insecurity, housing instability, and health outcomes.
- Through legal and regulatory challenges, organizations can collaborate with advocacy and legal partners to review state implementation for potential violations of non-discrimination laws and support litigation or amicus briefs opposing harmful eligibility restrictions.
- Health systems and safety-net providers should anticipate higher uncompensated care and service demands. Institutions can create contingency budgets, strengthen partnerships with food and housing programs, and reallocate resources to sustain core services for vulnerable populations.
- By engaging in shared risk and collective response, institutions can join coalitions that link health, housing, and nutrition sectors. Coordinated outreach and data-sharing can help track impacts, align advocacy efforts, and mobilize a unified response to community needs. Organizations can expand upstream programs, such as medically tailored meals or rental assistance partnerships, to reduce harm and maintain access for those at risk of losing benefits.
- Finally, strategic communication efforts should ensure consistent, multilingual messaging about program changes and available supports. Staff and leadership should be trained to address community concerns and reinforce that access to food, housing, and healthcare is essential to achieving health equity.
Associated or Derivative Policies
As this is a budget reconciliation law, it aligns with other fiscal legislation pieces in FY2025 (tax cuts, debt ceiling increase).
Builds upon earlier welfare-reform and eligibility-restriction frameworks (e.g., 1996 welfare reform for non-citizen eligibility) and consolidates multiple program cuts across nutrition/housing/health coverage.
Relates to earlier Medicare/Medicaid work-requirement proposals and SNAP administrative cost-sharing changes.
Policy Prior to 2025
Prior law under SNAP established federal/state cost-sharing and eligibility rules without the sweeping cost shifts and heightened error-rate penalties introduced in H.R. 1.
Under Medicaid/CHIP law, eligibility for many lawfully present immigrants existed, especially children and pregnant women via ICHIA, and federal funding (FFP) was guaranteed during verification periods; H.R. 1 reverses many of those provisions.
Housing/energy assistance programs (e.g., LIHEAP) prior to this measure had more stable federal funding and fewer state-cost shifts.
Additional Resources
For statistical baseline/context: facts on SNAP and Medicaid coverage prior to cuts from Kaiser Family Foundation and Census https://www.kff.org/medicaid/the-implications-of-federal-snap-spending-cuts-on-individuals-with-medicaid-and-other-health-coverage/
https://www.kff.org/topic/medicaid/
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