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News|Articles|October 15, 2026
5 Things to Know About the One Big Beautiful Bill Act
Author(s)Giuliana Grossi
Fact checked by: Ashley Gallagher, MA
HR 1 brings Medicaid work requirements and narrower immigrant eligibility by January 2027, and CBO projects 10 million more uninsured by 2034.
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Several provisions of HR 1, the 2025 federal budget reconciliation law, take effect between October 2026 and January 2027, including Medicaid work requirements and narrower immigrant eligibility, according to federal and state implementation timelines.1-3 The law, formally the One Big Beautiful Bill Act (Public Law 119-21) and now called the Working Families Tax Cuts legislation by federal health agencies, was signed July 4, 2025, and rewrites rules for Medicaid and the Affordable Care Act (ACA) marketplaces.4,5 Here are 5 things to know as its provisions take effect.
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