H.R.1, the “One Big Beautiful Bill Act,” represents one of the most significant Medicaid policy changes in recent history, mandating community engagement (work) requirements for many Medicaid expansion enrollees nationwide beginning in 2027. Congressional Budget Office projections and prior state experiences indicate that these requirements could result in substantial coverage losses driven largely by administrative complexity rather than changes in employment.

This symposium will provide a research-informed, nonpartisan forum to examine the anticipated effects of Medicaid work requirements on coverage, health equity, and system performance. Drawing on federal guidance, state implementation examples, and peer-reviewed evidence, the convening will explore how policy design and implementation choices shape outcomes for individuals and health systems — and what lessons can inform future Medicaid reform efforts.