Understanding Medicaid Cost Sharing and Policy Changes from the 2025 Reconciliation Law Authors: Anna Mudumala and Jennifer Tolbert Published: May 21, 2026

https://www.kff.org/medicaid/understanding-medicaid-cost-sharing-and-policy-changes-from-the-2025-reconciliation-law/ The 2025 reconciliation law makes significant changes to the Medicaid program, including requiring states to impose cost sharing on adults enrolled through the Affordable Care Act (ACA) Medicaid expansion, marking the first time the federal government has required states to impose cost sharing on Medicaid enrollees. Current federal rules allow, but do not require, states to impose cost sharing on certain Medicaid enrollees. In addition, the law creates new eligibility requirements that will affect expansion enrollees, including work requirements and the requirement for states to redetermine eligibility every six months. Together these provisions could create barriers to expansion enrollees maintaining coverage and increase their health care costs.