FAQs: One Big Beautiful Bill Act Impacts on Patients

The One Big Beautiful Bill Act (H.R.1) makes several major changes to Medicaid and the Affordable Care Act (ACA) that could affect people living with arthritis — including children and families. This FAQ is designed to explain what’s changing, how it may impact your care, and what you can do to stay covered. From new work and paperwork requirements to shortened enrollment windows and possible cost increases, it’s important to understand your rights and be prepared. If you or your child rely on Medicaid or ACA plans to manage arthritis, this guide will help you navigate the changes and take action to protect your health.

Q: What impact will the “Community Engagement” requirements have on access to care?

A: If you're an adult on Medicaid and considered able to work, H.R.1 will require you to show every month that you’re working, volunteering or receiving job training or education for at least 80 hours monthly. There are exceptions to this provision and we will continue to provide more information as the bill is implemented. This could make it harder for some people to stay on Medicaid — especially if they have trouble navigating paperwork or bureaucracy. For people with arthritis, flares and mobility issues may make this requirement particularly difficult.

Q: How will the changes to Health Savings Accounts (HSA) affect my care?

A: Under H.R.1, HSA access will expand for patients with high-deductible health plans (HDHPs) and patients with bronze and catastrophic-level plans. Patients with eligible plans will now be able to use their HSAs to pay for direct primary care, with patients paying a recurring monthly or annual amount directly to their primary care provider rather than through their insurance. The bill also allows telehealth services to be covered on a pre-deductible basis for people on HDHPs.

Q: Does H.R.1 address rural health?

A: Yes. H.R.1 sets aside $50 billion over five years to improve health care in rural communities. This new program encourages states to submit plans to strengthen rural hospitals and health care access. If done well, it could help make sure people with arthritis in rural areas have better access to specialists and care close to home.

Q: Could this bill affect children living with arthritis?

A: Yes. Many children with arthritis rely on Medicaid for their doctor visits, medications therapies and regular monitoring of their condition. H.R.1 makes changes that could make it harder for families to stay enrolled in Medicaid — due to stricter paperwork rules and less funding for states, for example. If parents lose coverage or face new burdens, children in the household also would be impacted. And if a parent is subject to the new “community engagement” requirements and can’t meet them because they’re caring for a child with a chronic illness, the entire family’s coverage could be at risk. For families in rural areas, the bill’s investment in rural health could eventually help — but it depends on how states implement the program.

Q: I am on Medicaid. Could how much I pay increase as a result of this bill?

A: Possibly. Before this bill, many Medicaid enrollees didn’t have to pay anything out-of-pocket for care. H.R.1 requires some people to start paying a cost per visit of up to $35 for certain services. For people living with a chronic condition like arthritis — who often have more than one condition and typically have multiple prescriptions and medical visits — every new cost can create a barrier to care.

Q: What changes are being made to Affordable Care Act open enrollment?

A: H.R.1 makes a few big changes:

• Shorter enrollment period: You’ll only have from Nov. 1 to Dec. 15 to sign up for a health plan.
• No more automatic re-enrollment: If you’re eligible for subsidies, you’ll need to actively re-enroll each year — or risk losing coverage.
• More paperwork: You'll need to verify your income and other details each year to keep your coverage.

For people with arthritis, staying insured is key to managing your condition. These changes make it even more important to pay attention to deadlines and paperwork during open enrollment.

Health care access is essential for managing arthritis and living well — for both adults and children. While H.R.1 brings new challenges, staying informed and taking action can make a big difference. Keep track of deadlines, ask for help when you need it and speak up about how these changes affect your health. 

The Arthritis Foundation is here to support you and connect you with resources, including our Helpline, 800-283-7800. Together, we can work to ensure that all people with arthritis have the coverage and care they need.