Nebraska Representative Mike Flood Faces Backlash at Town Hall While Defending One Big Beautiful Bill Act

Medicaid expansion enrollees face sweeping new requirements: 80 hours per month of work, community service, or education starting as early as late 2026; six-month eligibility redeterminations instead of annual; new cost-sharing up to 5% of income; and restrictions on who qualifies. States also face limits on provider taxes that many use to draw down federal matching funds. These changes could cause millions of expansion enrollees to lose coverage if they can't document compliance with work requirements or afford new cost-sharing.

Students get some benefits: Workforce Pell Grants expand to cover short-term job training programs, and 529 plan withdrawals can now cover more K-12 and credentialing expenses. However, Pell Grant eligibility tightens — students enrolled less than half-time are cut off, and those receiving enough non-federal aid lose eligibility. Subsidized loans end for undergrads after July 2026. Colleges must meet new earnings requirements or lose federal funding for low-performing programs. The net effect is more accountability but less financial flexibility for many students.

Medicare sees targeted reforms. Pharmacy benefit managers under Medicare are restricted to flat service fees only starting in 2028, which could lower drug costs for seniors. Orphan drugs get broader protection from the drug price negotiation program. However, non-citizens without permanent residency lose Medicare eligibility, and HSA eligibility expands to include Medicare Part A enrollees age 65+, giving seniors a new tax-advantaged savings option. The PBM reforms could meaningfully reduce prescription costs for many of Medicare's 67 million beneficiaries.

Lawful permanent residents retain access to most federal benefits, including SNAP, Medicaid, Medicare, and premium tax credits — they are specifically listed as an eligible category in the new restrictions. However, the 1% remittance tax will affect green card holders who send money to family in their home countries. New immigration fees may also apply to certain green card-related processes.

Tribal members receive a specific exemption from the expanded SNAP work requirements for able-bodied adults, recognizing unique employment challenges in tribal communities. However, the broader SNAP benefit reductions — including the Thrifty Food Plan freeze and elimination of SNAP-Ed nutrition education — still apply to tribal members. EPA grants for tribal air pollution programs are rescinded, and the Tribal Energy Loan Guarantee Program loses its remaining unobligated funds.