The One Big Beautiful Bill Act (OBBBA): Key Medicaid Changes in Colorado

On July 4, 2025, President Donald Trump signed H.R. 1: the One Big Beautiful Bill Act (OBBBA) into law, enacting the largest cut to health care in history, primarily targeting Medicaid and the Affordable Care Act (ACA) health insurance marketplace. OBBBA dramatically reshapes the health care landscape with sweeping changes that will impact access to care and health coverage for Coloradans and millions of individuals nationwide.

The scale of federal funding losses under OBBBA will have far-reaching consequences on the health and economic stability of individuals, families, and communities. The state faces difficult choices ahead to protect Medicaid – a vital lifeline for millions of Coloradans. Colorado Access is committed to partnering with the community and state to find solutions that mitigate harm and keep Coloradans covered.

To ensure all Coloradans can understand and successfully navigate the new health care environment, below is a breakdown of several key provisions, including their effective dates and the populations they will impact:

• Medicaid expansion population
• Immigration population
• Providers

We have also created a more detailed fact sheet that includes a deeper analysis of each policy.

Medicaid Expansion Population

Most of the eligibility and administrative hurdles are imposed on the Medicaid expansion population, which is characterized as adults aged 19 to 64, who do not have dependents, and have incomes at or below 138% of the federal poverty level. More than 377,000 Coloradans are part of this population and may be subject to these changes.

• Work requirements (Effective December 31, 2026): Defined in OBBBA as “community engagement requirements,” this provision requires that certain individuals covered by Medicaid expansion will need to provide proof of work, volunteering, or attending school for at least 80 hours per month as a condition to maintain Medicaid coverage. There are several populations exempt, including people with disabilities, certain caretakers, parents of children over age 14, pregnant and postpartum individuals, and more.
• More frequent redeterminations (Effective December 31, 2026): Eligibility redeterminations will occur every six months instead of every 12 months.
• Restricted retroactive coverage (Effective January 1, 2027): States will only cover one month of past medical care for expansion adults and two months for traditional enrollees instead of 90 days before the date of application.
• Cost sharing on certain services (Effective October 1, 2028): Medicaid expansion adults will have copays up to $35 per service. Colorado will have flexibility and discretion to set the copay amount. Several services and health care settings are excluded from this provision, including emergency care, primary care, and services provided at federally qualified health centers, among others.

Immigrant Population

OBBBA introduced new restrictions to a narrowed group of lawfully present immigrants, stripping access to health care for many others. Effective October 1, 2026, OBBBA redefines “qualified” immigrant to include only lawful permanent residents, certain Cuban and Haitian immigrants, Citizens of the Freely Associated States (COFA migrants) lawfully residing in the United States and lawfully residing children and pregnant adults if states have chosen to cover them, which Colorado has elected to cover. Although these populations will still be able to access Medicaid and the Children’s Health Insurance Program (CHIP), this is a significant reduction in the immigration statuses that can access coverage

Undocumented individuals are not eligible for federally funded Medicaid coverage except under specific, limited, and legally defined circumstances, such as Emergency Medicaid, which OBBBA did not change. Pregnant people and children, who would be eligible for Medicaid if not for their immigration status, remain eligible for Cover All Coloradoans.

Providers

One of the most immediate changes under OBBBA was its provision to freeze Medicaid reimbursement to “certain prohibited entities” for one year upon enactment. The new law narrowly defines these entities to target Planned Parenthood and its affiliates. This provision has faced ongoing legal challenges, resulting in service disruptions. In anticipation of further service disruptions, Colorado lawmakers passed a bill during a special session to allow the use of state funds for reimbursement to Planned Parenthood of the Rocky Mountains (PPRM). Colorado Access testified in strong support of this bill. Due to this new state law, PPRM can currently see Medicaid patients.

Outside of this provision, providers are deeply concerned about OBBBA’s changes to Medicaid financing mechanisms that help them serve Medicaid patients and the uninsured. These mechanisms – provider taxes and state directed payment programs – help Coloradans maintain health coverage and reduce the amount of uncompensated care. The rollbacks threaten the stability of the state’s safety net providers.

For further details or to address any questions, please contact us at policy@coaccess.com.