I’ve finished reading the “One Big Beautiful Bill Act” from Congress, also known as H.R. 1 — all 869 pages. I won’t recommend it to my friends, but we all ignore it at our peril. Because what is clear is that Rhode Island is on track for a world of hurt from what’s in that law.
While the bill impacts a range of issues, including taxes, the border, and immigration, the most consequential impacts are the sweeping changes to Medicaid and other federally supported safety-net programs, such as Supplemental Nutrition Assistance Program (SNAP) and health insurance subsidies. These changes will shift large scale costs and administrative responsibilities from the federal government to the states, with Rhode Island among those most affected.
Medicaid and other safety-net programs have always functioned as true partnerships between the federal government and the states — anchored in shared responsibility for administration, oversight, and most critically, cost sharing. However, H.R. 1 undermines this foundational principle. It upends the federal-state partnership by significantly reducing federal financing across the board. This law shifts program and administrative costs onto states without proposing any realistic alternatives.
This shifting of financial responsibility onto our state will have profound and immediate adverse implications for our annual budget. With limited options for raising new revenue, any substantial increase in Medicaid or SNAP costs would force Rhode Island to make large scale adjustments across not just health care and nutrition for children, but also other essential services like education, transportation, and public safety. Consider the scale: Roughly one in three Rhode Islanders — about 313,000 people — depends on Medicaid, while one in eight — approximately 114,000 residents — relies on SNAP benefits. We are talking about our working families, children, seniors, and vulnerable neighbors.
H.R. 1 carries other adverse impacts: It imposes new local administrative burdens with their own price tag. Chief among these are more frequent eligibility redeterminations for Medicaid and SNAP, as well as expanded verification of work requirements. These provisions may sound minor, but in practice they require the hiring of additional staff, upgrading of IT systems, intensified coordination with employers, and frequent data matching — all at the state’s expense, and without additional federal support. Georgia offers a timely and sobering example. In 2023, Georgia launched a limited Medicaid expansion tied to mandatory work requirements and more frequent eligibility reviews. While the program was projected to extend coverage to tens of thousands of low-income adults, by mid-2024 it had enrolled only about 4,400 people — less than 1 percent of the state’s uninsured population. Meanwhile, administrative costs ballooned to $26 million, with much of the funding diverted from health care delivery.
The takeaway is clear: These policies not only fail to deliver on coverage goals, they also saddle states with unnecessary bureaucracy and mounting costs.
The ripple effects of HR 1 will not only affect Rhode Island’s state budget, they will also have a devastating effect on our already struggling health care and support systems. Our hospitals, community health centers, food banks and other social service programs will feel the effects of lost coverage, delayed eligibility decisions, and diminished resources. It’s not like HR 1 can keep Rhode Islanders from getting sick or being hungry: We will still need to be treated, somehow, or fed, somehow, only now it is up to us to find a way, because our federal partner for many decades has pulled support way, way back.
Inevitably, with federal funding diminished, locally, costs for everyone will increase.
Fortunately, Rhode Island is not standing still.
The FY 2026 enacted state budget includes important first steps toward preparing for the anticipated fallout from H.R. 1. Specifically, it directs the Executive Office of Health and Human Services (EOHHS) to convene an interagency advisory group to assess the implications of federal policy shifts on the state’s Medicaid program and related safety-net services. Findings and recommendations are due Oct. 31.
This critical planning effort must be paired with accelerated action. Rhode Island must also begin sophisticated contingency planning now — exploring state-based revenue stabilization measures, establishing rapid-response public-private partnerships, and advocating forcefully at the federal level for implementation delays, waivers, and increased flexibility. While the EOHHS efforts are integral to developing a deep understanding of the extent and parameters of these problems, a joint effort from the highest levels of state government, our hospitals, our congressional delegation, our charitable leaders and others is necessary.
Without leadership and swift, coordinated action, the state risks being overwhelmed by both the scale of the financial burden, and the bureaucratic complexity H.R. 1 imposes. In the face of this federally driven disruption, and for the good of all of us, we must use every available tool to ensure that safety-net services remain strong, efficient, effective and accessible to all who need them.
An engineer and part-time legislator, state Senator Louis DiPalma chairs the state Senate Committee on Finance and represents Middletown, Little Compton, Newport and Tiverton.