Resource: Overview of the One Big Beautiful Bill Act Exemptions for American Indian and Alaska Native People
On July 4, 2025, the President signed the One Big Beautiful Bill Act (OBBBA) into law. The OBBBA is a major bill that delivers many elements of President Trump’s legislative agenda, including new requirements for access to Medicaid and SNAP. Fortunately, Indians, Urban Indians, California Indians, and individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary are exempted from the Medicaid requirements in the OBBBA and included in exemptions for the Supplemental Nutrition Assistance Program (SNAP) work requirements.
Community Engagement Requirements for Certain Medicaid Beneficiaries
What it Does: States are required to implement community engagement and work requirements for able-bodied adults without dependents beginning after December 31, 2026. Compliance may be achieved through working, volunteering, or participating in a work program for at least 80 hours/month; or enrolling in an educational program at least half-time.
AI/AN People Exempted: The bill exempts American Indian and Alaska Native beneficiaries from these requirements.
Medicaid Redetermination Period
What it does: State are required to conduct eligibility redeterminations at least every 6 months for Medicaid expansion adults beginning after December 31, 2026.
AI/AN People Exempted: The bill exempts American Indian and Alaska Native beneficiaries from these requirements and maintains the 12-month Medicaid eligibility redetermination cadence.
Modifications to SNAP Work Requirements for Able-Bodied Adults
What it does: The provision institutes exemptions to the SNAP work requirements for able-bodied adults.
AI/AN People Exempted: The bill exempts American Indian and Alaska Native beneficiaries from work requirements as part of SNAP eligibility.
Cost Sharing Requirements Under the Medicaid Program
What it Does: States are required to impose cost sharing on Medicaid Expansion adults with incomes 100 – 138 percent of the federal poverty level (FPL). This cost-sharing is capped at $35 per service and may not exceed five percent of the individual’s income.
Impact on Indian Country: The American Recovery and Reinvestment Act of 2009 mandates “no cost sharing for items or services furnished to Indians through Indian health programs.” This will remain in place.
