This November, the largest Medicaid cut in the program's 61-year history will begin taking effect — and Black Americans will bear a disproportionate share of the devastation. In July 2025, President Trump signed H.R. 1, the "One Big Beautiful Bill Act," into law. The legislation slashed Medicaid funding and imposed new work requirements that civil rights and health equity advocates say will strip coverage from millions of the most vulnerable Americans.

What the Law Does

H.R. 1 makes sweeping changes to Medicaid that will reshape health coverage access for tens of millions of Americans. Among the most significant provisions: mandatory 80-hour-per-month work requirements for Medicaid recipients ages 19 to 64 under state expansion programs. Beginning this November, individuals who cannot document these work hours — whether due to caregiving responsibilities, disability, irregular employment, or paperwork burdens — risk losing their coverage entirely.

The Congressional Black Caucus Foundation is tracking this as one of five key policy areas where recent legislation, executive actions, and court rulings will have lasting impacts on Black life, economic security, and civic participation. The CBCF has warned that these changes will create devastating gaps for the most vulnerable Americans and that Black communities will feel the impact disproportionately.

Why Black Americans Are Most at Risk

Black Americans make up over 20 percent of Medicaid recipients nationwide — a figure that reflects both the program's critical role as a health safety net and the structural economic inequalities that make that safety net necessary. Medicaid funds cover low-income adults, children, pregnant women, seniors, and people with disabilities. For Black families, it often represents the only path to prenatal care, mental health treatment, diabetes management, cancer screenings, and chronic disease support.

The work requirement creates a particular trap. Many Black Medicaid recipients are already working — often in hourly, gig, or informal economy jobs that do not provide health insurance. But proving 80 hours of documented work per month requires paperwork, internet access, and bureaucratic navigation that can be difficult to fulfill, especially for low-income individuals dealing with transportation barriers, childcare responsibilities, or unstable employment. The result, health equity experts warn, will be mass disenrollment of people who are actually working but unable to prove it on paper.

The Health Consequences

Losing Medicaid coverage is not an inconvenience. For many Black Americans, it is the difference between managing a chronic condition and experiencing a medical crisis. It is the difference between accessing mental health care and going without. It is the difference between a healthy pregnancy and a preventable maternal mortality statistic — a category in which Black women already die at three to four times the rate of white women.

A new study found that a common blood test for ovarian cancer may miss some Black and Native American patients, already contributing to delayed treatment and worse outcomes. Against this backdrop of pre-existing health disparities, the elimination of Medicaid coverage for hundreds of thousands of Black Americans would be catastrophic.

Congressional Response and the Fight Ahead

In response to these sweeping changes, Congressional Black Caucus Chair Rep. Yvette D. Clarke introduced the AI Civil Rights Act to hold tech companies accountable for harm caused by biased AI tools — recognizing that AI is increasingly being used in healthcare decision-making in ways that may worsen racial disparities. But the fight to restore and protect Medicaid funding requires broader legislative action and public pressure.

Advocates are calling on Black communities to take urgent action before November: understand what changes are coming to your state's Medicaid program, ensure your documentation is in order if work requirements apply to you, connect vulnerable family members with legal aid and enrollment assistance, and contact your elected officials to demand that these cuts be reversed.

What You Can Do Right Now

Check your Medicaid status and eligibility through your state's health insurance marketplace. Organizations like the National Health Law Program and local legal aid groups can help you navigate work requirement documentation. Call your Congressional representatives and demand they oppose the Medicaid work requirements and fight to restore funding. Share this information with elderly parents, young adults, and anyone in your community who relies on Medicaid. The cuts are coming — but community knowledge and political action are our most powerful tools.

Black health is not a policy abstraction. It is the lived reality of millions of families across Atlanta and the nation. November is coming. We cannot afford to be unprepared.