AOTA Webinar Summary OBBA
Cite: American Occupational Therapy Association. (2025, July 7). Understanding the One Big Beautiful Bill Act: Implications for Occupational Therapy. Webinar/Online.
Summary of notes during this webinar and it’s impact to occupational therapy taken by Holly Ross in order to inform CANOE clients and therapists working for CANOE along with the people that follow us. For more information or verbiage that is exactly from the webinar please wait until August 6th and then access the recorded webinar on your own.
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
The One Big Beautiful Bill Act (OBBBA) is signed by the president now it moves to federal committees then potentially back up to congress to vote on items before full implementation takes effect.
FMAP: Federal Matching Assistance Percentage - The main area where this bill is targeting.
Medicaid state expansion states will be the most affected. Colorado is one of those states. 41 out of 50 states have Medicaid expansion. (For full map of the USA and their involvement in this program see the picture below from the AOTA webinar)
Decreased eligibility enrollment time frame (as in a shorter time to register) and more frequent eligibility checks (as in re-validation periods that are shorter)
Work requirements 80 hours per month (Expansion States ONLY):
Work/volunteering/school all count towards those 80hours
Increased cost individual cost sharing
Limits on what lawfully present immigrants qualify for Medicaid
21-65years most at risk for losing Medicaid coverage depending on circumstance at this time.
States are required to provide these services (this bullet and list underneath covered in this AOTA article https://www.aota.org/practice/practice-essentials/payment-policy/pay-medicaid) :
Inpatient and outpatient hospital services
Physician, midwife, and certified nurse practitioner services
Laboratory and x-ray services
Skilled nursing facility services
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for eligible children up to age 21
Family planning services and supplies
Rural health clinic or federally qualified health care center services.
Medicaid enrollment expectations over the next 10 years
Community engagement requirements: 5.2 million adults disenrolled
Six-month eligibility checks: .7million
Decrease FMAP to states providing benefits to non-citizens: 1.4 million
Total with other previously voted on Medicaid divisions: 7.8 million
Provider tax cap and phase down: “Mechanism for states to help finance Medicaid expenditures and draw down more matching funds. Often used to increase payments to providers (SNFs and hospitals) that see a high % of Medicaid patients”
State Funded Medicaid Expectations over 10 years
FMAP Sunset: 13.6 billion
Changes to state directed payments: $191 billion
Changes to provider tax: $150 billion
Affordable Care Act Changes Expectations:
Changes to enrollment process and support: .9 million
Changes to eligibility: 1.4 million
Expiration of enhanced premium tax credit: 4.2 million to lose coverage (Not in the Bill but was already set to expire)
Impact on Occupational Therapy (OT)
Fewer people can access OT through Medicaid and the ACA marketplace
Fewer people in the marketplace could lead to;
Increased premiums
Insurance companies trying to decrease reimbursement rates
Decreased payments to hospitals and SNFs with high Medicaid populations may put those facilities as risk of closure
Changes at the State level to reduce funding
For more information on this bill from AOTA...Join AOTA for the whole scoop and so our membership can continue to pay lobbyists to fight for our profession as a whole! Also, join OTAC to stay up to date on what Colorado is doing and so OUR state lobbyists can be our eyes and ears on the ground protecting our profession. Thanks for reading!
Holly Ross
OTR/L, WSI/T, LTP, ATRIC
Summary of the AOTA Webinar One Big Beautiful Bill Act from 7/31/2025
