Maryland will be worse off for years to come as families, communities, and our state leaders adjust to the historic cuts to health care and food assistance that were part of the sprawling federal tax and budget bill enacted this month, known as the “One Big Beautiful Bill Act” (H.R. 1). Contrary to the bill’s name, the impact on the tens of thousands of Marylanders who will face new financial hardship as a result can better be described as ugly.
The legislation also targets immigrants, both with massive amounts of new funding for mass deportation operations and detention centers, and by taking away assistance from some refugees and other legal immigrants who are able to get support with health care and food today.
And, as it strips support away from families who are struggling to make ends meet, the new law gives a windfall to the wealthy few in the form of new and extended tax breaks that disproportionately benefit millionaires and billionaires.
Leaving Marylanders Less Able to Afford Food
There are more than 600,000 Marylanders whose ability to have enough to eat each day depends on food assistance through the Supplemental Nutrition Assistance Program (SNAP). Most SNAP participants are children, and many are now at greater risk of going hungry as provisions in the federal legislation target their parents with additional paperwork requirements and time limits.
More than 107,000 adults in SNAP households with children in Maryland are now at risk of losing some or all of their benefits under the new rules, according to estimates from the Department of Human Services (DHS). While the children’s food assistance might not be affected, household benefits will shrink if the parents’ assistance is cut. That means parents who were already struggling to stretch their food budgets for an entire month will face impossible choices, like skipping meals, buying cheaper and less nutritious food, or passing up other household essentials to buy sufficient food.
An additional 66,700 adults ages 55 to 65 who aren’t supporting children under 18 will also now be subject to the time limits and paperwork requirements for the first time that put their food assistance at risk.
In addition, the new rules target people with certain legal immigration statuses, including refugees and asylees, who were previously eligible for food assistance. DHS estimates that there are nearly 8,000 Marylanders who could be affected by these new limits.
State policymakers should explore using state funds to continue to provide assistance to those who are eligible, as well as developing processes that help eligible people easily retain food assistance, rather than getting caught up in burdensome paperwork that causes them to lose a much-needed income support.
Harming the Health of Our Communities
Our own health and the health of our communities depends on widespread access to affordable health coverage. Since implementing the various provisions of the Affordable Care Act, Maryland has had very low rates of people without insurance. The new federal budget bill represents a major step backward as it cuts nearly $1 trillion from Medicaid nationwide.
Hundreds of thousands of Marylanders will be at risk of losing their health coverage through Medicaid due to new “work requirement” policies and additional burdensome paperwork requirements. The reality is, the vast majority of people receiving Medicaid already work or attend school, or they are unable to work because they are elderly, disabled, or caring for a family member.
What will actually cause most people to lose Medicaid is not being able to document that they do meet the requirements. In addition, people will now have to submit forms twice a year confirming that they are still eligible, rather than once a year as they do now. This creates much greater opportunities for missed notifications or other errors that cause people to temporarily or permanently lose their health coverage, leaving them unable to afford care.
Another group of Marylanders who are now at risk of being unable to afford health care are people who purchase private insurance through the Maryland Health Connection marketplace. Congress allowed premium tax credits to expire that were helping lower the cost of coverage, which is expected to significantly increase the cost of health plans purchased for next year. Health insurers anticipating the end of these credits earlier this year applied to raise costs for insurance plans sold through the marketplace by an average of 17%.
These policies will ultimately harm all of us, no matter how we get our health coverage. Fewer people with insurance means more people using emergency rooms, potentially setting back efforts to reduce ER wait times across the state, already some of the longest in the country. Increased ER use also tends to raise the cost of care for everyone as hospitals absorb the costs of treating patients who can’t afford to pay.
Many of the Medicaid-related provisions don’t go into effect for several years, so state policymakers should use this time to develop systems to ease red tape and keep as many people as possible from losing their health coverage.
Tripling Down on Cruel Mass Deportation Efforts
The Trump Administration has already launched a significant deportation campaign removing immigrants from their communities, their workplace, and often from their families. Some have been deported while others are facing indefinite incarceration in detention centers. Immigrants with legal status and work authorization have also had their status stripped through executive orders or targeted actions, leaving people who have lived and worked here for years, sometimes decades, suddenly in legal limbo.
HR 1 supercharges these cruel actions by putting more than $170 billion into building detention centers, hiring additional immigration enforcement agents, and other related expenses, representing a massive expansion of the Immigration and Custom Enforcement agency’s budget.
Increased targeting of immigrant Marylanders will harm families and communities across the state. It also will hurt our economy. More than 1 million Marylanders are immigrants, running small businesses and working in all sectors and industries, and immigrants have been key to economic growth in the state.
Maryland policymakers must continue to take steps to ensure immigrants feel safe living and working here, including by prohibiting local law enforcement agencies from enforcing federal immigration laws.
Straining Maryland’s Budget
In addition to the direct harm thousands of Marylanders will experience, all of us will be left to deal with expensive cost shifts from the federal to the state government. This puts funding for essential, life-saving public assistance programs in competition for funding with other services that are the backbone of our communities and our economy, like our public schools and universities, child care, transit service and road repair and construction.
Starting in October 2027, the state will have to pay a percentage of SNAP benefits, something that the federal government has always fully funded. If this provision were in place today, Maryland would have to pay about $240 million per year because the payment is based on a state’s “error rate” in determining someone’s benefit amount, either awarding them too much or too little in a given month.
By the end of the Hogan administration, Maryland had one of the highest SNAP error rates in the country, something Department of Human Services officials say they are trying to address. While the error rate has come down significantly over the last couple of years, there is still work to do in order to reduce the amount of the benefits cost shift when that provision goes into effect.
States will also have to pick up a greater share of the administrative costs for running the SNAP program. This will cost Maryland an additional $57.5 million per year starting in October 2026.
On the health care side, there are new restrictions on one of the tools that Maryland has used to fund Medicaid, a tax on major health care providers like hospitals and nursing homes. State officials believe Maryland’s current use of the tax is already in line with the new rules, but these limitations will affect the state’s flexibility to address future needs. There will also be additional administrative costs to the state to implement the more frequent eligibility checks and work requirements.
In addition, some of the tax provisions in the legislation could decrease state revenues. Policymakers could avoid this by decoupling from those federal tax provisions in the next legislative session.