Cook County PHHS outlines impacts of federal Medicaid, SNAP changes
House Resolution 1, more commonly known as the One Big Beautiful Bill Act, will bring major changes to Medicaid and SNAP in the coming years. According to Cook County Public Health and Human Services (PHHS), the changes will affect individuals receiving benefits as well as the states and counties that administer them. In addition to a multi-year timeline with extensions and unanswered questions, states could face fees and penalties based on their payment error rates.
During Tuesday’s PHHS Board meeting, Public Health Supervisor Grace Grinager presented an overview of the changes. For each change, she outlined potential impacts ranging from people losing benefits to increased administrative burdens for states and counties.
Some groups are excluded from the Medicaid changes. They include people who qualify because of a disability, those 65 and older, people 20 and younger, and those who are pregnant. Even with those exclusions, the scope of the changes remains uncertain. Some groups, such as members of American Indian tribes, are exempt from certain provisions but not others.
“It sounds like a straightforward question, and it’s challenging. We actually don’t know yet, because the state is still coming out with additional information,” Grinager told WTIP.
While the exact impact on counties is unclear, Grinager said eligibility specialists in Cook County will likely face more work related to redeterminations for Medicaid eligibility and compliance with new work requirements.
“There is a staffing element to this that the people who are employed at the county doing this work–they may have more work to do,” Grinager said. “And then the department may need to look at how we’re staffing the service of essentially supporting community members and applying for and maintaining their benefits.”
Changes to SNAP will also affect the program’s funding. Previously, states received 50% federal reimbursement for administrative costs, but that will now be lowered to 25%.
“The county receives funding from the states to fund the positions that help people apply for benefits, and so if the state is getting less funding from the federal government, what does that mean for the amount of funding that the state’s able to provide to us at the county level?” Grinager told WTIP. “It’s still unknown. So it’s something that we’re going to continue to watch.”
Payment error rates for both Medicaid and SNAP could result in penalties. For Medicaid, the Centers for Medicare and Medicaid Services (CMS) will penalize states with error rates exceeding 3%. For SNAP, states may be required to pay 0-15% of benefits based on their error rates. According to CMS, an improper payment rate is not a fraud rate but a measurement of payments that did not meet statutory, regulatory, or administrative requirements.
The presentation included a timeline of the changes to both programs. The slides from the presentation are linked in the agenda from the meeting, and the presentation is also included in the recording of the meeting.
“It’s not something that you want to let sit because, you know, we have people here to help through the process, and as you have questions, reach out and ask them,” Grinager told WTIP.
Residents with specific questions about their benefits can call the PHHS Economic Assistance team at 218-387-3620.
WTIP spoke to Grace Ginager about her presentation and the upcoming changes to Medicaid and SNAP. The audio of that conversation can be found below.
Josh Hinke September 20, 2025
