Those last few sections were no fun, but now we get back into the drama. This section explains the messy divorce between President Trump and his ex-BFF Elon Musk. This is taking on and eliminating much of the green new deal and taking away tax credits for green energy and solar. It also goes into the first sections of Medicare.

70501 to 70515 cuts short many clean energy and efficiency tax credits, ending them years earlier than planned. Most of these credits are used for new clean vehicles by late 2025, energyefficient home improvements by the end of 2025, and clean hydrogen and clean electricity credits several years sooner. It also tightens rules to stop foreignowned companies from claiming certain clean energy tax benefits and increases U.S. content requirements for clean energy projects. Some credits for advanced energy projects and clean fuels are extended but with stricter rules, including limits on where fuel materials can come from and preventing double payments. Overall, the law focuses on encouraging U.S.-based clean energy production while ending or limiting many incentives earlier than before.

Starting with 70522 these sections ban certain foreign owned companies from getting carbon capture tax credits and updates payment rules for new carbon projects. It changes how oil and gas companies report income by requiring them to count drilling costs more directly, reducing tax breaks starting in 2026. It allows publicly traded partnerships to treat income from clean energy sources like hydrogen, carbon capture, nuclear, hydro, and geothermal as qualifying for tax benefits beginning in 2026. Finally, it lets businesses get fuel tax refunds if they mistakenly paid tax on dyed fuel that’s normally tax-exempt, starting six months after the law is passed.

Starting with 70601 this group of laws makes several important tax changes. It permanently limits how much businesses can lose to use to reduce taxes and updates how that limit is calculated. It clarifies tax rules for payments from partnerships to partners for services or property given, applying only to future payments. It closes a loophole that let companies dodge limits on tax deductions for executive pay by splitting salaries across related firms, now requiring fair sharing of the $1 million cap among them. Starting in 2026, a 1% tax applies to certain cashbased money transfers sent from the U.S., with some payment methods exempted. The law also cracks down on fraud involving COVID-related employee retention tax credits by penalizing promoters who fail to do proper checks and limits new claims after January 2024. Treasury is funded $15 million to study and report on replacing the IRS’s direct e-file system, exploring costs, taxpayer preferences, and options for free tax filing partnerships with private companies. The part that is more applicable to most of us, is starting in 2026, education tax credits require taxpayers and students to include SS Numbers and schools’ IDs on tax returns to claim the credit. If claiming for someone else they also need SS numbers Now we are getting to the part I have been waiting for Medicaid. This is possible the section that has received the most scrutiny. The first three parts (A-C) of the Medicaid sections mostly deal with getting rid of fraud and who is eligible to receive it. This law makes several changes to Medicaid, Medicare, and CHIP programs. It requires states to prevent people from enrolling in multiple states’ by verifying addresses and sharing data. It mandates regular death checks to remove deceased patients and providers from Medicaid; tightens penalties on states with too many payment errors starting 2030. It requires more frequent eligibility checks for some Medicaid recipients starting 2027 and allows states to raise home value limits for Medicaid long-term care eligibility starting 2028. It restricts federal Medicaid funding to only citizens with certain exemptions and reduces federal payments for emergency care for undocumented immigrants. Finally, what might be the most controversial part it bars Medicaid funds to abortion Starting with section 71114 these laws make several important changes to Medicaid funding. It ends extra federal bonus money for states that expand Medicaid after January 1, 2026; it reduces how much states that expanded Medicaid can tax healthcare providers from 6% down to 3.5% by 2032; it caps Medicaid payments to providers at 100% of Medicare rates for expansion states and 110% for others, with gradual cuts for previously higher payments, especially affecting rural hospitals. It tightens rules to ensure healthcare provider taxes are fair and don’t unfairly target providers serving many Medicaid patients. Finally, starting in 2027, Medicaid pilot programs must be budget neutral, meaning they can’t cost the federal government more than existing Medicaid spending, with any savings counted in future approvals.

This last paragraph is just what it says, not how it will affect states. I know there are many afraid these changes will affect rural hospitals. While I am not smart enough to understand how, when I searched for the reason for this fear this is what I found. These are not my ideas, so take them for what they are. Many rural hospitals rely on higher Medicaid payments to cover their costs because Medicare rates often don’t fully cover expenses. This cap limits their ability to get extra funds through Medicaid. If rural hospitals were already getting special higher payments, those will have to be reduced by 10% each year starting in 2028 until they reach the new caps. That means less money over time, which can strain their budgets. Yet at the same time the law does include some protections for rural hospitals, like recognizing “critical access” and “low-volume” hospitals and sets aside $7 million per year through 2033 to help implement these rules, which could ease the impact somewhat.

The section that starts with 71119 is about increasing personal accountability with Medicare. Basically, starting in 2027, most people of working age on Medicaid will need to work at least 80 hours a month volunteering, going to school, or at an actual job to keep their coverage. There are some exemptions like being pregnant, disabled, a caregiver, living in a high-unemployment or in a disaster area. States must check compliance regularly and give people 30 days to fix any issues before ending coverage. States will receive $200 million in grants to build systems and enforce the rules, and safeguards will prevent conflicts of interest in how compliance is checked. Then, starting in 2028, states must begin charging small copays to some low-income adults who earn above the poverty line. These copays are limited to $35 per item or service, don’t apply to key services like primary care or mental health, and can’t exceed 5% of a family’s income. No premiums will be charged, and providers may still waive the fees.