Protecting the Health of Washington’s Children: Understanding the Impacts of H.R. 1 

Total Medicaid Enrollment 

This county-level map of Washington shows the percentage of all people who were enrolled in Medicaid in each county in 2023. 

Context:  

In 2023, 1.86 million children and adults were enrolled in Washington’s Apple Health program, representing about 20% of Washingtonians. Of those enrolled, 39% were children under age 19, representing about 720,000 children.  

The maps above show that Central and Eastern Washington have the highest concentrations of adults and children enrolled in Medicaid, with Yakima and Adams counties standing out for child enrollment at 50.3% and 47.5%, respectively. Because of H.R. 1, an estimated 248,000 people in Washington could lose coverage, including 14,000 children. Cuts of this scale will have devastating impacts across Washington state, fundamentally altering the state’s health care system and increasing health care costs for everyone. 

Source: This map draws from analysis done by Georgetown University Center for Children and Families, pulled from 2022-2023 American Community Survey (ACS) Public Use Microdata Sample. They define children as under 19 years old. 

SNAP Impacts 

SNAP (Basic Food) provides individuals and families with monthly benefits to help them buy the food they need. These benefits strengthen families and support local businesses. Under H.R. 1, federal SNAP spending will be reduced over the next decade, and new work requirements will be added, creating barriers for people trying to keep food on the table. These changes will reduce or remove benefits for families throughout Washington and limit access to food in many communities, with some SNAP retailers potentially closing and leaving people without anywhere in their area to buy groceries. (source: https://www.americanprogress.org/article/snap-cuts-are-likely-to-harm-more-than-27000-retailers-nationwide/). 

Households with Children Enrolled in SNAP 

This county-level map of Washington shows the percentage of households with children under 18 enrolled in SNAP in 2023. 

Households Enrolled in SNAP 

This county-level map of Washington shows the percentage of households enrolled in SNAP in 2023. 

Context:  

In 2024, 888,300 Washington residents were served by SNAP benefits, representing around 11% of Washingtonians. Of those using SNAP, 45% of participants were families with children or around 153,283 households. From the maps above, we see that there are higher concentrations of SNAP participants in Central and Eastern Washington, specifically Yakima and Franklin counties where 21.7% and 19.5% of households participated in SNAP in 2023. Additionally, many counties in Central and Eastern Washington show that a majority of participating households had children under 18. For example, in Adams County, 65.9% of SNAP households had children under 18 in 2023, and in Franklin County, that figure was 64.2%. As a result of H.R. 1, and estimated 517,000 families in Washington could lose some of all of their SNAP benefits. This includes the 34% of SNAP recipients who are children. SNAP cuts could reduce spending at Washington businesses by $252 million annually, potentially forcing grocery stores to close and increasing hunger and food deserts across the state. For more information on impacts to food retailers, see this analysis. 

Source: Data for these maps comes from the U.S. Department of Agriculture Food and Nutrition Service SNAP Community Characteristics Explorer, which pulls from ACS 1-Year Estimates. 

Hospitals At-Risk of Closing/ Scaling Back Services 

This map of Washington shows the locations of hospitals at risk of scaling down services or closing due to H.R. 1. 

Note: Mid-Valley Hospital (Omak, WA) was included in this Senate letter, which identified rural hospitals at risk of closure under H.R. 1. However, it did not submit 2024 payer data to the Hospital Financial Data Reporting (HOFIDAR) database. Therefore, it could not be included in this map. 

In a June 2025 letter, U.S. Senators shared the findings of national analysis examining which rural hospitals are at risk of closure under H.R. 1. The analysis defined “at-risk hospitals” as those in the top 10% of Medicaid payer mix across the country, and/or hospitals that have experienced three consecutive years of negative total margin. By breaking down the data state by state, the Senators highlighted the rural hospitals most vulnerable to scaling back services or shutting their doors under H.R. 1.   

Notably, there is a high concentration of hospitals at risk of closure in Central Washington and on or near the Olympic Peninsula—areas where we also see some of the highest proportions of children and families relying on Medicaid and SNAP. These overlapping challenges tell a powerful story about who will feel the impacts of H.R. 1 first and most.  

Under H.R. 1, the combination of increased barriers and reduced funding for Medicaid and SNAP together with the potential closure of rural hospitals will fall hardest on children and families in Central Washington and other rural areas. For many, it will mean losing access to the food, care, and stability children and families in this region rely on and deserve. It will leave communities without a hospital to turn to and force families to travel long distances for even the most basic medical care.  

These are not abstract policy changes. They are shifts that will put essential resources out of reach for the people who depend on them most.  

Source: Data for hospital coordinates and payer mix came from HOFIDAR Yearly Payer Report and Health Center Program Uniform Data System (UDS) Data Table 9D. Data on potential hospital closings/service reductions is based on findings from this Senate letter. 

H.R. 1 Implementation Timeline 

Below we outline relevant pieces of H.R. 1 as they relate to Medicaid, SNAP, and hospital access and utilization. 

2025: 

• SNAP 

  • Imposes work requirements 

  • Ends eligibility for immigrants who are not legal permanent residents, those granted the status of Cuban or Haitian entrant, or Compacts of Free Association (COFA) migrants.   

  • Eliminates the Nutrition Education Program 

  • Eliminates Low-Income Home Energy Assistance Act and Internet Deductions (increasing countable income, thereby decreasing SNAP eligibility)

• Medicaid 

  • Places a one-year moratorium on Medicaid payments to nonprofit reproductive care providers such as Planned Parenthood 

2026: 

• SNAP 

  • Increases the state share of SNAP administrative costs 

• Medicaid 

  • Limits eligibility for most immigrants, refugees, and asylees 

2027: 

• SNAP 

  • Increases the state share of SNAP program costs 

• Medicaid 

  • Imposes work requirements 

  • Requires twice-yearly eligibility verification 

  • Reduces retroactive coverage periods  

  • Restricts Affordable Care Act eligibility and subsidies 

  • Prohibits individuals disenrolled due to work requirements from purchasing subsidized marketplace coverage 

2028: 

• Medicaid

  • Decreases the home-equity limit for long-term care eligibility 

  • Introduces cost sharing for Medicaid expansion enrollees with incomes above 100% of the federal poverty level 

  • Decreases state-directed payments to safety-net hospitals 

2029:  

• Medicaid

  • Requires states to submit Medicaid enrollees’ Social Security numbers to a federal system and verify enrollee addresses 

Source: Information surrounding these dates for implementation comes from the Washington State Office of Financial Management, Northwest Health Law Advocates, and the Center for American Progress.

Conclusion 

As shown in the maps presented above as well as outlined in the implementation timeline, H.R. 1 will impact support services that are critical to the health and well-being of countless families and children in Washington. Key impacts include the following: 

• Central Washington will be hit hardest: The increased barriers and reduced funding for Medicaid and SNAP together with the potential closure of rural hospitals will fall hardest on children and families in Central Washington.  

• Food retailers and rural hospitals will likely close: Cuts to Medicaid and SNAP through H.R. 1 threaten to close food retailers and hospitals in areas of critical need. Food assistance programs like SNAP create economic stimulus. with every $1 spent on SNAP generating up to $1.80 in economic activity. Additionally, rural hospitals rely heavily on Medicaid to keep their doors open. When Medicaid payments are reduced, there’s no easy way to replace the lost funding. 

• H.R. 1 budget cuts will fundamentally change Washington’s support service landscape, creating lasting impacts that expand beyond those enrolled in these specific programs: SNAP and Medicaid are not only fundamental services to support our under-resourced communities, they are critical programs for stabilizing our costs for basic needs and maintaining the health and well-being of all children and families in Washington. 

Children’s Alliance will continue updating and maintaining this resource as a part of our commitment to ensuring policymakers, advocates, and community members have the most up-to-date information on how H.R. 1 may affect Washington’s children and their families.  

Stay informed by joining our mailing list, where you will receive updates on our work, action alerts, and invitations to upcoming events. Click here to sign up. 

Additional Resources 

For more information about SNAP and Medicaid impacts, see the Urban Institute’s analysis: https://www.urban.org/urban-wire/about-12-million-households-receive-both-medicaid-and-snap-reconciliation-bill-puts-them 

For more information on regional impacts to hospitals in Washington, see this report from Senator Maria Cantwell. 

For more information about the H.R. 1 timeline, advocacy tools and impacts on immigrant communities, see Northwest Health Law Advocates’ Federal Health Care Changes Hub. 

For more information about economic impacts of SNAP cuts, see this analysis from the Center for American Progress. 

For more information about state readiness to implement H.R. 1, see this tracker from Georgetown University. 

Notes: In creating this resource, Children’s Alliance consulted closely with our partners at Voices for Virginia’s Children, Arkansas Advocates for Children and Families (AACF), and the Urban Institute. Our approach mirrors the mapping projects developed by AACF and Voices. Our team is incredibly grateful for their insight and assistance. 

Data Limitations 

All projections are rooted in past trends and cannot account for future policy behavior at the state or federal level (i.e., state-level investments, future error rates, work requirement implementation, individual behavioral responses, etc.).