The Multnomah County Board of Commissioners was briefed Tuesday, Oct. 13, on the harmful and ongoing effects of House Resolution 1 (H.R. 1). The federal law, signed July 2025, introduced broad funding cuts and other sweeping changes to safety net programs that serve hundreds of thousands of vulnerable Oregonians, including Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
Beyond reducing funding, the federal law sets strict eligibility requirements, work rules and other limits that could prevent people from accessing the healthcare, nutrition and other public assistance they need.
Tuesday’s briefing detailing how these changes are affecting Multnomah County and its community members included leaders from the Health Department and Department of County Human Services (DCHS), alongside representatives from the Oregon Health Authority (OHA) and the Oregon Department of Human Services (ODHS).
Nationally, the Medicaid cuts equate to $1.15 trillion reduction in federal spending over the next decade. H.R. 1 also reduces projected SNAP spending by $187 billion through 2034, while shifting a larger financial burden onto state budgets.
Over the past 18 months, both the State and County have prepared for the downstream effects on community members, healthcare and social service providers, and other community partners. The work of responding to and managing the effects of these federal actions and shifting requirements has so far led to updates in eligibility systems, notices, provider processes, outreach strategies, and implementation and communication plans — with additional changes still anticipated.
“We’ll continue to translate that guidance to try to ensure that we can prepare our community and prevent benefit loss,” said Rachel Pearl, director of the Department of County Human Services.
SNAP changes
“The impact of H.R. 1 requires us to treat this as the emergency response that it is,” said Dave Baden, deputy director of policy and programs for OHA.
The legislation significantly expanded the number of people subject to so-called “Able-Bodied Adults Without Dependents” work or activity rules. The rules generally, which went into effect last fall, require adults ages 18 to 64 without a child under 14 in their SNAP household to complete 80 hours of work or other qualifying activities per month to remain eligible for the food assistance program, unless they qualify for an exemption. The change affects more than 254,000 Oregonians.
Nationwide, SNAP participation dropped by nearly 13% between the law’s enactment and June 2026, according to U.S. Department of Agriculture data. And in Oregon, more than 70,000 people lost SNAP benefits between July 2025 and June 2026.
“In 2025, we had to make changes to our system almost immediately, with lagging federal guidance. This has been a difficult transition,” said Nate Singer, director of innovation and capacity for ODHS. “Over $112 million less funds have come into our state because those individuals are not eligible.”
Work and activity rules had applied even before H.R. 1 to residents of Multnomah County and other parts of Oregon, but about 30 other counties were exempt from requirements based on unemployment rates, homelessness rates or veteran status. Singer said that changed as part of H.R. 1.
Between January and July 2026, he said, more than 38,000 Oregonians lost SNAP benefits because they could not meet the new verification requirements.
Singer said he spoke with a business owner in Multnomah County who could not keep up with running his business while also having to constantly provide documentation.
“Many of these individuals are working or doing other things, but having to provide monthly verifications to the state becomes onerous,” Singer said.
Additionally, approximately 2,500 lawfully present immigrants in Oregon have lost SNAP benefits since Oct. 1, 2025, due to revised federal immigration eligibility definitions.
Medicaid changes
Many community members on the Oregon Health Plan (Oregon’s Medicaid program) have already received notices about needing to meet new Medicaid work or activity rules starting Jan. 1, 2027. Approximately 600,000 OHP members statewide — including about half of Multnomah County’s 281,000 Medicaid members — could be subject to these rules. Individuals can submit exemption documentation to their state eligibility files.
In addition, many adults 19 to 64 years old will be required, starting in 2027, to renew their eligibility for Medicaid benefits every six months instead of every two years. Children, people over 65 and individuals with qualifying disabilities will be required to renew every year instead of every two years.
“This will be an extraordinary administrative burden,” said Baden, the OHA deputy director of policy and programs. “We’re trying to do everything we can to have our systems aligned so that there’s few notifications for families… But it is going to be a big challenge. People are going to get a lot of mail, and as we know, it’s hard to pay attention to everything that you get.”
New eligibility rules for certain immigrant populations (PDF) on Medicaid or the Children’s Health Insurance Plan (CHIP) also took effect Oct. 1, 2026.
Because Oregon remains committed to providing health insurance regardless of someone’s immigration status, thousands of immigrants will no longer be assigned to Coordinated Care Organizations and will shift, instead, to Open Card (PDF), a fee-for-service model under OHP’s Healthier Oregon Plan. The Healthier Oregon Plan provides the same covered benefits and is fully financed by the State of Oregon; however, some patients may need to switch providers. That reassignment will affect more than 100,000 children and adults who will transition out of CCOs (such as Health Share of Oregon and Trillium) by Jan. 1, 2027.
The Multnomah County Community Health Center, which provides primary care and dental services to more than 60,000 patients annually, will continue accepting both Open Card and CCO-assigned Medicaid patients under OHP and its Healthier Oregon Plan, including recently and newly reassigned patients.
State efforts to help community members
State officials are leveraging technology to reduce administrative burdens by allowing automated payroll verification uploads whenever possible. Case managers are also prioritizing support for people enrolled in SNAP and Temporary Assistance for Needy Families (TANF) work requirement programs; meeting those rules automatically fulfills Medicaid requirements.
“We’re trying to find a low-cost, low-touch way to prevent loss of healthcare access when OHP work or activity rules begin,” said Baden.
Public communication campaigns are also underway to encourage community members to update their contact information so renewal notices reach them on time. People can get help, ask questions or report changes at benefits.oregon.gov, by phone at 800-699-9075 or at a local Oregon Department of Human Services office.
“Our goal is to keep healthcare and nutrition benefits as accessible as possible, even when the administrative requirements and other things — that were not our choice — were thrust upon us by changes in H.R. 1 in the federal government,” Baden said.
County departments take steps to reassure and support community
Starting in the summer of 2025, the Multnomah County Department of County Human Services — which provides services for youth and families, older adults, veterans, and people with disabilities, among others — has worked with community partners to address the impacts of H.R. 1.
When SNAP changes began last October, DCHS, the Health Department, the Office of Emergency Management and others activated an Emergency Operations Center, launching daily briefing calls with state and city partners.
Following a state of emergency declaration by Chair Jessica Vega Pederson in December 2025, the DCHS Youth and Family Services Division increased access to food assistance, housing and mental health supports to community members in need as well as support for local nonprofits and service providers responding to their own increased demand.
The work has continued to grow to include new efforts to reach community members. The County joined the State to launch the Community Empowerment and Benefits Preservation Project, which will prepare staff and community members for the January 2027 Medicaid changes.
“One of the things we want to do is remove the confusion and create clear messaging,” said Pearl, and to work “arm-in-arm, not just with our County and State partners, but all of our providers in the community.”
Homeless outreach workers, for example, may be tapped to help reach people who may not receive mail.
“We want to make sure that we’re able to help people everywhere they go,” said Pearl.
Starting in January, the DCHS Aging, Disability and Veterans Services Division will conduct expanded SNAP and Medicaid redeterminations for people who receive services through its “no wrong door” policy — meaning a person in need of assistance can apply at any office and be connected to the right services and support.
Pearl said shifting renewals down from every two years to every six months will create an immense workload, noting the department would need to hire up to 57 additional staff members to handle the increase.
Meanwhile, over 85% of Multnomah County’s Community Health Center patients rely on Medicaid. Lower reimbursement rates under the Open Card model, along with reduced specialty care access, will place new pressure on the Community Health Center system, which operates eight primary care centers, seven dental clinics, seven pharmacies and nine Student Health Centers.
“We expect to see an increased number of uninsured patients over the next year due to the significant administrative burden of reporting and general confusion from new paperwork,” Health Department Director Rachael Banks said.
Impacts extend beyond primary care patients to community members enrolled in the County’s Women, Infants, and Children (WIC), maternal and infant health, STI Clinic, and behavioral healthcare programs.
“There’s going to be impacts across every division in the Health Department for a variety of reasons — either loss of coverage or increased potential enrollment,” Banks said.
For instance, Multnomah County estimates that there are 19,000 families who are eligible for, but not currently enrolled in, the WIC program, which offers nutrition and breastfeeding support for pregnant women, infants and new parents.
“As SNAP eligibility decreases, eligible folks will want to enroll in WIC services,” Banks said. “We will need additional case management capacity and other staffing.”
Banks said the changes carry far-reaching equity implications, too. “All of these things are going to hit hardest on those folks who are marginalized, whether that’s housing status, some sort of medical issue, or a race-based or other discriminatory piece.”
The Health Department will continue focusing on upstream and preventative health services to keep community members from needing crisis or emergency care. A key strategy will be reaching patients through trusted community voices.
“This is an emergency,” said Banks. “We need to focus all our energy here.”
Board comments
“We must act with absolute urgency to protect the dignity of our residents, ensuring changing federal rules never cost a neighbor their healthcare, their food security or their peace of mind,” said Commissioner Meghan Moyer. “I appreciate how hard Multnomah County and our state partners are working together to protect Oregonians.”
“I was working on the front lines of homeless services before Medicaid expansion and need people to remember that it was impossible to get people behavioral health services that they needed and wanted. We can’t go back to that,” said Commissioner Shannon Singleton. “This work is something that needs to be done across the County enterprise. I’ll be interested to know how we’ll pull the resources together that we'll need for this. There are things we’re doing as a County that require a lot of staff effort, time and energy. I would prefer that our staff spend their time on this.”
“The Trump administration’s reckless cuts to healthcare and food assistance are a direct attack on our most vulnerable communities,” said Commissioner Julia Brim-Edwards. “I will continue standing up against these cuts and fighting to protect the essential services our residents depend on.”
“Currently 85% of our food is exported,” noted Commissioner Vince Jones-Dixon. “So what role do we play as far as circulating and getting healthy foods to our neighbors that are losing their SNAP benefits for a whole host of reasons, but especially H.R. 1?”
“Let’s be clear: The reason for these cuts is that they were used to pay for tax breaks to the wealthiest people in this country,” said Chair Vega Pederson. “Now Oregon is seeing the direct impacts to our most vulnerable: children, families and adults who have many needs, who are currently being served by the system our state set up. We are losing that. People are going hungry and people are not receiving healthcare because of it.
“This was done intentionally. It was to make services and programs that people are eligible for that much harder to access because they actually don't want those programs to be successful.”