Some 175,000 Marylanders could lose Medicaid coverage, and the state could lose $2.7 billion in federal funding and be on the hook for millions more to implement the tax-and-spend bill that recently cleared Congress.

These are the findings of a new analysis from the Maryland Department of Health of key aspects of President Donald Trump’s signature legislation, the One Big Beautiful Bill Act.

Some of the losses are tied to new paperwork-heavy work requirements for Medicaid enrollees and extra eligibility checks.

The law also includes a menagerie of wonky policy changes that affect how states raise money to pay for their share of the government health programs, if doctors can get paid extra to care for patients with complicated needs and which immigrants can participate.

State officials anticipated significant costs from legislation as it was being debated, but the new analysis found even more profound effects.

Potential losses from the legislation could affect almost every Marylander, not just the low-income residents who are enrolled in Medicaid. The officials warned of reduced access to medical care and even longer emergency room wait times.

“Many of the effects are still unknown,” said Ryan Moran, the outgoing deputy health secretary who oversees the state’s Medicaid program. Medicaid covers about 1.5 million, or 1 in 4, Marylanders.

“But collectively over time, the provisions will really shock the health care system,” he said. “The effects will trickle across the board.”

The moves kick in over time, but officials say the most consequential provisions begin next year. That’s expected to put significant economic pressure on already strained state coffers, as well as on hospitals and other health care providers.

The squeeze could force reductions in jobs and spending and potentially lead to closures of some health care facilities, often a community’s largest employer. Some hospitals in rural areas may be able to tap into a special fund created by the legislation, officials said.

Lawmakers declined to include an extension of enhanced tax credits that 190,000 Maryland use to buy private health insurance through the state health exchange, created under the Affordable Care Act, known as Obamacare. They expire at the end of the year.

Other provisions could make it harder to enroll or cost people more for coverage.

“The One Big Beautiful Bill Act significantly increases health care costs for Maryland Health Connection consumers, placing vital health coverage further out of reach for many families,” Michele Eberle, executive director of the Maryland Health Benefit Exchange, said in a statement.

She said the law will undo years of state-focused work to expand affordable health insurance, leaving many without coverage.

In anticipation of the federal cuts, insurers selling health plans on the exchange have sought an average 17% rate increase.

Some provisions of the law are being litigated, including payments to clinics that also perform abortions, which is primarily aimed at Planned Parenthood.

The state analysis found that that could cost Maryland $2.7 million for those clinics, but a temporary retraining order allows funding to continue while the challenge winds through the courts.

In a separate move Thursday, Attorney General Anthony Brown joined several other states in challenging new rules from the Trump administration related to the Affordable Care Act, which he said threaten coverage for more people.

The lawsuit claims that the rules, set to go into effect in August, would cause premiums and out-of-pocket costs to rise. Some 1.8 million Americans could lose coverage, including 34,000 Marylanders.