With more than $2 billion in expected bills in the drawer and the federal government shifting costs to states, Virginia lawmakers face hard choices on state tax policy to determine how much revenue they'll have to pay for the services they provide now.

The "One Big Beautiful Bill Act" that President Donald Trump signed into law on July 4 pays for a massive package of tax cuts — some old, some new — with $1.2 trillion in cuts to federal spending on Medicaid, food assistance and other safety net programs.

Most changes to Medicaid policy will not take effect until after midterm congressional elections next year, but Virginia health care providers already are taking steps to prepare for steep cuts in reimbursements for the services they provide. For example, Augusta Medical Group has

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