5 Ways AARP Is Fighting to Protect Medicaid

Legislation introducing cuts and new work requirements threatens health coverage for millions of older adults

Deirdre van Dyk and Emily Paulin,

Updated June 13, 2025

AARP

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Published May 14, 2025

/ Updated June 13, 2025

Low-income older Americans who rely on Medicaid for their health insurance could face stringent new work requirements, higher medical bills and possible loss of coverage under President Donald Trump’s sweeping tax and spending bill, which is making its way through Congress.

The One Big Beautiful Bill Act narrowly passed the House on May 22, with ballots cast primarily along party lines. The legislation is now headed to the Senate as Republicans aim to get the bill through Congress and to Trump before July 4. The proposed $793 billion cuts to Medicaid over the next 10 years are part of the GOP’s effort to shrink federal spending in some areas to help offset Trump’s campaign promise of bigger tax breaks.

More than 17 million adults ages 50 and older rely on Medicaid for health care and other services. Federal and state governments run Medicaid jointly, and it covers the cost of everything from doctor’s visits to prescription drugs, as well as long-term care in nursing homes or services that allow older adults to remain in their homes.

The slate of proposed cuts and changes to Medicaid in the bill could harm older adults, AARP argues. A new requirement that able-bodied adults under age 65 must work to remain Medicaid eligible could affect as many as 9.2 million enrollees ages 50 to 64, according to a new report by AARP’s Public Policy Institute (PPI). Some risk losing coverage because they don’t meet the new requirement or qualify for an exemption. Most, however, risk losing coverage, not because they are ineligible but because they will become entangled in the legislation’s burdensome new paperwork to prove eligibility.

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Other harmful changes include new “cost-sharing” measures that would require some enrollees to start paying fees for services. The bill also includes a proposal to shorten the period in which the program makes retroactive payments for those newly enrolled. Such changes are expected to create confusion and coverage gaps.

“Millions of older Americans have worked hard, played by the rules, and now find themselves barely getting by,” Nancy LeaMond, AARP’s chief advocacy and engagement officer, wrote in a May 21 letter to the House's speaker and minority leader. “What they need are common-sense policies that lower costs, make health care more affordable, and reflect the contributions they’ve made to this country.”

As the bill makes its way through the Senate, AARP is urging lawmakers to “prioritize policies that help older adults make ends meet and age in their own homes and communities, and to oppose those policies that make it harder for those same Americans who are most in need to get health care,” LeaMond wrote.

Here’s what AARP is doing to ensure that Medicaid remains available to, and reliable for, those older adults who need it:

1. Opposing work requirements for older adults and family caregivers

The new bill calls for broad Medicaid work requirements for able-bodied adults ages 19 to 64, starting by the end of 2026 at the latest. Older adults would need to work, volunteer or enroll in a training course for 80 hours a month and would need to submit documentation to prove they are complying — or risk losing coverage. Adults who work hourly jobs where schedules are variable, do seasonal work, work in unstable industries or are facing age discrimination in the workplace may struggle to work the required number of hours and could lose their Medicaid coverage.

People with a disability, those who suffer from a serious medical condition, or people who are the parents, guardians or caretaker relatives of a child or a disabled person would be exempt. However, they would be required to prove as much by supplying the right documents at the right intervals to their Medicaid agency. Some enrollees would be required to prove their eligibility at double the frequency of what is required now. How exactly you must prove your eligibility is unclear. The additional red tape, however, could create new barriers to gaining or maintaining coverage.

A study by KFF, a health policy research nonprofit, examined the impact of work requirements instituted in Arkansas during the first Trump administration. The study found that a quarter of those who either met the requirements or qualified for the exemption lost benefits because of difficulties complying with the requirements to collect and file paperwork regularly online.

AARP opposes “efforts to add new burdens that could cost people their health care coverage not because they are ineligible, but because they missed a deadline or could not navigate a complex system,” LeaMond wrote. If lawmakers do move forward with these requirements, AARP urges that “additional, reasonable, and common-sense exemptions be made,” she added, including a lower age-based exemption and expanding the definition of who is considered a caregiver.

2. Working to keep costs down for older adults

There are two ways the proposed changes to Medicaid would increase the cost of care: new copays and a shortening of the period in which the program makes retroactive payments for those newly enrolled in the program.

Under the House version of the bill, many people earning over 100 percent of the federal poverty level ($15,650 for a single adult) would face costs to access care — paying up to $35 for certain services that are now free. Costs would be capped at 5 percent of their income per year. These changes would take effect after October 1, 2028.

Retroactive coverage of medical bills or nursing home fees would also decrease, dropping from three months of coverage to just one month, starting at the end of 2026. This benefit is often essential after sudden medical emergencies, such as needing immediate nursing home care, where Medicaid enrollees or their families incur out-of-pocket medical costs before Medicaid coverage has been approved. Retroactive coverage allows enrollees to recover such costs.

AARP is urging lawmakers to make any cost-sharing nominal so those at or near the poverty line do not face a financial barrier when accessing health care. AARP is also opposing the reductions in retroactive coverage, which could lead to larger financial losses for those needing Medicaid on an unforeseen basis.

3. Strengthening Medicaid in states

While the federal government provides a portion of the money and establishes minimum eligibility and benefit standards for Medicaid, states administer the program. States and their lawmakers determine the services and groups of people covered beyond the federal minimums.

One key decision states make is whether to offer Medicaid expansion. Under the Affordable Care Act, states were given the option to expand eligibility for Medicaid coverage to include adults up to age 64 earning less than 138 percent of the federal poverty level, or $21,600. The federal government pays 90 percent of the costs for Medicaid expansion, which is a higher proportion of the costs, compared with regular Medicaid. Only 10 states have not expanded Medicaid eligibility.

This year, AARP endorsed legislation to improve Medicaid for older Americans or fought restrictions on access and coverage in many states, including Georgia, Idaho, Iowa, Mississippi, Montana, Nebraska, Oregon, South Dakota and Texas.

In Montana, we backed legislation that makes the state’s Medicaid expansion permanent, helping secure health care for more than 81,000 low-income Montanans. Meanwhile, in Georgia and Mississippi we supported bills that would expand Medicaid, and in Idaho and Iowa we fought against bills to introduce work requirements for certain Medicaid recipients.

4. Joining with others to amplify our voice

In February, AARP joined the Modern Medicaid Alliance, a coalition of more than 100 national and regional advocacy organizations committed to protecting Medicaid. Alliance members include organizations representing consumers, doctors, nurses, other professionals, hospitals and insurers.

The alliance is working to educate policymakers and the public on Medicaid’s importance to local communities, especially in rural areas where access to health care is important to residents and a key part of the economy. Since February, when proposals to cut Medicaid emerged in federal budget discussions, the alliance has provided a steady stream of statements, studies and stories about the program’s critical role, including among older adults.

The Medicaid policies contained in the House bill have the potential to strip millions of low-income people of their health care coverage, destabilize hospital systems and medical providers that rely on Medicaid to operate, and force states to make further cuts to their Medicaid programs, the alliance says.

In a June 12 letter to Senate leadership that urged senators to reject the Medicaid provisions in the bill, the alliance wrote that “cutting upwards of $700 billion from the program will do real harm to all enrollees and among all providers” and “imposing new, massively bureaucratic mechanisms ... will result in unprecedented coverage loss.”

5. Educating decision-makers and the public on Medicaid’s importance

With Medicaid’s future under threat, AARP’s Public Policy Institute has published leading reports on Medicaid’s importance to older adults, along with analyses of the proposed Medicaid changes in the One Big Beautiful Bill Act.

In April, PPI released 52 fact sheets for the U.S., each state and the District of Columbia highlighting Medicaid’s value to older adults. Each fact sheet provides a detailed, data-driven breakdown of the population of older adults who rely on Medicaid and how they use the program, whether it's for coverage of home and community-based services, nursing home care or Medicare premiums and deductibles.

In May, PPI released two new reports, one highlighting the impact proposed work requirements could have on more than 9 million Medicaid enrollees ages 50 to 64 and another on Medicaid’s importance to more than 4 million family caregivers who rely on the program for their own insurance.

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Deirdre van Dyk is an AARP associate editor covering Social Security, caregiving, technology and fraud. She previously worked at USA Today and Time, where she covered business, government, sustainability and innovation.

Emily Paulin is an editor at aarp.org who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.