Looming Changes to Medicaid Could Hurt These Older Americans. Here’s How

Many caregivers are likely to be in a similar position. About 4.3 million family caregivers rely on Medicaid for their health care coverage, according to AARP research. A quarter are 50 to 64 years old and most of the remaining are adults under 50 who often take care of a parent or grandparent. On average, this group provides 35 hours of care per week for loved ones, with close to two in five dedicating 40 hours or more per week.

Under the new law, caregivers are exempt from the work requirements, but only if they are a “parent, guardian, caretaker relative or family caregiver of a dependent child 13 years of age and under or a disabled individual.” The bill’s definition of a caregiver is “narrow and administratively complex,” AARP’s LeaMond wrote in a June 29 letter to Senate leadership. Who, exactly, will be classified as a disabled individual remains unclear — for example, will someone with a chronic condition or a functional limitation qualify? — and has been left to federal and state officials to decide.

Even for those caregivers who do end up fitting the bill’s definition of a caregiver, proving as much could be hard. Federal and state infrastructure are in place to track employment activity or disability status, but similar systems for unpaid caregiving typically don’t exist. Caregivers are also likely to face a higher paperwork load compared to others trying to satisfy the work requirements because they could have to prove the status of both the individual in need of care and the one providing it.

If Fertitta must prove Emily has a disability and that he is her son, he is confident he could do so with documents he already has on hand. But when it comes to proving his round-the-clock care, he wouldn’t know where to start. “I’m not exactly sure how I would do that other than say, ‘Take a long journey and come hang out with me for a week,’” he says.

Now that the work requirements have become law, states (which administer Medicaid) will be responsible for building the systems that track eligibility — and quickly. The new law demands work requirements start by the beginning of 2027 at the latest unless a state is granted a temporary delay. It gives states the option to start them earlier, though, if they are granted a waiver.

Loss of coverage could be fatal

For people who are sick and rely on Medicaid, the new law also poses risks.

At the Rocky Mountain Cancer Center, located at the eastern foot of the mountain range in Colorado Springs, Leilia Gibson-Green, 63, has a recurring appointment every four weeks. Her attendance “is not optional,” she says. “It’s essential.”

About 10 years ago, Gibson-Green was diagnosed with Stage 4 blood cancer. Years of chemotherapy and other forms of treatment helped her recover, but her immune system was compromised. She now needs an intravenous immunoglobulin treatment every four weeks and will for the rest of her life, she says. Medicaid covers the costs of about $40,000 per round.

Gibson-Green works up to 20 hours per month as a community coordinator. Her health prevents her from doing more. “The treatment has side effects, so for one or two, or sometimes three, weeks out of the month, I’m sick,” she says. “There’s no way I could work 80 hours a month.”

While the new law exempts people with a “serious or complex medical condition” from work requirements, it’s unclear which conditions will qualify. Gibson-Green has been denied for Social Security Disability Insurance (SSDI) three times; her conditions were deemed not severe enough. She wonders if the same could happen with a Medicaid work requirement exemption.

But even if Gibson-Green is granted the exemption, maintaining it could be hard. Enrollees like Gibson-Green who are part of the Medicaid expansion population — meaning they became eligible for Medicaid coverage under the Affordable Care Act (ACA) expansion— must prove eligibility twice as often as they do now, so every six months. The legislation gives states flexibility to require proof as often as they wish though.

If past experiments with state work requirements offer a national preview, the future for millions of Medicaid enrollees looks bleak.

Arkansas put considerable money and effort into implementing work requirements in 2018 before a federal court deemed the policy unlawful 10 months after it took effect. Proponents argued the requirements would lead to an increase in the number of poor people who worked. Research showed no significant change in employment and, instead, more than 18,000 people lost coverage — the vast majority of which actually met the requirement or qualified for an exemption but failed to report it.

Researchers predict a similar outcome from federal work requirements, where employment does not increase but rates of uninsured Americans rise instead. More than 10 million people are estimated to lose Medicaid coverage within the decade under the One Big Beautiful Bill Act, according to the CBO’s analysis of the House version of the bill. That number could rise even higher under the final version of the legislation, which includes deeper Medicaid cuts.  

If Gibson-Green were to lose her Medicaid coverage, she fears for her future. “If I lost my Social Security, I’d lose my home, but I’d find shelter. If I lost [food assistance], there are food pantries. But insurance,” she says. “I can’t get my life back.”