How States Can Support Family Caregivers Under Medicaid’s Community Engagement Requirements

States play a crucial role in supporting the health and well-being of family caregivers through Medicaid, which provides health coverage to nearly 7.3 million caregivers ages 18 -64 as of 2025. This coverage helps caregivers sustain their caregiving roles and enables them to keep older adults and others they support in their homes and communities, where most prefer to be. However, new federal Medicaid policy changes will challenge states to ensure that family caregivers maintain their coverage. 

The recently enacted One Big Beautiful Bill Act (OBBBA) introduces new community engagement requirements (often called work requirements) for some adult Medicaid beneficiaries. While the law exempts family caregivers, questions remain about how states will implement the policy and ensure that family caregivers receive the exemption they are entitled to under the law. OBBBA provides states with some flexibility in designing and implementing these requirements, and those choices can have a direct impact on family caregivers. States, therefore, can and must take deliberate steps to protect family caregivers consistent with OBBBA. 

This Spotlight report highlights Medicaid’s critical role in supporting the health and well-being of family caregivers. It reviews the Medicaid community engagement requirements in OBBBA and the family caregiver exemption. Finally, it outlines options, enabled by the law, for states to consider as part of their efforts to protect continuity of coverage for family caregivers. Read the full report.

Key takeaways:

• About 7.3 million family caregivers ages 18 to 64 receive Medicaid coverage for their own health insurance.
• The One Big Beautiful Bill Act (OBBBA) introduces new community engagement requirements (also referred to as work requirements) for certain Medicaid beneficiaries. The law broadly exempts family caregivers; however, as states implement OBBBA, they will need to ensure that family caregivers receive the exemption to which they are legally entitled.
• Loss of Medicaid coverage can exacerbate the challenges family caregivers face and weaken the overall long-term care system by reducing their capacity to provide care for others while they also care for themselves.
• States have several tools to ensure continuity of coverage for family caregivers, including implementation of timelines, verification and reporting requirements, and targeted outreach. States can maximize available data sources to identify and/or verify an enrollee as a family caregiver on an ex parte basis, consistent with OBBBA’s requirements.