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In July, President Donald Trump enacted the “Big and Beautiful Bill,” which sets new work requirements for adults aged 19 to 64 relying on Medicaid for their health coverage.
Family caregivers, however, are notably exempt from these requirements.
A forecast suggests that by 2025, around 7.3 million family caregivers aged 18 to 64 will be eligible for Medicaid, part of the estimated 63 million caregivers across the U.S., as indicated by AARP, a nonprofit organization advocating for older Americans.
There’s a bit of breathing room for affected beneficiaries and the states, as the rules from the One Big Beautiful Bill Act won’t kick in immediately.
States have until January 1, 2027, to implement the new work requirements.
The way states carry out these changes will be crucial for ensuring that family caregivers continue to access Medicaid, according to a recent study from AARP.
AARP’s data reveals that those family caregivers enrolled in Medicaid typically provide about 35 hours of unpaid care each week. In total, the estimated value of their unpaid care reaches approximately $600 billion annually.
“The well-being of family caregivers is essential for them to provide care effectively,” stated Megan O’Reilly, AARP’s vice president for health and families.
Impact of Medicaid changes on caregivers
The OBBBA introduces a “community involvement” requirement, basically a work requirement tailored for Medicaid recipients between 19 and 64 years old.
This applies to registrants of the Medicaid expansion program. Individuals with incomes below a specific threshold qualify for coverage based on the Affordable Care Act.
Proponents argue that these new work requirements might motivate people to seek employment while also keeping federal spending in check. On the flip side, critics worry that the complicated reporting processes may leave some without health insurance due to these restrictions.
The new federal guidelines stipulate that individuals must log at least 80 hours of work, training, or other approved activities each month to qualify for Medicaid.
Family caregivers of children under 13 or individuals with disabilities at any age are exempt from this rule. However, caregivers need to demonstrate their eligibility for this exemption, and states can help simplify that process, as per AARP’s findings.
What states should consider as they implement changes
States have a timeline until January 1, 2027, to roll out these Medicaid community engagement requirements, a timeframe AARP suggests should be effectively utilized for thorough preparation.
The initial deadline offers some flexibility; states working toward compliance can request one extension, possibly lasting two years or going until 2029.
Additionally, the One Big Beautiful Bill Act allocates $200 million for states to facilitate these implementation efforts.
As states move toward compliance, AARP emphasizes that there are methods to enforce exemptions for family caregivers from Medicaid work requirements. This could involve making sure that those caregivers enrolled in Medicaid are well-informed about the changes and what they need to do going forward. Collaborating with health plans, providers, and community organizations could assist in this information dissemination, as highlighted in their report.
“We understand that family caregivers might feel overwhelmed, especially when juggling responsibilities for both children and aging parents,” O’Reilly noted. “Outreach will be crucial to prevent people from feeling lost in the process.”
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AARP suggests that states could ease the documentation and verification steps for family caregivers seeking to prove their eligibility, perhaps via self-certification or quick-check options on registration forms.
They recommend implementing a one-month eligibility exercise for new and existing Medicaid enrollees as the minimal time frame under the law.
To maintain eligible caregivers in the Medicaid program, states must verify compliance during initial enrollment and coverage renewals but can do so even more frequently if they choose. However, reducing the frequency of re-verifications could help stabilize caregiver enrollment, according to AARP.
States can leverage data from various agencies, including those focused on aging, to ensure that all eligible caregivers receive Medicaid. This would include information from Medicare applications, Social Security, Veterans Affairs, and even health records reflecting the caregiving status of family members.
Further clarity on these new Medicaid community engagement requirements is expected when the Centers for Medicare and Medicaid Services release an interim final rule, which is anticipated by June.
