Medicaid Changes in the ‘One Big Beautiful Bill’ Act: A Guide for Family Caregivers

Medicaid Changes in the ‘One Big Beautiful Bill’ Act: A Guide for Family Caregivers

In July 2025, the One Big Beautiful Bill Act (OBBBA) was signed into law. Among its many provisions are significant changes to Medicaid: the public health insurance program that millions of family caregivers rely on for their own health coverage — and for the people they care for.

Under the new law, many Medicaid beneficiaries ages 19–64 will eventually need to meet “community engagement” (work) requirements to keep their coverage. Importantly, qualifying family caregivers are exempt from these work requirements. However, caregivers may still need to prove their eligibility for the exemption, and how easy (or difficult) that process is will depend heavily on how each state implements the law.

New research from AARP emphasizes that strong state implementation is essential to prevent caregivers from losing coverage due to paperwork barriers, lack of information, or administrative delays.

As AARP notes, caregiver health is essential to caregiving itself — coverage disruptions can have ripple effects on entire families.

What the Law Requires (and Who Is Exempt)

  1. Medicaid Work (“Community Engagement”) Requirements
    1. Apply to Medicaid expansion enrollees ages 19–64
    2. 80 hours per month of work, job training, education, or similar qualifying activities
  2. Family Caregiver Exemptions
    1. Cares for a child age 13 or younger, or
    2. Cares for a person with a disability of any age

Why State Implementation Is So Important

States have flexibility in how they apply the law, and that flexibility can either protect caregivers — or put coverage at risk. States must adopt these requirements by January 1, 2027 (with possible extensions to 2029).

According to AARP research, states can help caregivers by:

  • Providing clear, accessible outreach about new Medicaid rules
  • Partnering with health plans, providers, and community-based organizations
  • Allowing self-attestation or simple checkboxes to confirm caregiver status
  • Limiting verification to one month of qualifying activity–the shortest allowed timeframe
  • Reducing how often caregiver status must be re-verified to prevent coverage “churn,” which occurs when an individual loses and regains coverage over the course of a year
  • Using existing data sources (aging services, disability programs, VA, Social Security, health records) to identify caregivers automatically

Medicaid caregiverWhat Family Caregivers Can Do Now

Protect Your Coverage

  • Document your caregiver status via medical documentation, school records, disability determinations if applicable.
    • Caregivers must document or attest that they qualify for the exemption; this is where problems may arise if states do not design caregiver-friendly systems.
  • Watch for Medicaid notices — do not ignore mail or online messages
  • Ask your state Medicaid agency how caregiver exemptions will be verified

Stay Informed

  • Follow updates from your state Medicaid agency
  • Watch for federal guidance from Centers for Medicare & Medicaid Services — an interim final rule is expected by June 2026

If You Run Into Problems

  • Request help from enrollment assisters or navigators
  • Ask about appeal rights if coverage is delayed or terminated

Helpful Resources for Caregivers

Caregiver Action Network (CAN): Support, education, and advocacy for family caregivers

Medicaid (Official Federal Site): State contacts, eligibility, and program rules

AARP – Caregiving & Public Policy: Research and advocacy on caregiver protections

State Health Insurance Assistance Programs (SHIPs): Free, unbiased help navigating public coverage

Aging & Disability Resource Centers (ADRCs): Local, community-based support