What Medicaid ‘big beautiful bill’ changes mean for family caregivers
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President Donald Trump’s “big beautiful bill” enacted in July requires adults ages 19 to 64 to rely on Medicaid for health insurance to meet certain work requirements.
A notable group of people who are exempt from these changes are eligible family caregivers.
About 7.3 million family caregivers ages 18 to 64 were Medicaid beneficiaries in 2025, out of a total of 63 million caregivers in the United States, according to data from AARP, a nonprofit, nonpartisan organization that advocates for Americans ages 50 and older.
Both the affected beneficiaries and the states responsible for implementing the changes have some time before the provisions of the Big Beautiful Bill Act come into force.
States have until January 1, 2027 to adopt the new working conditions.
How states implement these changes is crucial to ensuring family caregivers have uninterrupted Medicaid access, according to new research from AARP.
According to AARP data, family caregivers enrolled in Medicaid provide an average of 35 hours of unpaid care per week. Family caregivers provide nearly $600 billion in unpaid care annually, according to the nonprofit’s research.
“A family caregiver’s health is critical to their ability to provide care for their loved ones,” said Megan O’Reilly, AARP’s vice president of government affairs for health and family.
How do Medicaid changes affect caregivers?
OBBBA includes “community involvement” requirements, also called work requirements, for Medicaid beneficiaries ages 19 to 64.
Working conditions apply to registered persons. Health benefit expansion programs. Some states expanded their borders medical assistance programs Under the Affordable Care Act, we make all individuals below certain income levels eligible for coverage.
Advocates of new work requirements say the change encouraging people to find work and it also helps constrain federal spending. Critics said some employees could lose health insurance coverage due to restrictions due to complex reporting requirements.
The new federal law includes: $911 billion Work requirements account for the largest share of Medicaid cuts at approximately $326 billion, according to the Congressional Budget Office.
By law, individuals will be required to engage in employment, education, or other qualifying activities for at least 80 hours per month to qualify for Medicaid coverage.
Specifically, family caregivers who are responsible for children age 13 and under or individuals with disabilities of any age are exempt from this requirement.
It will be the responsibility of caregivers to successfully prove that they qualify for the exemption. States can help facilitate this process, according to new research from AARP.
What can states consider when implementing changes?
While states must adopt Medicaid community participation requirements by January 1, 2027, they must take all of the time leading up to that date to ensure they are fully prepared, according to AARP.
AARP notes that the initial implementation deadline introduces some flexibility, as states that show they are working to comply with the changes can seek a one-time extension of up to two years or through 2029.
The One Big Beautiful Bill Act also provides states with $200 million to support these enforcement efforts.
As states try to adapt, there are ways they can implement the law to help exempt family caregivers from Medicaid work requirements, according to AARP.
This includes efforts to ensure family caregivers who are enrolled in Medicaid are aware of the new changes and what they need to do to comply with them. According to AARP research, states can partner with health plans, providers and community-based organizations to ensure caregivers get the information they need.
“The one thing we know about family caregivers is that they’re tired,” O’Reilly said, and they may be caring for both children and aging parents.
“This outreach component will be critical to making sure people don’t get lost,” he said.
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States may limit the documentation and verification process family caregivers must undergo to prove they are qualified according to AARP, for example, through self-certification or checkboxes on online or paper registration forms.
States may also consider making compliance verification for both new and existing Medicaid enrollees required one month of qualification activity, the shortest period possible under the new law, according to AARP.
The new law requires states to complete compliance verifications both when a person first enrolls in Medicaid and when they renew coverage. While states have discretion to complete these verifications more frequently, AARP research points to less frequent rechecks as a way to “limit loss of coverage and provide some stability for enrolled caregivers.”
To help ensure that all Medicaid enrollees who qualify for a caregiver waiver receive it, states can also leverage multiple data sources, such as state agencies and area agencies focused on aging, according to AARP; Applications for Medicare, Social Security, Veterans Affairs, and other benefits disclosing caregiver status; and health records documenting the family’s caregiving situations.
More clarification on new Medicaid community participation requirements is expected when the Centers for Medicare and Medicaid Services issues an interim final rule by June.
