Introduction to the One Big Beautiful Bill Act
The One Big Beautiful Bill Act, enacted in July, introduces new work requirements for adults aged 19 to 64 who rely on Medicaid for health coverage. However, qualifying family caregivers are exempt from these changes. According to data from the AARP, a nonprofit organization that advocates for Americans aged 50 and over, about 7.3 million family caregivers aged 18 to 64 were Medicaid beneficiaries in 2025.
Family caregivers enrolled in Medicaid provide an average of 35 hours of unpaid care per week, with an estimated $600 billion in annual unpaid care, according to AARP research. The health of a family caregiver is critical to their ability to provide care to their loved ones, says Megan O’Reilly, vice president of government affairs for health and family at AARP.
How Medicaid Changes Affect Caregivers
The One Big Beautiful Bill Act includes “community engagement” requirements, also known as work requirements, for Medicaid beneficiaries aged 19 to 64. These requirements apply to enrollees in Medicaid expansion programs, which certain states expanded under the Affordable Care Act to make all individuals below certain income levels eligible for coverage.
Proponents of the new work requirements argue that the change could incentivize people to find work and help curb federal spending. Critics, however, claim that some workers may lose health insurance coverage due to complicated reporting requirements. The new federal law includes $911 billion in Medicaid cuts, with work requirements accounting for the largest share at approximately $326 billion, according to the Congressional Budget Office.
Per the law, individuals will need to have at least 80 hours per month of employment, training, or other qualifying activities to qualify for Medicaid coverage. Notably, family caregivers responsible for children aged 13 and under or disabled individuals of any age are exempt from this requirement.
Implementation of the New Law
States have until January 1, 2027, to adopt the Medicaid community engagement requirements. However, they may seek a one-time extension of up to two years, or until 2029, if they demonstrate they are working toward compliance. The One Big Beautiful Bill Act also provides $200 million to states to support implementation efforts.
As states work toward compliance, they can implement the law to help ensure family caregivers are exempt from the Medicaid work requirements. This includes efforts to inform family caregiver enrollees in Medicaid about the new changes and what they need to do to comply. States may partner with health plans, providers, and community-based organizations to ensure caregivers receive the necessary information.
Supporting Family Caregivers
States can limit the documentation and verification process for family caregivers to prove they qualify, such as through self-attestation or checkboxes on online or paper registration forms. They may also consider making compliance verification for both new and existing Medicaid enrollees require one month of qualifying activity, the shortest possible time period under the new law.
To ensure all Medicaid enrollees who qualify for the caregiver exemption receive it, states may draw from multiple sources of data, such as state units and area agencies focused on aging, applications for Medicare, Social Security, Veterans Affairs, and other benefits that disclose caregiver status, and health records that document family caregiving situations.
Conclusion and Next Steps
More clarification on the new Medicaid community engagement requirements is expected when the Centers for Medicare and Medicaid Services issues an interim final rule, due by June. In the meantime, states must take the necessary steps to ensure uninterrupted Medicaid access for family caregivers.
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Smart Tip for Readers
If you are a family caregiver, it is essential to stay informed about the new Medicaid community engagement requirements and how they may affect your coverage. Reach out to your state’s Medicaid office or a local non-profit organization for guidance and support to ensure you receive the necessary exemptions and continue to provide care for your loved ones.
