Issue #2 · June 2, 2026
New Medicaid requirements are rolling out state by state. Here's what caregiving families need to know.
The biggest story in elder care right now isn't about hospice directly, but it could ripple through millions of caregiving families. The 2025 Reconciliation Law included new Medicaid work requirements, and states are now figuring out how to put them into practice. Several states have already submitted or are preparing 1115 waivers, which are essentially requests to the federal government for permission to implement these rules in their own way. If you have a loved one who relies on Medicaid for home health services, personal care, or nursing home coverage, this is something to understand sooner rather than later.
At the same time, the conversation about artificial intelligence in healthcare keeps getting louder. Dr. Patrick Conway, the CEO of Optum, recently discussed how AI is being used across health services, including tools that help with care coordination and treatment decisions. For families dealing with hospice or home health, this might eventually show up as faster prior authorizations or more personalized care plans. But there are real questions about whether AI decision-making actually serves patients well, especially older adults with complex needs. We'll keep watching this one closely.
The Medicaid work requirements deserve your close attention, even if your loved one is over 65 and on Medicare. Here's why: many seniors receive both Medicare and Medicaid (these folks are often called "dual eligibles"), and Medicaid frequently covers services that Medicare does not, like long term personal care, home aides, and extended nursing facility stays. While most work requirement proposals include exemptions for people over a certain age or those with disabilities, the details vary dramatically from state to state. Some states are still sorting out their exemption criteria right now through those 1115 waiver applications.
What you should do is straightforward. Find out whether your state has submitted or plans to submit a work requirement waiver. If your loved one receives any Medicaid-funded services, make sure their enrollment information and any disability or age-based exemption documentation is current. Don't assume they'll be automatically exempt. States have a mixed track record when it comes to smoothly implementing these kinds of changes, and paperwork gaps can lead to temporary loss of coverage even for people who clearly qualify for an exemption.
Let's talk about something that surprises a lot of families: the difference between what Medicare covers for home health versus what Medicaid covers. Medicare will pay for skilled home health services, things like nursing visits, physical therapy, and occupational therapy, when a doctor certifies that the patient is homebound and needs skilled care. But Medicare does not cover long term custodial help. That means if your mom needs someone to help her bathe, dress, and prepare meals every day, Medicare won't pick up that tab.
That's where Medicaid often steps in for families with limited income and assets. Medicaid home and community-based services can cover personal care aides, adult day programs, and other supports that keep people out of nursing homes. These programs save states money compared to institutional care, and they're what many families depend on to keep aging loved ones at home. The average cost of a home health aide nationally runs around $30 to $35 per hour if you're paying out of pocket, which adds up to over $4,000 a month for just four hours of help per day. That's exactly why any disruption to Medicaid eligibility, including confusion around new work requirements, matters so much for caregiving families.
We know that keeping up with policy changes on top of everything else you're managing feels like a lot. That's part of why we're here. Best Hospice and Home Health is a completely free service for families, and we can help you find verified hospice and home care providers in your area whenever you're ready. If someone in your life is starting to ask questions about care options for a parent or spouse, please send them our way. Sometimes the hardest part is just knowing where to start, and we're happy to be that starting point.