Issue #6 · November 3, 2026
New Medicaid work requirements are rolling out state by state. Here's what families need to know.
If you've been hearing about Medicaid work requirements and wondering what they actually mean for your family, you're not alone. The 2025 reconciliation law included provisions requiring certain Medicaid recipients to meet work or community engagement requirements to keep their coverage. States are now in various stages of applying for and implementing these rules through what are called 1115 waivers, and the picture looks different depending on where you live.
This matters enormously for elder care. Many family caregivers in their 40s, 50s, and 60s rely on Medicaid for their own health coverage, especially those who have reduced their work hours or left jobs entirely to care for aging parents. If a caregiver loses Medicaid coverage because they can't meet a work requirement while also providing round the clock care for a loved one, the ripple effects hit everyone. Meanwhile, home health aides and direct care workers, many of whom are Medicaid enrollees themselves, could also be affected, potentially worsening an already strained workforce.
The implementation questions are piling up fast. Which exemptions will apply to family caregivers? How will states verify compliance? What happens during the gap between a coverage termination and an appeal? These are not abstract policy questions. They are the kinds of details that determine whether your mom's home health aide shows up next month or whether your sister who quit her job to help Dad can still see her own doctor.
The single most important thing to do right now is find out what your state is doing. Some states are aggressively pursuing these waivers and could have work requirements in effect soon. Others are moving more slowly or may seek broad exemptions for caregivers and older adults. Your state Medicaid office website is the best starting point, and the Kaiser Family Foundation is tracking each state's progress if you want a clearer national picture.
If you or anyone in your family currently receives Medicaid, make sure all contact information on file with your state Medicaid agency is current. When states rolled out eligibility redeterminations after the pandemic, hundreds of thousands of people lost coverage simply because renewal notices went to old addresses. The same thing could happen here. Keep your address and phone number updated, respond to any mail from your state's Medicaid office immediately, and don't assume that being a caregiver automatically exempts you until you've confirmed it in writing.
Let's talk about why a Medicaid disruption can be so financially devastating for families managing elder care. Medicaid is the single largest payer for long term care in the United States, covering roughly 60% of all nursing home residents and funding a huge share of home and community based services. If a loved one loses Medicaid coverage, the out of pocket cost for a home health aide averages around $30 per hour nationally, which adds up to over $5,000 a month for just eight hours of daily help. Nursing home care without Medicaid runs $8,000 to $10,000 a month or more in most states.
For family caregivers who lose their own Medicaid coverage, marketplace insurance plans can cost several hundred dollars per month even with subsidies, and going uninsured is a financial time bomb. One medical emergency could wipe out savings that the family needs for their loved one's care. If you think anyone in your household could be affected, now is the time to talk with a benefits counselor. Your local Area Agency on Aging can connect you with one for free, and many State Health Insurance Assistance Programs, known as SHIP, offer free counseling specifically about coverage options for older adults and their caregivers.
We know that policy changes like these can feel overwhelming, especially when you're already stretched thin caring for someone you love. That's exactly why we're here. Best Hospice and Home Health is a completely free service for families, and we're happy to help you find verified hospice and home care providers in your area no matter what your insurance situation looks like. If this newsletter was helpful, please forward it to a friend, a coworker, or anyone in your life who might be facing these decisions. Nobody should have to figure this out alone.