There Are Big Changes Coming to Medicaid: What You Need to Know to Protect Your Health, Home and Independence

If you receive Medicaid, no doubt you are aware that it provides essential assistance to yourself, along with millions of other Americans who need help paying medical bills, obtaining long-term care, or remaining in your own home.

However, upcoming federal policy changes could soon affect the resources some older women depend on, from healthcare costs to affordable housing.

Federal legislation enacted in July 2025, known as the One Big Beautiful Bill Act (H.R.1), includes substantial changes to Medicaid financing, eligibility procedures, and certain out-of-pocket healthcare costs. Meanwhile, federal housing funding decisions could affect the availability of affordable housing for older adults.

Bear in mind that although these changes won’t affect everyone in the same way, understanding them now can help you make informed decisions.

So, let’s now look at what is changing, what it could mean for you, and the practical steps you can take now to protect your future!

The New Medicaid Work Requirement: Does It Affect Senior Women?

You’ve probably heard about the new Medicaid requirement involving 80 hours of work or other qualifying activities each month.

Beginning no later than January 1, 2027, states must generally implement this requirement for certain adults ages 19 through 64 who receive Medicaid through specified eligibility categories and are not enrolled in or entitled to Medicare. Some states may implement it earlier.

People subject to the requirement may need to demonstrate 80 hours per month of qualifying activities, such as:

• Paid employment.
• Qualifying volunteer or community service.
• Approved employment or training programs.
• Certain educational activities.

Some individuals may meet the requirement through qualifying monthly earnings instead. Certain groups are exempt, including people who meet specified disability or medical-frailty criteria and certain caregivers.

The Important Distinction for Women Over 65

If you’re 65 or older and enrolled in Medicare, the new 80-hour Medicaid work requirement generally does not apply to you.

However, being exempt from the work requirement does not exempt you from every other Medicaid policy change. Older women who receive both Medicare and Medicaid may still be affected by changes to other aspects of the program, depending on your eligibility category, state, and the particular provision.

If you’re under 65 and receive Medicaid, don’t assume you’re exempt. Ask your state Medicaid agency whether the requirement applies to you and whether you qualify for an exemption.

What You Can Do

• If you’re subject to the requirement, find out which activities qualify and how your state will verify them.
• Keep records of work hours, qualifying activities, and any documentation supporting an exemption.
• If a notice says you haven’t met the requirement, respond promptly and follow the instructions for proving compliance or exemption.
• If you believe the requirement has been applied incorrectly, ask about your appeal rights.

For older women already receiving Medicare, the more useful priority is to understand the other changes that could affect Medicaid benefits.

More Frequent Medicaid Eligibility Reviews: Keep Your Benefits on Track

One of the upcoming changes involves how often certain Medicaid recipients must have their eligibility reviewed.

Beginning with renewals scheduled on or after December 31, 2026, states must generally conduct eligibility redeterminations every six months for adults covered through the Affordable Care Act‘s Medicaid expansion group. Previously, these adults generally received annual eligibility reviews.

This does not mean that every woman over 65 who receives Medicaid will automatically have to renew every six months. Different rules apply to people whose eligibility is based on age or disability.

Nevertheless, keeping your records organized is important for anyone who receives Medicaid, because a missed notice, outdated address, or incomplete application can create unnecessary problems when your eligibility is reviewed.

Tips to Protect Your Benefits:

• Keep your contact information current. Make sure your state Medicaid agency has your correct mailing address, telephone number, and other requested information.
• Open every official notice. Don’t assume a letter is unimportant simply because you recently renewed your benefits!
• Create a benefits calendar. Record renewal dates and set reminders well before deadlines.
• Keep copies of your documents. Save applications, notices, supporting paperwork, and confirmation numbers.
• Ask for assistance. If you don’t understand a form, contact your local Medicaid agency or a benefits counselor.

If your coverage is denied or terminated, request a written explanation and information about your appeal rights. Pay attention to the deadlines in the notice.

A few minutes of organization today could save you considerable stress later.

Could Medicaid Changes Affect Your Access to Doctors and Healthcare?

Medicaid funding changes may also put financial pressure on states and healthcare providers.

The 2025 federal law places new restrictions on certain ways states finance Medicaid and make additional payments to healthcare providers. These changes are being phased in over time.

It is important to pay attention to these changes, because when states have fewer resources to finance Medicaid, they may face difficult decisions about program spending. Depending on how a state responds, healthcare providers could face financial pressures that affect their willingness or ability to participate in Medicaid.

This is a potential concern, not a guarantee that your doctor or hospital will stop accepting Medicaid, but be aware.

What to Do:

• Ask your doctors whether they expect any changes to their participation in your insurance networks.
• Keep a current list of your healthcare providers and their contact information.
• If a provider stops accepting your coverage, ask your insurer or Medicaid agency for help finding an appropriate alternative.
• If you receive care through a Medicaid managed care plan, review any notices about network or benefit changes.
• Avoid delaying necessary care because of rumors about possible changes. Confirm your coverage with the appropriate agency or insurer.

If you rely on specialists, prescription medications, or regular treatments, knowing where to turn if your circumstances change can give you greater peace of mind!

New Healthcare Cost-Sharing Rules: Could You Pay More?

Another important change involves certain out-of-pocket healthcare costs.

Although this is not an imminent change, you should be aware that starting on October 1, 2028, the federal law will require states to impose cost sharing for certain nonexempt services on some adults covered through Medicaid expansion whose incomes fall between 100 percent and 138 percent of the federal poverty level.

The law will allow charges of up to $35 per service for covered services subject to the rule. Certain services, including primary care and mental health services, are exempt under the new requirements. Special protections also apply to certain populations and services.

What Will This Mean for Older Women?

The new requirement will be directed at a specific group of Medicaid expansion adults. It does not mean that everyone receiving Medicaid will suddenly face these charges.

For example, an older woman enrolled in both Medicare and Medicaid may be subject to different rules depending on her eligibility category and the services she receives.

Steps to Take:

• Know which program pays your bills. If you have both Medicare and Medicaid, ask how the two programs work together.
• Check your eligibility for Medicare Savings Programs. Depending on your income and resources, you may qualify for assistance with Medicare premiums and, in some cases, other Medicare costs.
• Review bills and explanations of benefits. If you receive a bill you don’t understand, contact the provider or insurer before paying it.
• Ask about assistance before skipping care. If a medical expense becomes difficult to afford, ask your healthcare provider or benefits counselor about available financial assistance.

Understanding your coverage can help you avoid unnecessary expenses and make informed healthcare decisions!

Home-Care Services: Protecting Your Ability to Age in Place

For many women, remaining in their own home is a top priority.

You may love your neighborhood, enjoy your independence, and prefer familiar surroundings, as opposed to moving into a nursing facility.

Medicaid can help make this possible by covering certain Home and Community-Based Services (HCBS).

Depending on your state and eligibility, these services may include:

• Assistance with bathing and dressing.
• Help with preparing meals.
• Personal-care assistance.
• Certain services that support independent living.
• Other approved services that help eligible individuals remain in the community.

Be aware, though, that Medicaid home-care services are not identical in every state. Some services are provided through state plans, while others are offered through waiver programs that may have enrollment limits or waiting lists.

Federal funding reductions could put pressure on state budgets and make decisions about these services more difficult. The effects will depend on the state and the specific program.

How to Protect Your Access to Care

If you currently receive home-care services, start by reviewing your existing benefits.

Ask your Medicaid agency, caseworker, or managed care plan:

• Which services am I currently approved to receive?
• How many hours of assistance have been authorized?
• When will my care plan or eligibility be reviewed next?
• What should I do if my needs increase?
• Where can I get help if my services are reduced or denied?

Keep copies of your care plan and any notices about changes to your services.

If your benefits are reduced or terminated, request a written explanation and learn how to appeal. Follow the deadlines in your notice.

It’s also wise to explore backup resources, such as meal delivery, transportation, caregiver support, and local senior services.

Affordable Senior Housing: Why You Should Start Looking Early

Federal housing programs help eligible older adults find affordable rental housing, but demand can exceed available resources in many communities.

The administration’s proposed fiscal year 2027 budget and congressional funding decisions may affect programs that support affordable housing and the construction of new units. A proposed budget reduction should not be treated as a final funding decision, however; the outcome depends on the appropriations process and the program involved.

There are several programs worth investigating:

• Section 202 Supportive Housing for the Elderly. This federal program supports affordable rental housing for eligible older adults, sometimes with supportive services.
• Housing Choice Vouchers. These vouchers help eligible households afford private-market rental housing, subject to program requirements and local availability.
• Public Housing. Some local housing authorities operate public housing developments for eligible older adults and people with disabilities.
• State and Local Assistance. Your state or community may offer additional rental assistance, accessible housing, or home-modification programs.

What You Can Do Now:

• Contact your local public housing agency and ask which waiting lists are open. If a waiting list is closed, ask when applications may reopen and whether other housing programs are available.
• Apply to suitable programs as early as possible.
• Ask how to keep your application active.
• Keep your mailing address and telephone number current.
• Investigate accessible apartments if you have mobility limitations.
• Ask whether local programs can help with ramps, bathroom modifications, or other home improvements.

You don’t have to be ready to move to begin exploring your options – be the early bird!

Protect Your Home and Understand Medicaid Estate Recovery

If you own your home, you may worry about what will happen to it if you eventually need Medicaid to help pay for long-term care.

Federal law requires states to pursue certain Medicaid estate recoveries, particularly for specified long-term-care expenses paid for people aged 55 and older. State laws and procedures determine how recovery works within federal requirements.

Estate recovery generally occurs after a recipient’s death. It does not automatically mean that everyone receiving Medicaid must sell their home to qualify for benefits.

Certain protections may apply, including circumstances involving a surviving spouse or certain surviving children. States must also provide procedures for requesting hardship waivers.

Your Action Plan:

• Ask your state Medicaid agency for information about estate recovery.
• Consult a qualified elder law attorney if you own a home and anticipate needing Medicaid-funded long-term care.
• Review your will and broader estate plan.
• Before transferring property or giving away assets, obtain legal advice about potential Medicaid consequences.

Avoid making major financial decisions based on alarming headlines or unverified advice! A qualified professional can help you understand the rules and evaluate your options.

Build Your Personal Healthcare and Housing Safety Net

Even if you aren’t currently experiencing difficulties, preparing for the future can help you feel more confident.

Start by gathering important documents and keep them all in one place.

Include:

• Medicare and Medicaid information.
• Contact details for doctors and other healthcare providers.
• A list of your medications and important medical information.
• Notices about your benefits and renewal dates.
• Housing applications and correspondence.
• Information about retirement income, insurance, and monthly expenses.
• Contact details for trusted family members or professionals who may be able to help.

Next, Consider Your Future Needs:

• Would you be able to manage your home if you had difficulty walking?
• Who could help with transportation or meals?
• Are there affordable housing options nearby if you eventually need to move?

You don’t have to answer every question immediately. Begin with the issues that matter most to you.

Where to Find Free Assistance:

• Medicaid: Medicaid.gov provides information about the program. Contact your state Medicaid agency for advice about your individual benefits.
• Housing assistance: HUD.gov provides information about federal housing programs and local housing agencies.
• Local senior services: Eldercare.acl.gov can help you locate your Area Agency on Aging and other community resources.
• Medicare counseling: Your State Health Insurance Assistance Program (SHIP) offers free, personalized Medicare counseling.
• Legal assistance: Local legal aid organizations and elder law attorneys may be able to help with benefit denials, housing problems, and estate recovery questions.

Be cautious about anyone who promises guaranteed benefits in exchange for an upfront fee or who pressures you to provide financial information immediately!

Your Future Is Worth Protecting!

Changes to Medicaid and federal housing programs may create challenges for some older women, especially those who depend on home-care services, need affordable housing, or have limited financial resources.

But you have meaningful steps you can take today.

Understand which rules apply to you. Keep your paperwork organized. Investigate housing options before an urgent need arises. Review your healthcare coverage and learn how to challenge a decision you believe is incorrect.

Most importantly, don’t assume that every headline applies to your situation.

Your best first step is to understand your current benefits and find out which changes, if any, could affect you personally.

You don’t have to solve every potential problem today. One phone call, one application, or one conversation with a knowledgeable benefits counselor can be a valuable beginning.

A little preparation today can help you move from fear and uncertainty regarding these changes to Medicaid to a tomorrow filled with knowledge, empowering you to make the best decisions for YOU in the future!

Questions:

How do you feel about all these changes coming to Medicaid? Are there any links or information you can share that you’ve found useful to help you navigate Medicaid?