When faced with a medical crisis, the last thing you should have to worry about is navigating unnecessary bureaucratic hurdles. But a looming new health care law, included in the so-called Big Beautiful Bill, makes federal changes to Medicaid that will only make it harder for those who rely on both Medicaid & Medicare for their health coverage—especially older adults and people with disabilities—to get and keep the care they need. 

As someone with complex health conditions, Maria credits her independence to the health coverage and care she receives through Medicare and Medicaid. “[Medicaid and Medicare] really allow me to be as independent as possible. So, although I do live with my family, I really try to structure my life and my lifestyle so that I can do everything that I want to do without total reliance on them.” 

Despite finding the right health care plan—one that integrates her Medicare and Medicaid benefits and covers the services and supplies she needs to be and stay healthy—Maria still runs into problems with her coverage. Health care providers routinely charge her copays she shouldn’t owe, administrative staff pose confusing questions about her insurance status, and insurance claims that should be processed automatically, often get denied or delayed. 

The health care system is far from perfect, and with the Big Bad Bill going into effect, Maria’s health and freedom to live her life is on the line.

Here’s how the largest health care cuts in American history threaten the health of the 12.5 million dually eligible people who receive health coverage through Medicare and Medicaid:
Cuts to Home and Community-Based Services & Other Vital Care 

Beginning now, federal Medicaid funding is being reduced—leaving states with less money for home and community-based services (HCBS) and other vital supports. HCBS is designed to meet medical needs or support daily living and includes services like skilled nursing care, physical therapy, meal programs, adult daycare and more. For people with long-term complex health needs, reduced funding for these programs means: 

  • Fewer at-home services and supports such as caregiver training, medication management, and help with daily living activities like eating, dressing and bathing
  • Longer wait lists
  • Health care staffing shortages
  • Stricter eligibility rules
  • Reduced access to essential services such as adult dental, vision, and hearing care 

In the past, states have responded to funding cuts by reducing their HCBS offerings, and we’re seeing the same pattern emerge under the Big Bad Bill. Effective Sept 1, Idaho implemented 4% cuts to Medicaid providers including nursing homes’, home health, and personal care services. 

These cuts to HCBS threaten the health and independence of people like Maria for whom these services are a lifeline. Without access to care at home and in their communities, many dually eligible individuals will no longer have the freedom to choose where they live and receive care – forcing them into medical debt, nursing homes or other costly institutions. And let’s be clear, cutting or reducing HCBS does nothing to cut costs. In fact, it does the opposite. Reducing these services and supports will force people into expensive institutional care like nursing homes and long-term hospitals, driving up costs across the board: families will pay more out-of-pocket and our health system will have higher emergency and hospital expenses. What may look like budget savings will actually only create higher costs for everyone.  

More Red Tape, Fewer People Covered 

The new rules introduce costly, time-consuming, and complex bureaucratic hurdles to the Medicaid enrollment process—additional income verification, complex paperwork, work requirements, frequent renewals and eligibility checks, and decreased retroactive coverage—making it harder for older adults, people with complex health needs, and their caregivers to get and keep coverage.  

In states that have expanded Medicaid, people will be required to meet work reporting requirements every month. These requirements put older adults, people with disabilities, family caregivers, people living with chronic health conditions, and direct care workers at risk of losing coverage because many won’t qualify for the narrow exemptions or will struggle to navigate reporting red tape and paperwork.

Dually eligible people, who already struggle to navigate complex enrollment systems, are at risk of incorrectly losing coverage due to paperwork issues. While technically exempt from many of the enrollment hurdles introduced by HR 1, history has shown that dually eligible people often lose coverage even when they should not. States are already cutting funding and staffing that could help prevent these losses – Idaho Gov. Brad Little has already ordered Idaho state agencies to reduce their budgets.  

These increased hurdles and further strained systems will lead to: 

  • Loss of coverage for older adults, people with disabilities, family caregivers, and direct care workers
  • Reduced capacity of home health and caregivers
  • Increased reliance on expensive long-term care institutions and facilities
  • Greater confusion and less coordination, with more individuals slipping through the cracks
  • More expensive medical bills leading to increased medical debt 
Our Health Care System is on the Line 

These changes are just one part of the largest cuts to health care in recent history—pushed through by congressional Republicans and rubber-stamped by the president. All to give tax breaks to the wealthy and big corporations. The new health care law does nothing to make health care more affordable or accessible; in fact, they do the opposite: piling on new barriers, slashing support for home care and services, and jeopardizing the coverage of hard-working people.  

These changes won’t just hurt people at the margins—they’ll hurt millions of families across the country who rely on coverage from both Medicaid and Medicare for stability and peace of mind for themselves or their loved ones.  

While this new law may seem like it just adds paperwork to the process, for many people—like Maria—the consequences could be devastating. Without access to the care she needs, Maria will lose her health, her independence and her autonomy. 

A woman with curly blonde hair, glasses, and a pink blouse is speaking on-camera.
As someone with complex health conditions, Maria credits the benefits she receives through her dual eligibility for Medicare and Medicaid for her personal independence. But those benefits didn’t come easily. Navigating two health care systems and finding the right health care plan took more than three months of phone calls, dead end leads, and countless denials. Maria today has a plan that better serves her needs. But most impotently, she has her life back.

Health care is a human right—not a privilege reserved for the wealthy, or a bargaining chip for corporate tax cuts. No matter our race, income or where we live, we all deserve to be able to get the care we need to stay healthy and keep our communities thriving. Congress must repeal the Big Bad Bill’s health care cuts and pass the Protecting Health Care and Lowering Costs Act to keep coverage affordable and keep communities strong by preserving access to care. 

Your Story Matters—Help Us Fight Back 

If you or someone you love relies on Medicaid and Medicare, your voice can make a difference. 
 
Record a short video sharing how these changes could affect your life—whether you’re a caregiver, an older adult, someone with a disability, or just trying to stay healthy and housed.   

Your story will show policymakers what’s really at stake and can help us demand better. 

Click here to record your story now

Let’s make sure those in power hear from the people these cuts will harm the most. 

Read More from Our Partners at Justice in Aging 

For a deeper dive into the policy changes above and what they mean for older adults, people with disabilities, and over 12 million people that are dually eligible for Medicare and Medicaid, check out these trusted resources from our partners at Justice in Aging: 

Justice in Aging also regularly publishes blogs, webinars, and policy updates, including resources focused on California and other states grappling with policy implementation.