Significant Changes to Medicaid Home Care Eligibility by 2034

A recent analysis projects significant changes in the eligibility for Medicaid's home care services, with an anticipated reduction of 311,879 individuals by 2034, largely due to modifications under the HR 1 legislation. Insights from the 2026 Medicaid Home Care Chartbook, released by the National Alliance for Care at Home and the Research Institute for Home Care, underscore these impending shifts.

The report emphasizes major eligibility changes for Medicaid's home and community-based services (HCBS), highlighting a shift towards in-home care instead of center-based or residential options. Key policy adjustments include more stringent eligibility verifications, constraints linked to home equity, introduced work requirements, and obligatory cost-sharing for specific services starting in 2028.

An examination of government data involving 3.3 million Medicaid home care recipients in 2023, conducted with Health Management Associates' consultancy, helps in forecasting the effects of these program changes. States will experience varying impacts, with potential reductions up to 30% in Alaska and Rhode Island, while states like Florida, Minnesota, Mississippi, South Dakota, and Wyoming foresee less than a 1% decrease.

Particularly affected will be states that expanded Medicaid under the Affordable Care Act, though Minnesota and South Dakota anticipate minimal impacts despite participating in the expansion. Furthermore, the implementation of new cost-sharing requirements by 2028, mandated by HR 1 legislation, will affect over 75,000 home care recipients.

Jennifer Sheets, CEO of the National Alliance for Care at Home, stressed the significance of understanding this data to influence future policies that bolster Medicaid home care services. "The insights gained from this report," she noted, "will be critical to shaping future policies that strengthen Medicaid home care services and protect the future of beneficiaries who use Medicaid HCBS."

The Alliance and Institute plan to further discuss these findings in an upcoming webinar, providing a platform for deeper engagement with the data and proposed policy changes.