How does the One Big Beautiful Bill affect you, caregivers, and those with disabilities? 

In early July, the United States Congress passed, and President Trump signed, the One Big Beautiful Bill (OBBB).  This is one of the most sweeping pieces of federal legislation in years, combining tax changes with deep cuts and major reforms to public benefits programs—especially Medicaid, a public benefit program relied upon by many disabled individuals and older adults requiring long-term care, and lower-income Americans needing insurance.

While the bill’s full impact will unfold over the coming months and years, one thing is clear: older adults, individuals with disabilities, and families who rely on Medicaid and ABLE accounts will be significantly affected.

As elder law attorneys, we’re breaking down what this means so you can begin to prepare—and protect—what matters most.

The One Big Beautiful Bill and Medicaid: More Red Tape, Fewer Safety Nets

The One Big Beautiful Bill imposes new restrictions and procedural hurdles that may result in many people loss of Medicaid coverage—not because they no longer qualify, but because of increased administrative burden, and increased challenge initially accessing coverage.

Key Medicaid Changes Affecting Older Adults:

  • Biannual Redeterminations
    Instead of the annual eligibility review, or “redeterminations,” required under current law, Medicaid enrollees will now be subject to redetermination every 6 months. This means more paperwork, more documentation, and more opportunities for coverage to lapse due to simple mistakes or delays.

NOTE: It is our understanding at this time that biannual redeterminations apply only to Medicaid expansion services, not to Medicaid benefits received by Assisted Living Facility Residents, Home & Community Based Services, or  Nursing Home Residents.

  • Work Requirements for Adults Aged 50–64
    Many Medicaid recipients between 50 and 64 will need to verify at least 80 hours per month of work, volunteer activity, or education, unless they are formally exempt. Even those who are exempt due to age or health will have to submit documentation proving that exemption.
  • Shortened Retroactive Coverage Period
    Previously, Medicaid could extend coverage 90 days prior to the filing of an application for benefits, presuming the applicant was otherwise eligible.  This was helpful for unexpected nursing home admissions, and because it often takes time to assemble needed documents and information in anticipation of filing an application for benefits. That window is now reduced to just 60 days, leaving families more financially exposed in a health care crisis.

NOTE: Medicaid benefits for certain Medicaid insurance programs (not long-term care programs) have 30-day retroactive coverage.

  • Cuts to Long-Term Care Support
    While specific numbers are still emerging, we know that Medicaid funding reductions are expected to impact nursing home reimbursements and Home and Community-Based Services (HCBS)—programs that help older adults stay in their homes and avoid institutional care.

One Big Beautiful Bil and ABLE Account Enrollees: Positive Changes

ABLE (Achieving a Better Life Experience) accounts allow individuals with disabilities to save money without losing eligibility for Medicaid or other benefits:

  • Permanent ABLE-to-Work: Extends the ABLE-to-Work provision permanently, allowing eligible working individuals with disabilities to contribute above the standard annual limit based on their earnings.
  • Permanent 529 Rollovers: Permanently allows tax-free rollovers from 529 education savings plans into ABLE accounts.
  • Permanent Saver’s Credit Eligibility: Contributions to ABLE accounts permanently qualify for the Saver’s Credit.
  • Increased Saver’s Credit Limit: Starting in 2027, the annual contribution eligible for the Saver’s Credit increases to $2,100, with a potential maximum credit of $1,050.
  • Potential Annual Limit Increase: Includes a provision to change the base year for calculating the annual contribution limit, potentially increasing the limit in future years.

What This Means for You and Your Loved Ones

This is a pivotal moment in elder care and disability planning. The new rules will:

  • Make it easier to lose Medicaid coverage, especially through paperwork and procedural mistakes.
  • Increase the need for organized, proactive planning—particularly for spouses, families supporting aging parents or disabled children.
  • Potentially making access to long-term care supports, both in nursing homes and in home settings, more administratively onerous and complex .

Nursing Home Staffing & Transparency: Mixed Outcomes

The One Big Beautiful Bill includes significant provisions related to nursing home staffing, but with a mixed message for residents and families:

  1. No Federal Staffing Requirements
    • The bill explicitly bars the federal government (i.e., CMS) from enforcing minimum staffing ratios or national mandates for nurse or aide hours per resident.  This is a dramatic reversal of the Biden Administration’s initiative to increase staffing requirements in nursing homes.
    • Impact: Nursing homes will not be federally required to meet specific staffing levels, potentially worsening conditions in already understaffed facilities. States may still set their own requirements, but federal oversight is curtailed.
  2. Transparency Requirements Remain
    • The law preserves and expands public access to staffing and ownership information.
    • Facilities must continue to report:
      • Ownership structures (including private equity ties)
      • Daily staffing levels and job roles
      • Use of contract or temporary workers
    • Impact: While enforcement of staffing adequacy is weakened, families and advocates retain important tools to evaluate and compare nursing home performance through public data.

Bottom Line: Consumers will have more visibility—but potentially fewer protections—when it comes to ensuring adequate staffing in nursing homes. This makes it more important than ever to review facility data, ask detailed questions, and advocate persistently for loved ones in care.

We’re Watching Closely—and We’re Here to Help

While many parts of the One Big Beautiful Bill will take effect over the following six to 18 months, much remains unknown. Agencies are still releasing implementation guidelines, and states may take different approaches to enforcement and exemptions.

We will continue to monitor developments, update our clients, and adjust strategies as needed. We do expect that Home and Community-Based Services (HCBS) will be impacted in some way, though the specific scope and timing remain unclear.

We understand and empathize with the anxiety and worry about accessing these critical benefits.  For more than 25 years, our Elder Care Law Attorneys, Care Coordinators, Benefits Specialist, and Advocates at Rothkoff Law Group have faced legal and policy changes just like those under the One Big Beautiful Bill.  We are here to help and address your worries.

Now is the time to:

  • Plan proactively if you or a loved one has been diagnosed with a physical or cognitive impairment
  • Review your (or your loved one’s) Medicaid eligibility status and prepare for biannual redeterminations
  • Ensure your personal, financial, and legal documents are readily available
  • Most importantly, talk to us about how asset protection, legal and care planning, and crisis management strategies may need to shift going forward

Our team is ready to help you navigate these changes and safeguard your family’s care and financial security. Contact us to get started.

On July 29th from 12PM – 1PM EST, Jerry Rothkoff and Bryan Adler will lead a live webinar to discuss how the One Big Beautiful Bill can affect you, caregivers, and those with disabilities. The event will be hosted virtually on Zoom. Register by clicking here.