Exploring the Impact of Proposed Changes to Medicare & Medicaid on Caregivers
With significant attention on the reconciliation bill and its proposed changes to Medicare and Medicaid, it has become apparent that many of these changes would disproportionately affect women and gender-expansive individuals. Approximately 36 million women are enrolled in Medicare (MA) and about 24 million women are enrolled in Medicaid—56 percent of whom are in their reproductive years and over half of whom are women of color (NPWF). Should the proposed changes move forward, some impacts will be readily visible and measurable, such as the loss of coverage for many health services predominately used by female patients. This blog examines the bill’s disproportionate impacts on women by focusing on one particularly vulnerable group: care workers. Women make up a large majority of paid adult care workers—88 percent in “home-based” or “home care” settings and 85 percent in institutional settings (IWPR)—and they provide essential services that are frequently overlooked and undervalued. Those caring for others often face compounded systemic barriers, underscoring how harmful these policy changes could be.
Work Requirements
The bill proposes additional “work requirements” to retain Medicaid coverage, with the intent of overwhelming people out of the system. This change is likely to lead to a significant loss of health coverage—especially for the roughly 75% of adult women and children who are on Medicaid. The current system incentivizes employers to keep workers below a certain number of hours to avoid providing benefits. Opportunities for steady, regularly scheduled work that meets the proposed requirements are not always available. Often, the only jobs accessible are part-time or hourly positions that lack benefits like sick days, paid leave, or stability. Individuals with multiple part-time jobs would be required to complete paperwork for each employer—a process that could be confusing and burdensome for anyone who wants to remain eligible for Medicaid. Jocelyn Frye, President of the National Partnership for Women & Families, explained, “there is a demeaning narrative about folks who receive Medicaid to question their work ethic, argue that people don’t deserve it, or they don’t need it. This narrative is disrespectful, it’s dishonest, and it’s disconnected from reality. The vast majority of Medicaid recipients—most mothers on Medicaid—already work. Among those who don’t work, of which is a small percentage, only a small percentage of those are considered able to work. Many of those folks are older women, they are people who either have a disability themselves or they’ve dropped out of the workforce to care for somebody. Imposing work requirements on these folks often does not increase the number of recipients who are working. What it really does, because of the onerous burdens in terms of paperwork and confusion, it leads people to lose their coverage entirely.”
As Frye noted, many individuals are not part of the traditional workforce because they are providing care for someone in their lives. Analysis found that among Medicaid adults who are not working, one in five women enrolled in Medicaid did not work in 2023 because of caregiving responsibilities. Notably, even among women without children, over one in ten reported that caregiving—for adult children, aging parents, or ill relatives—prevented them from working (KFF). Many family caregivers are already employed part-time or full-time—often uncompensated—and their critical caregiving roles do not fulfill formal work requirements. Consequently, adding these requirements would heavily impact women on Medicaid, causing many who do not work or qualify for an exemption to lose their coverage. According to the Congressional Budget Office (CBO), approximately 13 million Medicaid recipients will be unable to meet the work requirements or complete all of the necessary paperwork, meaning that a significant number of people, mainly women and children, could no longer qualify for Medicaid.
Cuts to Medicaid
Everyday women in this country already face an uphill battle against a system that underpays and overworks them as they strive to afford the basics. It is not just among parents that women carry the load of essential work in the home. Across all groups, women are significantly more likely than men to spend more time on unpaid work in the home such as, cooking, cleaning, and other types of household work. Many women are the chief executive, chief financial and chief medical officers of the household and, since the COVID-19 pandemic, this role has become more expansive and complex, often extending to caring for adult children or aging parents or both. For a woman navigating hourly jobs with minimal paid leave who is reliant on support from Medicaid, CHIP and Medicare to support her family, any cuts would create massive gaps and impose near impossible challenges for meeting their needs so her family can thrive.
In addition to many other damaging effects, the reconciliation bill’s proposed cuts to Medicaid would increase costs for services such as home care for the elderly or disabled. Medicaid is the largest provider of long-term care for older adults and people with disabilities, and through it, care workers enable folks to live at home, independently, and in their communities. According to the National Domestic Workers Alliance, “cuts to Medicaid will make it even harder for families to find and afford the in-home care that older adults and people with disabilities overwhelmingly prefer, forcing families to make impossible decisions like forgoing paychecks to provide full-time care or sending loved ones to institutional settings. Meanwhile, many care workers, who often get their coverage through Medicaid themselves, will lose their jobs when we desperately need more workers, not less” (NDWA). Without adequate in-home medical care, some women may be forced to quit their jobs to provide care or leave folks without the care and services that they need. When our own family members need care, it becomes clear how essential caregiving is and how the priority should be supporting these services instead of cutting funding that helps individuals and families.
Families & Care Workers Bear the Costs
As the U.S. population ages, the demand for care jobs is projected to rise dramatically. Ideally, this increased demand should lead to more quality care positions that offer steady employment, fair wages, and accessible healthcare. The reconciliation bill does the opposite of this and will have harmful effects on the folks who depend on these programs. Many women rely on Medicaid for their healthcare and their families who rely on them need the program to be strengthened, not cut. With wages barely covering living expenses and benefits increasingly difficult to obtain, many women in caregiving roles struggle to make ends meet to provide for their families. Failing to protect and improve working conditions—amid attacks on healthcare, family stability, and livelihoods—risks deepening inequality and may confine many female workers, particularly immigrant women and women of color, to roles with little economic security.
Moreover, chronic underfunding of care work in the United States has left families to bridge the gaps and supplement this role. This often results in unpaid family members taking on caretaking responsibilities—even when they have limited time or resources—leading to economic stress. Consequently, families end up shouldering a large portion of adult care, often because the high costs of paid long-term care are unaffordable. As Senator Hirono said, “when the government is very busy dismantling all of these programs that we rely upon, the people who suffer the most are the caregivers—and who are the caregivers, mainly women—and so every time there are cuts or changes that make it a lot harder for people to have healthcare, it’s women who bear the brunt.” Under current policies, care workers are struggling to make ends meet while family members—often women—provide uncompensated care work on top of their household responsibilities. The proposed work requirements and cuts to Medicaid will be untenable for many families, disproportionately affecting women and leading to increased economic hardship for many.
Four U.S. Senators hosted a forum on this topic, highlighting the disproportionate impacts on women of the policies in the Republican’s proposed budget. We highly recommend watching it, particularly to hear the testimonies from women who face direct impacts.