An Elder Law Attorney’s Take: What the One Big Beautiful Bill Really Means for Seniors

There has been a lot of talk about the One Big Beautiful Bill Act that just passed the House and is going to be signed into law soon (at the time of this writing). As an elder law attorney who often helps families navigate the complexities of Medicaid, I wanted to provide some clarity on what this means for seniors. After spending quiete a bit of time analyzing the legislation, I can absolutely say that our seniors are, by and large, protected from the worst of the cuts to Medicaid.

The Real Target: Working-Age Adults

The focus of the Medicaid portion of the Act is on 18 to 64-year-olds. The explanation is that there are concerns that able-bodied people are choosing to rely on “government handouts” instead of working. Two of the many changes we see coming for them are: (a) the requirement that an “able-bodied” adult without dependents would be required to work, volunteer, or enroll in educational programs totaling 80 hours per month, and (b) requiring redetermination of their eligibility twice a year, instead of the current annual requirement. The 65+ age group will not be subject to these requirements.

These changes mirror what we’ve seen attempted in other states like Arkansas and Georgia, where similar work requirements led to thousands losing coverage due to administrative burdens rather than actual ineligibility. However, putting that discussion aside, it seems clear that seniors in nursing homes are not the focus of these changes.

The Hidden Threat: Nursing Home Staffing Standards

Truly, the area where I see the biggest concern for Florida seniors is in the moratorium on the somewhat recently (June 21, 2024) implemented requirement to increase staffing requirements at nursing homes. This provision delays these critical safety standards until 2035 – a full decade away. This ultimately means that nursing homes will not be forced to change their staffing policies to comply with the changes that were going to take effect in 2026.

This is somewhat troubling given that inadequate staffing has been linked to higher rates of infections, falls, and other preventable incidents in nursing facilities. The new standards were designed to ensure residents receive the care they deserve, but this moratorium effectively puts those protections on hold for years.

HCBS: An Indirect Impact

While much is being said about the reduction in Medicaid funds, I believe this to be focused primarily on the savings gained from the 18-64 population, eliminating double dipping with the Children’s Health Insurance Program, and not allowing benefits for the undocumented. However, if there are not enough savings from those changes, there could be an indirect impact on senior care through cuts that could impact the state’s Home and Community-Based Services program.  This is a program that allows seniors to get Medicaid to help pay for in-home care or assisted living expenses.  If there is a reduction in Medicaid funds available for seniors, these programs would likely be the first to fall.  This would push more seniors into nursing homes, creating even more demand for those facilities, which may be understaffed.

What This Means for Families

For families planning long-term care, the key takeaway is that while seniors themselves aren’t losing Medicaid eligibility, the quality and availability of care could be affected. The combination of relaxed staffing standards and potential funding pressures creates uncertainty in an already complex system.

My advice remains the same: plan early, understand your options, and don’t wait until a crisis to explore long-term care strategies. The landscape is changing, but with proper planning, families can still navigate these challenges successfully.

-Geoff Hoatson 

CEO & Founding Attorney