How the “Big Beautiful Bill” May Affect Medicaid Recipients

You may have heard about the One Big Beautiful Bill, which was signed into law recently and includes several changes to Medicaid. At Senior Solutions, we wanted to share a brief overview of what this could mean for our clients and others who rely on MassHealth or Medicaid coverage.

While there has been considerable media attention surrounding this new law, we want to emphasize that most of the changes will not take effect until 2027, and many of the practical impacts, especially in Massachusetts, are still uncertain. At this point, there’s no need to panic. However, it's always helpful to stay informed and plan ahead.

Here are a few key provisions of the law that may be relevant to seniors and individuals with disabilities:

1. Retroactive Medicaid Coverage Will Be Shortened

Currently, when someone applies for Medicaid, coverage can be granted retroactively for up to three months prior to the application date, as long as the applicant was eligible during that time. This has been especially helpful for nursing home residents, since unexpected medical events can happen quickly, and it sometimes takes time to gather the information needed to file the Medicaid application.

Under the new law:

• Retroactive coverage will be limited to one month for those eligible under the age 65 who are not disabled.

• For other Medicaid groups (including seniors and individuals with disabilities), coverage will only go back two months instead of three.

• This change takes effect January 1, 2027.

  
  

In practical terms, this means families and professionals will need to act promptly to reach out when they or a loved one requires nursing home care. We will need to file the Medicaid application as soon as possible to avoid gaps in coverage. The best way to prepare is to be organized. Know what you own, how much income you make and keep statements organized. Keep these records in one spot and let those who will you count on know where to find them.

2. Medicaid Eligibility Will Be Checked More Frequently

Right now, most states, including Massachusetts, perform annual redeterminations of eligibility. In reality, this sometimes happens less frequently.

Starting in 2027:

• States will be required to check eligibility every six months for Medicaid expansion recipients.

• It’s unclear whether or how this will be applied to other groups, like those over 65 or disabled.

  
  

Here in Massachusetts, MassHealth already faces resource constraints. I think they will have a very difficult time implementing a system of redetermining eligibility ever six months. It remains to be seen how this requirement will be implemented and whether it will directly affect seniors. Either way, we recommend that all clients keep their financial and personal information up to date and easily accessible, in case documentation is requested.

3. New Work Requirements for Some Medicaid Recipients

The new law introduces work requirements for Medicaid beneficiaries aged 19–64 who do not meet an exception.

This will not apply to individuals who are over age 65 or disabled, so most of our clients will not be impacted. But it may affect some caregivers or family members who rely on Medicaid themselves.

4. Federal Restrictions on Certain Rules

The bill also temporarily blocks federal enforcement of some Medicaid eligibility and enrollment rules, and delays implementation of the nursing home minimum staffing rule until at least 2034.

This could give states more flexibility, but again, much depends on how each state decides to move forward.

What Should You Do?

At this time, no immediate action is needed. Most changes won’t take effect until 2027, and we anticipate receiving additional guidance from MassHealth and other agencies in the coming years.

We will continue to monitor how these provisions are implemented and provide updates. As always, we are here to help you plan ahead to protect your assets and ensure you or your loved ones get the best care. Whenever possible, we try to help people stay out of nursing homes and explore less restrictive options.

Senior Solutions, Attorneys at Law, is an Estate Planning and Elder Law firm serving the Greater Boston, Massachusetts area since 2001. We are ready to help you with Medicaid Planning, Estate Planning, Probate, Guardianship & Conservatorships, Special Needs Trusts, and Fiduciary Services. We are here to help. Please call our office at 617-489-5900 or schedule a brief consultation (offered to new clients) by clicking on the button below:

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