What the “Big Beautiful Bill” Means for Medicaid Coverage—and Why Elder Law Experts Are Concerned

The U.S. Senate’s version of the budget reconciliation legislation—often referred to as the “Big Beautiful Bill”—contains several provisions that will significantly alter how elderly and disabled Americans access and retain Medicaid coverage. As elder law attorneys dedicated to protecting the rights and well-being of older adults, we believe it’s important to shed light on what’s at stake and share the concerns raised by national groups like the National Academy of Elder Law Attorneys (NAELA).

Key Provisions in the Senate Bill That Will Impact Seniors

The bill's sweeping health and economic reforms include several Medicaid-specific provisions which have drawn sharp criticism from elder law professionals across the country. These include:

1. Shortening the Retroactive Medicaid Coverage Period

The bill proposes reducing the current three-month retroactive coverage period to:- Two months for traditional Medicaid beneficiaries- One month for those in the Medicaid expansion population. NAELA warns this change will “disrupt care and increase medical debt for people transitioning from hospitals to nursing homes.” The retroactive coverage period is often the only safety net for individuals facing sudden and severe medical crises—times when patients and their families are understandably too overwhelmed to immediately seek help navigating the complex Medicaid application process.

2. Requiring Eligibility Redeterminations Every Six Months

Another provision would require states to review eligibility for the Medicaid expansion population every six months rather than once a year. According to NAELA and the Congressional Budget Office, this could lead to 700,000 people losing Medicaid coverage by 2034, not because they’re ineligible, but because of administrative hurdles, paperwork delays, and backlogged state systems. NAELA explains, “When states are burdened with a large volume of redeterminations to process in a short period of time, beneficiaries fall through the cracks and lose coverage, despite remaining eligible.”

3. Blocking Rules That Simplify Medicaid Enrollment

The bill would prohibit implementation of two major federal rules designed to streamline the Medicaid application process. These rules are especially important for seniors and individuals with disabilities. They aim to align income eligibility procedures, reduce documentation barriers, and improve enrollment in Medicare Savings Programs (MSPs)—which help low-income seniors pay for Medicare premiums and cost-sharing. NAELA notes: “Delaying these rules will undo progress toward ensuring older adults and individuals with disabilities are able to access the Medicaid services they need in a timely manner.”

4. Preventing Enforcement of Minimum Staffing Standards in Nursing Homes

The bill also seeks to block a proposed federal rule that would require minimum staffing levels in nursing homes. NAELA stresses this rule is critical, warning that without adequate staffing, residents face increased risks of malnutrition, bedsores, neglect, and medical emergencies. As NAELA put it: “Stopping this staffing rule from taking effect as planned will only increase the likelihood of neglect and medical emergencies individuals face at a time when they are at their most vulnerable.”

Why Medicaid Coverage Under The Big Beautiful Bill Matters for Seniors and Their Families

Troyer & Good helps clients apply for Medicaid, secure nursing home coverage, and protect assets while maintaining essential care. We witness firsthand how difficult these processes can be—especially during a health crisis. Policies that shorten coverage windows, complicate eligibility, or delay necessary reforms don’t just add red tape—they create real hardship for our clients. As NAELA emphasized in their letter to the Senate: “The clients of our members are often under immense stress... having a one-month period, in the middle of a medical crisis, to apply for Medicaid is simply not enough.”

Our Perspective

We echo NAELA’s call for Congress to reconsider these provisions. Any budget or health policy reform should enhance—not limit—access to the care and services seniors rely on. Medicaid is not just a safety net; it is a lifeline for millions of older Americans and their families. Changes to the system should be made with great care and respect for the unique needs of this vulnerable population. If you or a loved one are concerned about how these changes might impact your Medicaid eligibility or long-term care options, we invite you to contact our office and reach out to your congressional representatives. We are here to help you navigate these complex issues with compassion, clarity, and experience.