On July 4, the President signed into law the 2025 Budget Reconciliation Act (H.R. 1), previously known as the “One Big Beautiful Bill Act.” The law includes the largest cuts in history to Medicaid and the Supplemental Nutrition Assistance Program (SNAP), all to expand tax cuts for the wealthy. The law endangers the health and financial security of millions of older adults across America by cutting these programs by well over $1 trillion and taking health coverage from 15 million people.
These cuts break a promise to everyone in America that we can depend on assistance as we age. They weaken the foundation of our health and long-term care system and will impact us all, but the worst impacts will fall on those who can least afford them and who already face the greatest barriers to staying healthy and meeting their needs.
Justice in Aging is committed to providing advocates with the tools they need to minimize harm as the law is implemented and help older adults maintain access to essential services and supports. This resource provides a high-level outline of the impact of H.R. 1 on health care, long-term care, economic security, and civil rights of low-income older adults. Over the coming weeks and months, we will be releasing additional analysis, educational resources, and tools.
For more detailed information on the health and long-term care impacts, please see Justice in Aging’s chart, Budget Reconciliation Act of 2025: Medicaid and Medicare Provisions Impacting Low-Income Older Adults.
Reduces Access to Quality Long-Term Care
The law makes it harder for older adults and people with disabilities to obtain quality long-term care—whether at home or in a nursing facility—by limiting eligibility for long-term care and cutting back on staffing protections.
Places Access to At-Home Care and Other Optional Benefits at Significant Risk for Cuts[1]
The law restricts funding mechanisms that states use to fund their Medicaid programs, such as provider taxes and state-directed payments (SDPs) in managed care. Facing significant reductions in federal funding, states will be forced to cut benefits or eligibility categories that are “optional” under federal law, enrollment, or provider rates. Since Home-and Community-Based Services (HCBS) account for the majority of optional Medicaid spending, these services are likely to be cut first, leading to longer waiting lists and more institutionalization. While the law does include a new limited option for states to cover HCBS for people with lower care needs, states are unlikely to take this up in light of the significant loss of funding. During the Great Recession, for example, every state cut HCBS to fill budget shortfalls. With reduced Medicaid funding, states are also likely to cut optional services like adult dental, vision, and hearing that Medicare does not cover.
Pauses Minimum Staffing Requirements for Nursing Facilities[2]
For the next ten years, the law blocks the federal government from moving forward with new rules that would have increased staffing in nursing facilities —including requiring a registered nurse on-site 24/7. Chronic understaffing puts both residents and workers at risk, leading to preventable injuries, illnesses, and deaths. Experts estimate that 13,000 lives will be lost each year as a result of understaffing.
Limits Medicaid Eligibility for Long-Term Care[3]
The law caps the amount of home equity an individual can have to qualify for Medicaid coverage of long-term care at $1 million – and does not adjust this amount for inflation. Today, twelve states allow higher than the $1 million limit —so people in those states will lose eligibility upon this provision becoming effective in 2028. Over time, as home values rise, fewer people will qualify for long-term care across the country. This change will force many older homeowners to delay needed long-term care or sell their homes to get Medicaid.
The law also shortens retroactive Medicaid coverage from three months to two months for older adults, people with disabilities, and most other Medicaid populations (see below). This change jeopardizes access to care for those in medical crisis who often are unable to immediately complete burdensome enrollment paperwork, especially for those seeking long-term care, and will lead to increased medical debt.
Takes Away Health Care Coverage
The Congressional Budget Office estimates that 15 million people will lose their health insurance because of cuts to Medicaid in H.R. 1 and the expiration of the Affordable Care Act Marketplace subsidies. Older adults will lose health care coverage in multiple ways:
Pauses Rules that Simplify Medicaid Enrollment for Older Adults and Disabled People[4]
The law halts the Streamlining Medicaid Eligibility & Enrollment Rules for ten years. This will make it harder for older adults to get and maintain Medicaid coverage by allowing states to maintain bureaucratic requirements, such as complex income verification paperwork and frequent renewals that currently prevent eligible people from gaining and maintaining coverage. Older adults who rely on Medicaid to help pay their Medicare premiums and cost-sharing through Medicare Savings Programs will also continue to face this red tape, putting millions at risk of losing critical financial help that makes Medicare affordable.
Puts in Place New Work Requirements and Cost Sharing for Medicaid Expansion Population[5]
The law requires adults ages 19 to 64 eligible for Medicaid expansion to work or volunteer at least 80 hours a month to enroll in and maintain their coverage. Those who cannot document that they meet these requirements will have their coverage terminated. While there are exemptions for parents of minor children up to age 13, some family caregivers, and some people with disabilities, these are narrowly defined and will require verification. As a result, many people who cannot work due health issues or who provide caregiving will still have their coverage terminated.
Older adults ages 50 to 64 are especially at risk of becoming uninsured. Many are retired or face difficulties securing work. They are more likely to qualify for an exemption, but less likely to be able to prove it or navigate the red tape to report their work. An estimated 1.8 million people in this age group are expected to have their Medicaid terminated.
The law also makes it harder to stay covered by requiring states to recheck eligibility for the Medicaid expansion population at least every six months. It also requires states to charge people with expansion coverage out-of-pocket costs for some services and limits retroactive coverage to just one month before someone applies—making it more likely people will face gaps in care and increased medical debt.
Undermines Medicare
In addition to cutting Medicaid assistance, thereby making it more difficult for low-income older adults to utilize their Medicare benefits, the law also puts Medicare’s future at risk. Because the law increases the deficit, the law triggers future massive cuts to Medicare due to the Statutory Pay-As-You-Go Act of 2010 (S-PAYGO). This law kicks in when legislation increases the deficit, and Medicare cuts are set to begin in fiscal year 2026 unless Congress acts.
Reduces Food Assistance for Seniors and Families
The law slashes billions of dollars from the Supplemental Nutrition Assistance Program (SNAP), and will force states, whose budgets are already stretched thin, to make tradeoffs that will leave older adults and families hungry. Individuals and households who receive SNAP will receive less money because of across-the-board cuts—all at a time when food prices are increasing. The law also introduces work requirements and other measures that will prevent people from applying for, qualifying for, and keeping their benefits, including many older adults between the ages of 55-64 who would otherwise be eligible.
Reduces Funding for SNAP[6]
The law’s changes in Supplemental Nutrition Assistance Program (SNAP) funding for states means that states will lose $186 billion in federal SNAP funding through 2034–a 20 percent reduction. Further, the law eliminates the standard utility allowances and other measures that simplify eligibility determinations for SNAP and utility assistance. More than 40 million people, including 8 million seniors, will be impacted. Food benefits will be cut by an average of $100 per month for about 600,000 low-income households.
Expands Work Requirements for SNAP[7]
The law also expands the categories of people who must prove, through additional paperwork and reporting, that they meet certain “work requirements” in order to remain eligible for SNAP. Specifically, work requirements are expanded to families with children ages 15 and above, older adults ages 55-64, former foster youth, veterans, and people experiencing homelessness. Because of this additional red tape, more than two million people, many of whom would otherwise be eligible, will be cut off from SNAP benefits, including 900,000 adults between the ages of 55 and 64.
Provides a Tax Deduction for Some and Increases the Insolvency of the Social Security Trust Fund for All
The changes in the tax code in the law provide a modest deduction for some seniors while creating a huge cost in the long term. This temporary deduction will overwhelmingly go to higher income older adults and will not benefit lower income people over 65 or people with disabilities. The change will hurt the solvency of the Social Security Trust Fund for everyone.
Puts in Place a Temporary Tax Deduction[8]
The law provides a temporary tax deduction of up to $6,000 for certain people age 65 and over for the years 2025 through 2028. Because it is a deduction and not a credit, it does not provide any financial benefit for the majority of older adults, whose income is too low to pay income tax. However, the money lost from the Social Security Trust Fund will affect its solvency for everyone. The law is estimated to move up the date of Social Security insolvency to 2032, a year sooner. At that point there would be insufficient funds to cover all benefit payments and without congressional action, all benefits would be cut by 20%.
Cuts Immigrant Access to Health Care and Food
Over eight million immigrants over 65 live in the United States. Over 1.6 million noncitizens are enrolled in Medicare. This law cuts health care and food assistance for those who are lawfully present, authorized to work, and have lived in the U.S. and paid taxes for many years. These cuts will leave all immigrants, including older immigrants, poorer and sicker.
Restricts Medicaid Eligibility for Lawfully Present Immigrants[9]
The law eliminates Medicaid eligibility for lawfully present immigrants who are not Lawful Permanent Residents (LPR) (after a five-year or longer waiting period); certain Cuban and Haitian immigrants; individuals living in the U.S. under a Compact of Free Association; or lawfully residing children and pregnant people. It also removes Medicaid eligibility for most humanitarian immigrants, including refugees and asylees.
Restricts Medicare Eligibility for Lawfully Present Immigrants[10]
The law limits Medicare eligibility for lawfully present immigrants to three categories: Legal Permanent Residents, Cubans and Haitians who entered under a family reunification program, and People residing under the Compacts of Free Association (citizens of Micronesia, the Marshall Islands, and Palau). This change in the law breaks a longstanding promise by taking away Medicare coverage from many lawfully present immigrants who have lived, worked, and paid Medicare and other taxes in the U.S. for decades. Together with the Medicaid restrictions and comparable restrictions that limit enrollment and financial assistance to purchase Affordable Care Act Marketplace coverage, these new changes mean that many older immigrants who are not Legal Permanent Residents are likely to become uninsured.
Restricts SNAP Eligibility for Lawfully Present Immigrants[11]
The law limits Supplemental Nutrition Assistance Program (SNAP) eligibility for lawfully present immigrants to three categories: Legal Permanent Residents, Cubans and Haitians who entered under a family reunification program, and People residing under the Compacts of Free Association (citizens of Micronesia, the Marshall Islands, and Palau). This means it takes away food assistance from refugees and asylees who fled persecution and are trying to rebuild their lives.
Conclusion
In sum, the law rips away health care and food assistance from the people who most need them, including caregivers and immigrants who have lived and worked legally here for decades. Putting nursing home residents’ lives at risk while jeopardizing the ability of older adults to age at home leaves families with few options for long-term care—just as the population is aging. Justice in Aging will continue to provide tools for advocates to understand the law, mitigate the harm, and identify openings to repeal and rebuild, so that we can all age with dignity and justice.
Endnotes
An Act to provide for reconciliation pursuant to title II of H. Con. Res. 14, Pub. L. No. 119-21, §§71115, 71116, 71121 (2025) [“H.R. 1”]. ↑
H.R. 1, §71111 ↑
H.R. 1, §§71108, 71112 ↑
H.R. 1, §§71101, 71102, 44101 ↑
H.R. 1, §§71119, 71107, 71112, 71120 ↑
H.R. 1, §§10101 – 10108 ↑
H.R. 1, §10102 ↑
H.R. 1, §70103 ↑
H.R. 1, §71109 ↑
H.R. 1, §71201 ↑
H.R. 1, §10108 ↑
