A Major Shift in Medicaid
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On July 4, 2025, H.R. 1—the budget reconciliation bill known as the "One Big Beautiful Bill Act"—was signed into law. It represents the largest changes to Medicaid in a generation.
For families receiving home care services in Washington State, understanding these changes is critical. Some take effect as soon as October 1, 2026.
The Big Picture
According to Georgetown University's Center for Children and Families:
- $1.15 trillion in cuts to federal healthcare spending over the next decade
- $700 billion specifically from Medicaid
- An estimated 17 million Americans will lose health coverage
For Washington State, this translates to billions in reduced federal support—money that funds the care your loved one receives.
Key Changes and Deadlines
October 1, 2026: Immigration Eligibility Narrows
This is the most immediate change. Starting October 2026, many lawfully present immigrants will lose Medicaid eligibility, regardless of how long they've been in the United States.
Who loses eligibility:
- Refugees and asylees
- Victims of human trafficking
- Victims of domestic violence
- Humanitarian parolees (including many from Ukraine)
- Iraqi and Afghan special immigrant visa holders
- Native American tribal members born in Canada
Who remains eligible:
- Green card holders (after five years)
- Certain Cuban and Haitian entrants
- Citizens of Compact of Free Association nations
- Children and pregnant women in states with ICHIA coverage
If your family member or their caregiver falls into an affected category, plan now.
January 1, 2027: More Frequent Eligibility Checks
States must begin making Medicaid eligibility redeterminations every 6 months for expansion adults (up from annually).
What this means:
- More paperwork for families
- More opportunities for coverage gaps
- Greater importance of keeping information current
Work Requirements Coming
By December 31, 2026, states must implement work requirements for certain Medicaid enrollees. Exceptions exist for:
- People with disabilities
- Caregivers
- Pregnant women
- Those in treatment programs
But the administrative burden increases for everyone.
Impact on Home Care Services
For Clients
If you or your loved one receives Medicaid-funded home care:
- Verify your eligibility category now, not in October
- Gather documentation of disability status, citizenship, or qualifying immigration status
- Respond promptly to any eligibility verification requests
- Keep contact information current with your agency and DSHS
Coverage gaps mean service interruptions. Don't let paperwork cause a crisis.
For Families
The increased administrative burden falls heavily on families:
- More frequent renewals mean more paperwork
- Shorter response windows mean faster action required
- Documentation requirements may increase
Consider designating one family member to handle Medicaid correspondence. Missing a deadline can mean losing coverage.
For Caregivers
Many home care workers are immigrants. If their personal Medicaid coverage is affected, it creates workforce instability. Agencies may face:
- Caregivers dealing with personal coverage crises
- Increased turnover as workers seek stable situations
- Need for more support during the transition
What Washington Is Doing
Governor Ferguson has been vocal in opposing the federal cuts:
"It's difficult to overstate how devastating these cuts will be to Washingtonians."
The state budget includes $7.6 million to add 500 slots for DSHS clients losing coverage due to immigration status. But this covers a fraction of those affected.
Washington's Health Care Authority is tracking implementation requirements and will provide guidance as deadlines approach.
Action Steps for Families
Now (January 2026)
- Review your eligibility basis - Know why you qualify for Medicaid
- Gather documentation - Disability determinations, immigration status, citizenship proof
- Update contact information - Make sure DSHS can reach you
- Talk to your case manager - Understand how changes might affect your services
Before October 2026
- Complete any pending renewals - Don't let coverage lapse before changes take effect
- Explore alternative coverage - If you might lose Medicaid, what are your options?
- Connect with advocacy organizations - Washington State Developmental Disabilities Council and others can help
Ongoing
- Respond to mail promptly - Eligibility requests have deadlines
- Keep records - Document all communications with DSHS
- Stay informed - Requirements may change as implementation proceeds
What This Means for Care Quality
Here's the uncomfortable truth: when eligibility systems are stressed, care can suffer.
- Case managers spend more time on paperwork, less on monitoring
- Agencies deal with coverage verification confusion
- Families focus on keeping coverage, not improving care
The agencies and families that navigate this best will be those with:
- Clear documentation of services and eligibility
- Strong relationships with case managers
- Systems that handle verification smoothly
- Proactive communication about changes
How CareCade Helps Families Navigate Uncertainty
When eligibility systems are stressed and coverage is uncertain, visibility into care matters more than ever. CareCade provides the transparency families need:
Family Portal: Know What's Happening
Even when you can't be there, CareCade keeps you connected:
- Real-time visit verification: See when the caregiver arrived and departed
- "On My Way" notifications: Know when care is coming before they arrive
- Activity documentation: See what happened during each visit
- Progress updates: Track your loved one's goal progress over time
No more wondering. No more anxious phone calls. Just knowledge.
Case Manager Dashboard: Advocacy at Scale
For case managers monitoring clients through coverage transitions:
- One dashboard for all clients: See verified services across agencies
- Exception alerts: Get notified when something needs attention
- Documentation access: Review records without endless phone calls
- At-risk identification: Spot clients who may need extra support
When case managers can monitor effectively, vulnerable clients are protected.
Documentation That Proves Services
During eligibility reviews, documentation matters:
- Verified visit records: GPS-confirmed proof of service delivery
- Complete activity logs: What was provided, when, and by whom
- Goal progress tracking: Evidence that services are achieving outcomes
- Exportable reports: Generate documentation for any review
When coverage is questioned, you have the records to respond.
The Importance of Transparency
When coverage is uncertain, knowing what's happening with care matters more than ever.
Families should demand:
- Verification that visits are happening
- Documentation of services provided
- Clear communication about any issues
- Real-time visibility into their loved one's care
If you can't visit every day, you should still know that care is being delivered. CareCade makes this possible—and in uncertain times, it's essential.
Looking Ahead
H.R. 1 is law. The changes are coming. But how we respond is within our control.
Families who prepare now will navigate the transition more smoothly. Agencies that help their clients through the process will earn lasting loyalty. Case managers who prioritize communication will protect their clients.
The care your loved one needs doesn't change because policy changed. Being there for them means being ready for what's next.