Caring for Change: The Enduring Impact of Social Safety Net Policies on America's Caregivers

An essential read for every advocate: Delve into "Caring for Change: The Enduring Impact of Social Safety Net Policies on America's Caregivers." This article explores how programs like Medicaid and SNAP are vital for families, embodying the truth that "Our nation’s caregivers deserve a safety net that supports their work, not one that strips it away."

Proposed overhauls to vital programs like Medicaid, SNAP, and family leave repeatedly threaten both working and unpaid caregivers. While often framed as deficit-reduction measures, new requirements and funding cuts risk stripping away crucial support at moments caregivers need it most.

By Mark Fukae, Director of Advocacy for Professionals Who Care and Founder, Caregiver Advocacy and Support Initiative (CASI)

Welcome to the latest article in our Caring for Change Series. In previous pieces, we've explored the deeply personal and systemic challenges faced by caregivers. Today, we delve into a recurring theme in public policy: the significant national implications of proposed changes to our social safety net for the millions of Americans dedicated to providing care. Legislative efforts, such as the "One Big Beautiful Bill" (H.R. 1), often spark debate about federal budgets, but their true impact resonates profoundly in the lives of working and unpaid caregivers, risking their well-being and the stability of families across the country.

Micro-Level Impacts on Caregivers

Changes to social safety net programs consistently create immediate and severe hardships for caregivers at the individual and family level.

Strained Working Caregivers

Millions of working caregivers rely on programs like Medicaid to cover their families’ health needs, keeping them healthy enough to juggle paid employment and caregiving duties. Policy proposals that impose stringent "community engagement" or work requirements, such as an 80-hour monthly mandate seen in past legislative drafts like H.R. 1, often target nonelderly, nondisabled adults without dependents, risking loss of coverage [2]. Analyses of such proposals estimate that tens of millions of adults could be at risk of losing coverage-for instance, 8.7 million adults (one in ten Medicaid enrollees), including 20 million expansion adults and 16 million others, were projected to be at risk under one such proposal by 2034 [2].

For caregivers juggling both paid work and caring for loved ones, these rules create impossible trade-offs. Errors in reporting hours or navigating exemptions can jeopardize insurance, forcing many to choose between essential medical care and their jobs. Studies of state-level Medicaid work-reporting experiments, such as Arkansas’ brief program, have shown that nearly one in four affected enrollees lost coverage despite meeting work goals-demonstrating no employment boost but significant coverage loss [2].

Hardship for Unpaid Family Caregivers

Unpaid family caregivers-often spouses caring for aging parents or parents of children with chronic conditions-depend on programs like SNAP to feed their families and on Medicaid for in-home supports. Legislative proposals frequently aim to:

• Expand work requirements for SNAP recipients to broader age ranges, such as 18–64, narrowing exemptions for parents, veterans, and the homeless and imposing new reporting burdens that have historically driven eligible families off the rolls [2].

• Restrict future benefit increases by tying food assistance programs, like the Thrifty Food Plan, to less responsive inflation measures like the Consumer Price Index, potentially capping food assistance and cutting nutrition education funding [2].

Without these programs, unpaid caregivers face steep out-of-pocket costs, and many are forced to leave work or reduce care hours, threatening both family stability and home-care continuity.

Macro-Level Implications for Society and Policy

Beyond individual families, changes to social safety nets pose significant threats to the broader health, fiscal, and social infrastructure of the nation.

Eroding Health Infrastructure

Medicaid is the backbone of care for older adults with disabilities and low-income children. Proposals for deep Medicaid cuts, such as the $840 billion over ten years seen in some legislative efforts [5], coupled with actions like the elimination of provider taxes and state-directed payments [3, 5], can shrink federal hospital reimbursements by hundreds of billions. For example, estimates have shown this could fuel a $42.4 billion rise in uncompensated care by 2034 [5].

Rural hospitals, hospitals serving low-income areas, and critical access facilities—already operating on razor-thin margins—would face the deepest cuts. Projections indicate that nearly half of rural hospitals, such as 48% by 2029, could lose more than 20% of their Medicaid funding [4], jeopardizing emergency room access for rural caregivers and patients alike.

Fiscal and Economic Downturn

When federal matching funds for essential programs are reduced, states are forced to scramble to fill massive shortfalls (e.g., $500 billion in some past proposals [5]), often by cutting Medicaid eligibility and reducing optional benefits like home- and community-based services. The ripple effect on state economies can be staggering: a projected $154 billion GDP decline and 1.2 million job losses by 2029, equivalent to a 0.8 percentage-point unemployment spike-with virtually no state spared from these economic reverberations [5].

State and local tax revenues would also shrink, with estimates of losses like $12 billion [5], threatening funding for schools and other critical social services on which caregivers and their dependents also rely.

Deepening Disparities

Policies that undermine social safety nets often disproportionately target low-income families, women, seniors, and people of color. For instance, in one legislative analysis, 62% of Washington D.C.’s Medicaid enrollees were projected to be at risk of coverage loss, compared with 19% in Texas [2]-amplifying existing health inequities in the nation’s capital and across expansion states alike.

Removing essential protections like Medicaid and SNAP from vulnerable caregivers can widen health and economic disparities, undermining decades of progress in narrowing racial and gender inequities.

Advocacy and Policy Alternatives

The response from leading caregiving and elder-care organizations has been clear and strong in the face of such legislative proposals, highlighting the need for viable, compassionate policy alternatives.

Responses from Caregiver Advocacy Groups

Advocacy organizations like the Family Caregiver Alliance consistently condemn cuts to vital programs as “a direct attack on family caregivers,” warning that such bills can “jeopardize the care infrastructure” and force caregivers to “rearrange their lives” under unsustainable burdens. Similarly, groups like LeadingAge, which represents nonprofit home-care providers, have decried these as a “devastating blow” to Medicaid that “will exacerbate staffing shortages and hospital closures” and saddle caregivers with “impossible choices” between work and care.

Policy Alternatives and Future Proposals

Rather than imposing work requirements or making deep cuts, policymakers could:

• Strengthen work supports by investing in state Medicaid & SNAP employment and training programs, modeled after successful initiatives like Montana’s HELP-Link, which pairs screenings, referrals, and case management to connect enrollees with local job resources.

• Enhance “make work pay” policies by extending earned-income tax credits and child tax credits for all caregivers, closing the gap for those without dependent children.

• Invest in home- and community-based services, ensuring that Medicaid covers caregivers’ respite care, adult day services, and assistive devices—allowing more families to remain in their communities.

For disabled adults, rather than imposing arbitrary work thresholds, policymakers should expand supported employment and integrate employment goals into disability services, guided by programs like Georgia’s JobConnect, which delivers job coaching and wage subsidies to Medicaid managed-care members.

Conclusion

Legislative proposals involving Medicaid and SNAP work requirements, coupled with deep funding cuts (as exemplified by past efforts like H.R. 1), threaten to pull the rug out from under both working and unpaid caregivers-with no consistent evidence that these policies boost employment. Instead, they risk creating health coverage gaps, ending vital support services, and driving up uncompensated care costs across the nation.

Caregivers, families, and communities need better solutions, not more red tape. Lawmakers must consistently reject work requirements that punish the poor and embrace policies that expand access to affordable health care, nutrition support, and caregiver‐friendly tax credits. Our nation’s caregivers-professional and unpaid-deserve a safety net that supports their work, not one that strips it away.

Be a voice for caregivers. Contact your representatives today and urge them to oppose any Medicaid or SNAP work requirements, restore funding for home- and community-based services, and protect the health and economic well-being of those who care for us all.

Your Voice Matters. Take Action!

Your engagement is the key to creating a truly supportive care economy.

• Share Your Story: Have you experienced the impact of policy changes on your caregiving journey? Share your story with us at [https://www.professionalswhocare.org/your-story]. We’re amplifying voices that can drive change.

• Learn more about Professionals Who Care (PWC) and our mission: [https://www.professionalswhocare.org/]

• Discover the Caregiver Advocacy and Support Initiative (CASI): [https://casiadvocacy.org]

• Explore the details of the Federal CARE Act: [https://casiadvocacy.org/our-legislative-solutions/]

• Join our growing movement and sign our petition: https://chng.it/zHbMzKnBwJ

Let’s keep the conversation going: Share your thoughts in the comments on how social safety net policies impact you and your family.

Data Sources / References

1. www.congress.gov - Health Coverage Provisions in One Big Beautiful Bill Act (H.R. 1)

2. www.cbpp.org - Medicaid Work Requirements Could Put 36 Million People at Risk of ...

3. www.cnbc.com - How Trump bill Medicaid cuts will impact U.S. health care - CNBC

4. www.aha.org - Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten ...

5. www.kff.org - How Will the One Big Beautiful Bill Act Affect the ACA, Medicaid, and ...