Navigating Change: What the New Federal Policy Could Mean for Clients Who Rely on Public Benefits

On July 4, 2025, our current administration signed the One Big Beautiful Bill Act (HR 1) into law. This legislation plans to reshape major public benefit programs in the U.S. While many provisions will take years to implement and vary by state, early guidance reveals important changes that directly impact the populations we serve.

At National Care Advisors, our mission has always been to advocate for individuals with complex care needs, particularly when navigating public systems like Medicaid, Medicare, SNAP, the ACA Marketplace and other public benefits. Here’s what we know so far and how we’re adapting to support clients and their families during this time of transition and uncertainty.

Key Changes to Public Benefit Programs

Medicaid / Medi-Cal

Several changes will affect Medicaid access and maintenance including:

• Cost Sharing: Some beneficiaries will now face new or increased cost-sharing obligations.
• Work/Engagement Requirements: Adults aged 19–64 may be required to meet work or community engagement standards if they are NOT disabled. However, many of our clients are exempt, including parents/caregivers of children under 13 or of individuals with disabilities, medically frail individuals and disabled veterans
• Eligibility Redetermination: Will now occur at least twice per year, increasing the risk of loss of coverage due to administrative hurdles.
• Retroactive Coverage Reduced: Limited to 1–2 months prior to the application date (previously 90 days).
• New Home and Community Based Services (HCBS) Waivers: States can create waivers for individuals who do not need institutional-level care. This could increase options for some, but may further dilute funding for higher care need populations.
• Immigration Restrictions: Stricter eligibility requirements for certain immigrant groups.

Affordable Care Act (ACA)

• Immigration-based Restrictions: Some immigrants may lose eligibility for premium subsidies.
• Plan Changes: Certain Bronze and Catastrophic plans now qualify as HDHPs (High-Deductible Health Plans), which may allow for Health Savings Accounts (HSAs).
• Shortened Open Enrollment: Enrollment ends December 15, one month earlier than before.

Medicare

• Eligibility Tightened for Some Immigrants: Details are still emerging, but certain populations may see access reduced.

SNAP (Supplemental Nutrition Assistance Program)

• Work Requirements: Stricter work requirements have been put in place for parents with older children, adults aged 55–64, Veterans and individuals experiencing homelessness.
• Utility Deduction Changes: New calculations may reduce benefits. Clients may need to submit actual utility bills to maintain or increase benefit amounts.

What This Could Mean for Our Clients

While these changes are significant, many of our clients will qualify for exemptions. However, the administrative burden of maintaining benefits is likely to increase, and even short lapses in coverage can result in disruptions to critical care and services.

NCA remains here to help, and the advocacy we provide may be more important than ever. We want to assure our current and prospective clients that although the specific impacts of these legislative changes continue to unfold and continues to evolve on a state by state basis, NCA’s nurse consultants are dedicated to providing comprehensive, individualized and effective care coordination and advocacy services.

What NCA is Doing

We are taking steps to:

• Track how individual states implement HR 1, as many details and funding will vary locally.
• Identify other local resources that may be available to clients in the event of benefit loss or need for advocacy.
• Help clients and families prepare for more frequent redeterminations that require documentation and understand exemption criteria.
• Share updates with our clients based on verified sources, not speculation.

 What You Can Do Now

• Keep medical and financial documentation up to date and respond timely to hard copy mailed notices from Medicaid, Social Security, SNAP, and other government resources.
• Watch enrollment deadlines (ACA insurance open enrollment ends December 15—earlier than in previous years) – if that is the way that health insurance is accessed.
• Reach out to National Care Advisors if you’re unsure how these changes affect you or your loved one. Our team is here to help and to provide accurate and useful information.

Contact National Care Advisors to learn more about how our special needs nurse consultants can help you, your client or your family navigate this time of transition and uncertainty.