This op-ed was originally published on Syracuse.com on May 20, 2025. View it on Syracuse.com website here.
Proposed changes to Medicaid would have a devastating impact on millions of Americans, including a constituency frequently overlooked during critical legislative negotiations: adults on a low income who are ages 50 to 64.
For them, Medicaid is a lifeline that ensures access to quality health care and supports their ability to juggle the unique priorities that often define this stage of life.
This group of individuals isn’t eligible for Medicare coverage, but they still need programs and services to meet their basic needs. Roughly 30 percent of caregivers in the United States are between the ages of 50 and 64. To care for a spouse, partner, or aging parent, they take on time-intensive caregiving activities, including meal preparation, housekeeping, transportation to medical appointments, and help with personal care and finances. Many of these older adults also have one or more chronic medical conditions, such as diabetes, hypertension, and arthritis.
Meanwhile in Washington, Congress is trying to fast-track legislation that would scale back Medicaid funding and expand work requirements to include adults ages 50 to 64. Under the new rules, individuals would need to perform at least 80 hours of “community engagement” activities—either employment or volunteer work—each month.
This translates into an undue and unnecessary burden for a demographic that routinely faces age discrimination when navigating a competitive job market. Employment or volunteer work would also be hard for someone with family caregiving responsibilities, chronic health conditions—or both.
While the proposed legislation would exempt people considered “medically frail,” it provides no specific definition or examples. The interpretation of “medically frail” would be left up to each state. This would create confusion during the eligibility verification process.
In New York and other states that have expanded Medicaid through the Affordable Care Act, a report would be required every six months. Essentially, beneficiaries would need to reapply twice a year for their Medicaid coverage.
These measures would deter low-income older adults living in rural communities with limited or no access to broadband from recertifying for something as indispensable as their health care coverage. Many rural residents lack reliable transportation to travel to a public space with appropriate free internet access, and learning a new online system could make it even harder to fulfill these new obligations.
Simply put, more bureaucracy does not create more efficiency. A cautionary example is that of Arkansas, where similar requirements were rolled out in the summer of 2018. Within a few months, thousands of otherwise Medicaid-eligible individuals had been disenrolled due to confusing and time-consuming procedures. Congress is now proposing a plan that would similarly cause many older Americans to lose Medicaid coverage—through no fault of their own.
In addition, each state would need time and financial resources to develop and implement a new reporting system.
In the end, these new, expanded Medicaid requirements would only perpetuate the kind of bloated bureaucracy that Republicans have traditionally stood against. Weakening a program that supports basic human needs and services in order to subsidize tax cuts for ultra-wealthy individuals and corporations is shortsighted and immoral.
Medicaid is a popular and effective program that has helped Americans for six decades. It should not be weakened through scaled-back funding and onerous work requirements.
And yet the GOP-led Congress seems determined to tear at the fabric of Medicaid and hurt those who need it the most. How cruel that this is all taking place during Older Americans Month.
By María Alvarez, Executive Director of New York StateWide Senior Action Council, and Nora OBrien-Suric, PhD, President of the Health Foundation for Western & Central New York.
