Nearly 12 million older and disabled Americans are “dual-eligible”—meaning they qualify for both Medicare and Medicaid at the same time—and depend on that Medicaid coverage to cover their Medicare bills, according to the Kaiser Family Foundation (KFF). As states nationwide tighten paperwork rules, advocates warn that safety net is starting to fray—one missed renewal letter at a time.
It starts with one sweeping new federal law, according to national research, healthcare advocates and professionals, including Lawanda Muhammad, a licensed Medicare and Medicaid advisor.
She works with seniors every day in California—one of the states where these changes are already playing out, and a useful window into what’s unfolding across the country.
In July 2025, the U.S. Congress passed the One Big Beautiful Bill Act (OBBBA). It cuts hundreds of billions of dollars over the next 10 years from Medicaid—called Medicaid in most states—but known as Medi-Cal in California, MassHealth in Massachusetts, and by other names elsewhere.
The good news is that seniors 65 and older are not affected by the new “work requirement” rule at all. They don’t have to prove they’re working to keep their coverage. That part of the law targets younger adults, ages 19–64.
The real issue for seniors isn’t a work rule—it’s paperwork, mail, and a shrinking safety net underneath the paperwork.
According to KFF, Black people in America are most affected. Roughly 21% of Medicaid enrollees are Black, compared to about 13% of the overall population. Roughly 73.9 million Americans are enrolled in Medicaid nationwide, according to KFF’s most recent tracker.
If Black people make up about 18% of that group, that’s roughly 13 million Black people in America on Medicaid—out of an estimated 44–45 million Black Americans in the country overall, per Census Bureau population figures. In other words, nearly 1 in 3 nationally relies on Medicaid, a far higher share than the population as a whole.
For seniors specifically, Black and Latino elders are more likely to be dual-eligible—enrolled in both Medicare and Medicaid. If a state tightens Medicaid rules and someone loses their Medicare Savings Program help, it’s disproportionately Black and Latino seniors who feel that loss first, since more of them rely on that help to begin with, advocates point out.
Every year, the standard Medicare Part B premium (what pays for doctor visits) gets adjusted nationwide. In 2026, it’s $202.90 a month, the same amount for seniors in every state, and it’s projected to rise to around $209.50 in 2027. The Centers for Medicare & Medicaid Services (CMS), however, won’t confirm the official rate until this fall.
What makes it feel connected is that many low-income seniors do not normally pay that $202.90 out of pocket, noted Ms. Muhammad. Medicaid pays it for them, through something called a Medicare Savings Program, but if they miss their paperwork or deadline for recertification, they lose benefits.
“They’re already on a budget … they look up, and now they’re missing $202.90 out of their check. That’s a big deal,” said Ms. Muhammad. Nearly all of the real damage comes down to seniors missing something in the mail, she continued, and recommended they watch for these three things in their mailbox:
1. Renewal forms. Starting in 2027, some Medicaid recipients nationwide will need to renew their eligibility every six months instead of once a year. Missing the deadline stops coverage—even for someone who still qualifies. “If they don’t respond in the cutoff time, they lose their [coverage],” said Ms. Muhammad, describing what she sees among her California clients.
2. A notice about SSI/SSP-linked Medicaid changing. Some seniors who receive Supplemental Security Income (SSI) get an extra state check on top of it—in California, called the State Supplementary Payment (SSP); other states have similar supplemental programs under different names.
Ms. Muhammad said some of her California clients are now getting letters saying that extra payment—often a few hundred dollars—is going away, and they’re being moved to a different Medicaid program. This doesn’t necessarily mean losing Medicaid entirely, but it can mean losing the automatic help that was paying a senior’s Medicare Part B premiums, she explained.
3. A letter about bank accounts. Separately, some states are reviving “asset tests” through their own state budget decisions—not the federal law. California brought back an asset test starting January 1, 2026, with a limit of $130,000 in countable assets for an individual, according to the state’s 2025–26 budget act.
Other states have their own limits, or none at all, depending on local budget choices. Illinois, by contrast, has kept a stable $17,500 asset limit in place since 2023—one of the more generous in the country, with no similar disruption for seniors there, according to the Illinois Department of Human Services.
Other large states have kept their own versions: Florida sets a $5,000 limit for aged/disabled Medicaid ($2,000 for nursing home care specifically); and Texas and Georgia generally hold to the federal minimum of $2,000.
This is a state-by-state budget decision, separate from the federal law, but it’s a reminder that Medicaid rules—and how much they can change year to year—vary significantly depending on where someone lives.
Justice in Aging, a national legal advocacy organization focused on senior poverty, has been one of the most vocal critics of how these changes are being implemented.
In comments submitted to federal regulators in July, the organization stated that the new rules take “a more restrictive standard than the statute for determining when an individual should be exempt from work requirements due to health or disability … .”
The group warned, this approach is “especially harmful for older adults, many of whom leave the workforce because of health or functional challenges.”
Justice in Aging has also pushed back on the caregiver exemption specifically, noting the rule “narrows the exemption for caregivers, which will leave out caregivers such as neighbors, friends, and chosen family who provide essential support to older adults.”
More broadly, it warns that the danger isn’t the underlying rule so much as the process around it. Work requirements create administrative barriers that will lead to improper terminations and disrupted access to crucial healthcare, the group argues.
Further, older adults, people with disabilities and chronic health conditions, and family caregivers face heightened risk of losing Medicaid coverage because these administrative hurdles, reporting requirements, and narrow exemption processes can improperly terminate people, even when they still qualify, continued Justice in Aging.
The organization has also connected the dots to long-term care specifically, reporting that the work requirements could worsen staffing shortages at nursing homes, indirectly affecting residents who aren’t subject to the rule at all.
Ms. Muhammad emphasized, “Pay attention to the mail that’s coming in from the state … there’s a lot of changes.” If a letter looks confusing, she recommends calling the number on it, or call a trusted Medicare/Medicaid advisor, and ask “Do I still have Medicaid? And is it still paying my Part B premium?”
