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In July 2025, the U.S. Congress passed the One Big Beautiful Bill Act, a sweeping $3.4 trillion legislative package signed into law by President Donald Trump. This bill introduces significant changes to taxes, healthcare, and social programs, with far-reaching implications for Connecticut residents, particularly those relying on home care services through Medicaid. Below, we explore the key provisions of the bill and how they will affect home care recipients in Connecticut.
The One Big Beautiful Bill Act is a comprehensive piece of legislation that extends tax cuts from the 2017 Tax Cuts and Jobs Act, introduces new tax breaks, and imposes significant spending cuts to programs like Medicaid and the Supplemental Nutrition Assistance Program (SNAP). While it offers tax relief for many, including seniors and families, it also introduces stricter eligibility requirements and funding reductions for safety net programs, which are critical for low-income and disabled individuals who depend on home care services.
Medicaid, known as HUSKY in Connecticut, is a vital lifeline for nearly 950,000 state residents, many of whom rely on it to cover home- and community-based care. This includes services like personal care aides, home health services, and other supports that allow seniors and people with disabilities to remain in their homes rather than moving to nursing facilities. The Big Beautiful Bill introduces several changes to Medicaid that will directly impact these recipients.
One of the most significant changes is the introduction of work requirements for Medicaid recipients aged 19 to 64 with incomes between 100% and 138% of the federal poverty level (roughly $32,000 to $44,000 for a family of four). Starting no earlier than December 31, 2026, able-bodied adults in this group must prove they are working, volunteering, or attending school for at least 80 hours per month to maintain coverage. Exemptions exist for certain groups, including:
However, even exempt individuals must submit paperwork to prove their eligibility, and all recipients will need to verify their status twice a year instead of once. Connecticut’s Department of Social Services (DSS) Commissioner Andrea Barton Reeves has expressed concerns that these requirements could overwhelm recipients, leading some to abandon Medicaid due to the complex process. For home care recipients, losing Medicaid coverage could mean higher out-of-pocket costs or the loss of essential services, potentially forcing them into institutional care.
The bill includes approximately $1 trillion in Medicaid cuts over the next decade, which will strain state budgets and likely lead to reduced services. In Connecticut, the state’s Office of Policy and Management projected spending $11.6 billion on Medicaid in fiscal year 2025, with the federal government covering about 59% ($6.9 billion). The federal funding reductions could force Connecticut to cut back on optional services, such as home- and community-based care, which are critical for keeping seniors and disabled individuals out of nursing homes.
The Congressional Budget Office (CBO) estimates that these changes could result in up to 7.8 million people nationwide losing Medicaid coverage by 2034, with 156,000 Connecticut residents potentially becoming uninsured. For home care recipients, this could mean reduced access to aides, fewer covered hours of care, or increased co-pays (the bill introduces a $35 co-pay for most Medicaid services for some recipients).
The bill also caps and reduces taxes that states can impose on healthcare providers, which are used to fund Medicaid programs. This could cut Medicaid spending by $375 billion, threatening the financial stability of rural hospitals and home care agencies. In Connecticut, where rural areas rely on these providers, closures or service reductions could limit access to home health services, particularly for those in less populated regions.
While the bill imposes challenges for Medicaid-dependent home care recipients, it also includes provisions that could benefit some seniors, including those receiving home care:
These tax breaks could provide financial relief for seniors who pay out-of-pocket for home care services or who supplement Medicaid-covered care with private funds. However, for low-income seniors reliant on Medicaid, the benefits of these tax breaks may be outweighed by the loss of healthcare coverage or services.
The combination of work requirements, increased paperwork, and funding cuts creates significant hurdles for home care recipients in Connecticut. Many recipients, particularly those with disabilities or chronic conditions, may struggle to comply with the new documentation requirements, even if they qualify for exemptions. Commissioner Reeves noted that the already complex Medicaid process could become so burdensome that some recipients might seek higher-cost, lower-quality coverage or forgo care altogether, leading to worse health outcomes.
Additionally, the bill penalizes states like Connecticut that provide Medicaid to certain immigrants, such as through the “HUSKY for Immigrants” program, which covers children under 15 and postpartum individuals with qualifying incomes. Reductions in federal Medicaid reimbursements could force Connecticut to scale back this program, potentially affecting immigrant families who rely on home care services.
While tax breaks and some provisions will take effect soon, the most significant Medicaid changes, including work requirements, are not expected to begin until late 2026, with states having until 2028 to comply via waivers. This gives Connecticut time to prepare, but it also creates uncertainty for home care recipients and providers as the state grapples with how to absorb the funding cuts.
Connecticut lawmakers will face tough decisions about how to address the federal funding gap. They may need to allocate additional state funds to maintain Medicaid services or prioritize certain programs over others. Advocacy groups, such as CT Voices, warn that the cuts could push more families into poverty and increase healthcare disparities, particularly for children, seniors, and people with disabilities.
For home care recipients, staying informed and engaged will be crucial. Those enrolled in HUSKY should prepare for potential changes in eligibility verification and explore support from local organizations to navigate the new requirements. Connecticut’s DSS is likely to provide guidance as the implementation date approaches, and residents can contact DSS for assistance with Medicaid-related questions.
The One Big Beautiful Bill Act brings a mix of tax relief and significant challenges for Connecticut’s home care recipients. While seniors may benefit from new deductions, the Medicaid cuts and work requirements threaten to disrupt access to critical home care services for low-income and disabled residents. As Connecticut navigates these changes, the impact on vulnerable populations will depend on how the state responds to the reduced federal support. Home care recipients and their families should stay vigilant and seek resources to ensure continued access to the care they need.
