Nurse Pilar Rodríguez administers the COVID-19 vaccine to her patient Margarita Serra Crespi, 93, at her home in the town of Sa Pobla on the Spanish Balearic Island of Mallorca, Spain, Friday, April 30, 2021. (AP Photo/Francisco Ubilla)
A nonprofit organization in Tennessee warned nearly 1 million family caregivers could feel the effects of Medicaid cuts under the tax-and-spending law known as the “One Big Beautiful Bill Act.”

Nationwide, more than 4 million people rely on Medicaid for home health services.

Megan Schwalm, president and CEO of the Tennessee Caregiver Coalition, said earlier cuts already forced closure of an outreach program serving 7,000 mostly Black, brown and rural caregivers. She argued the new round of cuts will further strain families caring for loved ones with dementia and other serious conditions, in a state already near the bottom for access to caregiver services.

“We currently have a waitlist of over 200 people waiting for respite vouchers from us, and we anticipate that waitlist is going to increase exponentially,” Schwalm explained. “What we’re seeing already is fewer and fewer grant opportunities available to apply for.”

Medicaid is jointly funded by states and the federal government but federal cuts would slash spending by $880 billion over 10 years. Tennessee already ranks poorly among states for its lack of supports and services for caregivers and people with disabilities, according to AARP.

Schwalm is worried about new Medicaid work requirements, particularly in Tennessee, where lawmakers did not vote to expand Medicaid. She pointed out the state already has a severe shortage of direct care workers and reliable help is hard to find even with Medicaid waivers. She warned the rules could make the shortage worse, and even force more people into expensive institutional care.

“When work requirements come into play, and caregivers have to go to work and can’t find anyone to care for their loved ones, we anticipate that we will see more older adults going into nursing homes, more children with disabilities going into institutions,” Schwalm outlined.

Although some changes will not take effect until 2027, Schwalm thinks the law could backfire, ultimately costing the state more in institutional care if home-based supports are reduced. She added for her, this issue is personal. Her son with disabilities relies on what’s known as a “Katie Beckett waiver” for expensive medication and therapies not covered by private insurance, and losing Medicaid would be devastating for their family.