In June, Congress passed the so-called “One Big Beautiful Bill” (OBBB), a sweeping federal package that includes wide-ranging changes to Medicaid, healthcare subsidies, labor provisions, and rural health funding. While touted by supporters as a way to root out fraud and redirect resources, the bill presents serious consequences for the home care and hospice industry, especially for providers serving low-income and medically complex patients.

Let’s be clear: the Michigan HomeCare and Hospice Association (MHHA) supports efforts to improve program integrity and ensure that taxpayer dollars are used appropriately. However, OBBB’s blunt approach to Medicaid reform threatens access to care for thousands of vulnerable individuals in Michigan and across the country.

At the heart of the bill is a dramatic change to Medicaid eligibility and renewal processes. The bill places new restrictions on re-enrollment and directs states to conduct more frequent and aggressive eligibility re-determinations. While intended to remove ineligible participants, the result is that eligible patients may be wrongly removed from coverage. This creates care disruptions and delays for patients who rely on home health aides, hospice nurses, or DME deliveries to remain safe and stable at home.

OBBB also implements steep federal cuts to Medicaid by shifting more financial responsibility to the states. These cuts are expected to trigger state-level budget tightening that will directly affect provider reimbursement rates and covered services. For an industry already grappling with workforce shortages, rising operational costs, and complex regulatory demands, this reduction is unsustainable.

Home- and community-based services (HCBS) are particularly vulnerable. Despite national recognition that HCBS is a cost-effective and patient-preferred alternative to institutional care, this bill fails to protect or prioritize funding for it. Instead, it imposes new administrative requirements without investing in the infrastructure or workforce needed to deliver high-quality care at home.

The bill does include some provisions to support rural health centers and behavioral health initiatives, which we applaud. However, these measures are undermined by the scale of Medicaid disinvestment.

What does this mean for our members?

• Home care agencies may face new hurdles in billing, documentation, and Medicaid compliance.
• Hospice providers could see reduced access for dual-eligible patients.
• DME suppliers may experience longer authorization timelines and lower payment rates.
• Staff recruitment and retention will be further strained by financial uncertainty and resource cuts.

MHHA is committed to fighting for a better path forward, one that recognizes the essential role of home-based care in our healthcare system. We will continue engaging lawmakers, educating the public, and mobilizing our members to advocate for sustainable policies that protect access, support the workforce, and uphold the dignity of care at home.

The One Big Beautiful Bill may be signed, but the work ahead is clear: we must ensure the ripple effects don’t erode the future of care at home.

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