Congress is preparing to vote on a sweeping piece of legislation known as the “One Big Beautiful Bill Act” — a package that contains major Medicaid policy changes. While the bill includes some legitimate measures aimed at reducing fraud and improving program integrity, it also proposes several deeply concerning provisions that would restrict access to care for the people who need it most.

If passed in its current form, the bill would create new administrative and financial barriers for Florida’s medically fragile children, older adults, and individuals with disabilities who rely on Medicaid-funded care at home. This is a critical moment for our provider community to raise our voices and ensure policymakers understand the real-world consequences.

What’s at Risk?

The bill includes several provisions that would disrupt home- and community-based services (HCBS) across the country, including:

• Section 44109 – Revising Home Equity Limits for Medicaid Eligibility: This provision would disenroll older adults who own modest homes in areas where property values have appreciated, regardless of their current income or financial situation.
• Section 44141 – Community Engagement Requirements: Imposing these requirements could result in coverage losses for people with disabilities and direct care workers who may face challenges complying with new documentation rules.
• Section 44142 – New Cost-Sharing Requirements: Cost-sharing mandates for certain Medicaid expansion enrollees could limit access to critical in-home care — especially for low-income individuals with complex needs.
• Sections 44132-44134 – Limits on State Funding Flexibility: These sections propose caps on provider taxes and state-directed payments, threatening states’ ability to fund and sustain HCBS programs.

These changes would have devastating effects on the people we serve and the agencies that care for them.

Key Oversight Measures in the Bill

Certain provisions in the bill address program integrity and administrative efficiency and may represent important steps toward strengthening oversight without limiting access to care. These include:

• Section 44103: Verifying addresses to prevent duplicate Medicaid enrollments across states.
• Section 44104: Removing deceased individuals from Medicaid and CHIP enrollment.
• Section 44106: Strengthening provider screening to prevent payments to deceased practitioners.
• Section 44121: A temporary pause on the Centers for Medicare & Medicaid Services' (CMS) minimum staffing rule for nursing homes, which would otherwise drain workforce capacity and jeopardize HCBS.

Your Voice Matters: Take Action

Home care providers are essential to Florida’s health care system — and we need to ensure Congress understands that this bill, as written, would do more harm than good.

Congress should focus on curbing fraud where it actually occurs, not by creating blanket policies that penalize vulnerable populations and overwhelm providers. We must protect access to the care that keeps people safe and independent in their homes.

Please use the HCAF Legislative Action Center to contact your members of Congress and urge them to protect Medicaid home care. It only takes a minute, and your voice can make a real difference.

Click here to contact your lawmakers.

Thank you for standing with HCAF — and with the individuals and families who rely on Medicaid to receive care with dignity and independence at home.