The National Alliance for Caregiving (NAC) is a non-profit coalition of national organizations who share a vision of a society that values, supports and empowers family caregivers to thrive at home, work and life. NAC recently released “Policy Brief: The Role of Medicaid in Supporting Family Caregivers,” which highlights the 2022 National Strategy to Support Family Caregivers and important context around policy discussions around establishing work requirements or cuts to the overall Medicaid program.

While the federal government offers some assistance through programs like the National Family Caregiver Support Program, the Lifespan Respite Care Program, and Veterans Affairs Caregiver Programs, these fractured initiatives cannot meet the growing needs of millions of family caregivers.

Medicaid has emerged as the nation’s primary source of support for these caregivers, making it possible for many Americans to receive care in their homes rather than in costly nursing facilities. As the largest payer for long-term services and supports, Medicaid serves approximately 4.5 million people through home-and-community-based services (HCBS). Unlike Medicare, which typically does not cover these services, Medicaid provides both direct financial support to family caregivers and critical supplemental services such as respite care, training, and counseling – all of which help families avoid or delay institutional care.

The report lists out four policy considerations:

• Protect and Preserve Self-Directed Pathways: Ensure Medicaid beneficiaries can choose family caregivers to support complex in-home care, which helps alleviate the nationwide shortage of professional care workers while reducing the need for costly institutional care.
• Implement Realistic Exemption Policies: Create exemptions that recognize two key groups: beneficiaries with severe health conditions who cannot work, and family caregivers who provide their essential care. These exemptions should specifically protect caregivers who must reduce or leave their employment to provide full-time support for family members.
• Standardize Exemptions: Establish consistent, clearly defined standards for family caregiver exemptions across all state Medicaid work requirements to prevent coverage losses, minimize administrative burdens for state and federal systems, and ensure clarity for supporters.
• Recognize Caregiving as Essential Work: Both in policy and Medicaid eligibility criteria, caregiving should be recognized as vital labor that keeps our current healthcare system running. Treating caregiving as work, such as allowing caregiving activities to meet eligibility work requirements, would ensure that caregivers maintain access to the healthcare services they and those in their care need in order to continue providing care.

More information is available in the full policy brief here.