The passage of H.R.1, the massive Congressional budget reconciliation bill, has serious implications for older adults in California and across the country.
In addition to ending eligibility for Medicare and several other programs for a large group of legal immigrants, H.R. 1 expanded work requirements for the Supplemental Nutrition Assistance Program (SNAP, or CalFresh in California) and added work requirements to the Medicaid (Medi-Cal) program for the first time for those who remain eligible – primarily U.S. citizens and lawful permanent residents, or “green card” holders. Previously, SNAP work requirements ended at age 54, but both programs will require participation until recipients turn 65. For millions of older Americans approaching retirement age, H.R. 1 does more than just add another government requirement: It asks people who already face increasing age discrimination, chronic health conditions, and caregiving responsibilities to navigate new work reporting rules at precisely the stage of life when finding and maintaining employment often becomes most difficult.
Archstone Foundation is working with advocates on the ground to lift the voices and tell the stories of the older adults most affected by these changes and support the organizations positioned to help them navigate these systems and receive the care they need.
In this post, policy expert Cathy Senderling-McDonald describes the challenges at hand and what we can do to help ensure the health and well-being of older adults.
As I think about the impacts of H.R. 1, the “One Big Beautiful Act” that Congress passed on July 4, 2025, a particular San Francisco Chronicle article resonates. In April, Reporter Vanessa G. Sanchez shared the story of Rosa Maria Carranza, a 67-year-old child development professional originally from El Salvador, here in the United States legally under Temporary Protected Status and employed full time for decades, paying into the Medicare program with every paycheck just like millions of others.
Under H.R. 1, Rosa and an estimated 100,000 other lawfully present, legally working and contributing immigrants will soon be cut off Medicare and left with few options for health care coverage and food benefits.
For older adults and adults with disabilities, the new work rules are likely to be among the most difficult to comply with – not because of a lack of willingness to work or volunteer, but due to the new paperwork burden and the age- and disability-related discrimination they frequently face in the labor market.
A recent AARP poll of 1,656 workers aged 50-plus found that 64 percent of respondents had seen or experienced age discrimination in the workplace, with 22 percent reporting they felt they were being pushed out of work.
The picture is similar for workers with disabilities. A 2023 Urban Institute review found that four in ten adults with disabilities reported experiencing unfair treatment in health care settings, at work, or when applying for public benefits. Adults with disabilities were twice as likely as adults without disabilities to report unfair treatment.
Research has also shown that older workers who lose employment often remain unemployed longer than younger workers and frequently experience lasting reductions in earnings after reemployment.
Older workers are also often grappling with chronic health conditions; many are in the “sandwich generation,” with caregiving duties for aging parents, children, and even grandchildren at the same time.
These issues are more pronounced for those in lower income brackets who are more likely to have worked at physically demanding jobs in their younger years and less likely to have funds saved for retirement or emergencies.
And for those with cognitive issues or limited English proficiency, the need to navigate complex and overburdened bureaucracies to turn in paperwork and document hours of engagement will make them even more vulnerable to losing benefits.
Exemptions are fraught
Congress included a seemingly straightforward exemption for “medically frail” individuals in H.R. 1, but the federal agency governing Medicaid released guidance for states that will make it difficult to apply.
Rather than simply documenting the existence of a chronic illness or disability based on a person’s diagnosis and services received – data readily available to state Medicaid agencies – states must instead consider whether an individual’s condition significantly impairs their ability to work or engage in other required activities. This essentially requires a case-by-case determination that will often require contact with recipients.
Additionally, the use of self-attestation is limited, meaning that many recipients will need to seek verification from medical professionals and pass that information on to state and county eligibility workers who are already overwhelmed with the new rules. All of these requirements may cause delays in coverage and people erroneously losing coverage. States, including California, have sued over this burdensome interpretation, but the presiding judge is allowing the rules to take effect while the case moves through the courts.
For older individuals and their families, persons with disabilities and their caregivers, Medicaid is a true lifesaver, paying for specialized home-based care and long-term institutionalized care. Services like bathing, dressing, and help with meals and grocery shopping help to preserve quality of life and dignity, delaying moves into expensive (and often unwanted) institutional care.
At the same time, Medicaid finances medications, treatment for chronic illnesses, behavioral health care, rehabilitation, and other services that often enable people to remain employed. People who lose coverage because of reporting or documentation barriers may ultimately lose their jobs, plunging them and their families into further poverty.
For people like Rosa – legal immigrants impacted by the new H.R. 1 rules – finding health care coverage at all will be extremely difficult, and they are likely to go into medical debt for necessary services or simply go without care.
There’s much we can do
The next several years are likely to be a struggle for many low-income individuals and their families and communities, as well as for the organizations and institutions that serve them.
For local, state, and national advocacy groups, supporting older individuals, individuals with disabilities, and older immigrants to understand the requirements and access exemption processes will be crucial. This may include:
- Assistance with documentation forms,
- Following up to ensure all questions are answered, and
- Help with appeals and legal representation when needed.
These organizations will also need to keep tabs on systemic issues, engage with state and county officials to seek improvements, refer individuals to low- or no-cost care options, and document the harm that results in not receiving access healthcare.
Individuals can help by financially supporting these groups and volunteering their time to help.
For philanthropic organizations, key roles include providing support for community education at the local and regional level and coordinating these efforts with a wide variety of health and social care providers on the upcoming changes and what they need to do to stay enrolled. Other critical roles that funders can support include training for clinical staff on the new requirements, standardized assessment and documentation tools and processes, and research aimed at measuring impacts and identifying disparities across different demographic groups. Telling the story of what is truly happening on the ground with H.R. 1 implementation will help with future efforts to roll back the bill’s harshest changes.
The greatest threat posed by H.R. 1 for many older adults and adults with disabilities is not the expectation that they work — it's the mismatch between the realities of aging and disability, health, and today's labor market and a system that assumes compliance is straightforward. For legal immigrants like Rosa, who came to the United States seeking refuge, H.R. 1 will hurt not just them but also their families and communities.
Mitigating as much harm as possible, documenting the harm that does occur, and identifying and disseminating best practices for access and care will be critical as H.R. 1 is implemented. This may be a long-term effort, rather than a quick fix. Strengthening our partnerships in this work is essential. We will be stronger and more effective by staying connected, forging new alliances, and directing our efforts – along with and on behalf of all older adults and adults with disabilities, their families, and their communities.
