Medicaid Under Threat: NAC’s Unified Response to HHS Restructuring and Program Cuts
Fresh from the American Society on Aging’s #OnAging2025 conference, I’m filled with both inspiration and concern. The three days spent among fierce advocates reimagining care systems across the aging sector nourished my soul while simultaneously highlighting the urgent challenges before us. From panel discussions to conversations with community leaders on the ground, one thing became abundantly clear: people are intensely worried about the future of care.
There are moments when policy changes feel deeply personal—moments that remind us that behind every number is a real family, a caregiver, a life in need. Mass firings at the U.S. Department of Health and Human Services (HHS), efforts to slash contract spending by 35%, and proposed cuts to the Medicaid program, dominated conversations at the conference and have rattled our community, threatening the lifeline many caregivers depend on.
“When my mom got her diagnosis, we all got that diagnosis,” Carla Velastegui, who has cared for her mother with early-onset Parkinson’s disease, recently told NPR. Being seen as a caregiver helped her advocate for her mom and validated the grief that Carla was experiencing. She says the recognition gave her a sense of purpose.
Experiences like Carla’s underscore why programs like the National Family Caregiver Support Program (NFCSP), the National Plan to Address Alzheimer’s Disease, and Medicaid funded home- and community-based services can literally save lives. Everything HHS does—from support programs to cutting-edge research—ties back to that urgent need for recognition and support.
Caregiving in the Crosshairs
Recent proposals to eliminate $880 billion or more in Medicaid over a decade threaten to strip away essential supports such as home- and community-based services. These supports offer respite and training to caregivers and provide direct financial assistance that makes home care possible. States will be forced to gut critical services or slash their Medicaid programs.
The ongoing HHS reduction eliminates the Administration for Community Living (ACL). Its programs will be integrated into other HHS agencies, but there’s no clarity about the fate of the Administration on Aging, which manages the Older Americans Act and the National Family Caregiver Support Program. This elimination puts OAA reauthorization at risk, including recent progress under the 2022 National Strategy to Support Family Caregivers.
These programs reduce healthcare costs by creating and supporting infrastructure in home- and community-based settings. Without them, HHS risks increasing healthcare costs in a nation that already has the highest per capita spend on healthcare despite declining health outcomes.
Our Response
That’s why we jumped into action, framing the importance of HHS’ leadership in supporting family caregivers in outreach to policymakers and media. Our latest policy brief underscores Medicaid’s pivotal role in delivering direct support to family caregivers. By mobilizing partners through our networks, including the Act on RAISE Campaign, NAC is calling on policymakers to protect Medicaid and to ensure the reorganization of HHS doesn’t diminish our nation’s growing focus on supporting family caregivers.
Importantly, we are amplifying the voices of family caregivers who rely on these programs to make care possible, making the stakes crystal clear for policymakers. As Ty – a family caregiver for her mother living with dementia – told us, “If [Medicaid] cuts happen, that means my family would be homeless.”
Our unified advocacy extends through strategic partnerships. At #OnAging2025, we joined forces with the American Society on Aging, Grantmakers In Aging, and Grantmakers In Health to create an “Aging on the Line” action center, mobilizing hundreds of attendees to call Congress to support vital Medicaid and Older Americans Act programs. This coordinated response couldn’t come at a more critical time.
In This Chaos, We Won’t Let Up
The energy and determination I witnessed at #OnAging2025 gives me hope. These changes are meant to overwhelm us, but the strength of our unified advocacy proves we won’t let them.
This is a moment to stand up and call for protections. NAC and our coalition partners have been at the forefront of protecting family caregivers and responding to policy shifts. With our advocacy efforts, we are making it clear that Medicaid must remain robust, and HHS must preserve leadership over the National Strategy and caregiver-focused programs.
As we connect with advocates and policymakers willing to protect America’s family caregivers, we’ll keep you updated and engaged. When we publish the 2025 update to Caregiving in the U.S. with AARP, you’ll see an even clearer picture of why family caregivers need our support today.
When the systems that support family caregivers are under threat, we must respond. That’s why NAC will continue to advocate for these policy issues and push for legislative and administrative actions that enable family caregivers to reach their full potential.
Join us. Family caregivers need bold action, and they need it right now.