Congress has passed the so-called “Big Beautiful Bill,” a sweeping piece of legislation that will affect Medicaid eligibility, long-term care funding, and estate tax thresholds. While many of the changes are gradual, and some could still be revised, this new law points clearly toward a future of increased complexity in care access and funding. If you or a loved one could be affected by these changes, now is the right time to learn more about what could happen.
1. Medicaid Retroactive Coverage Will Be Reduced to One Month in 2027
Currently, individuals applying for Medicaid can receive retroactive coverage for up to three months prior to the application date, providing protection for families dealing with unexpected care needs. However, starting January 1, 2027, retroactive coverage will shrink to just one month. This change means families will have a much shorter window to apply after care begins and could be left responsible for tens of thousands of dollars in uncovered costs if they delay.
In addition to the burden on families, this change is expected to create added pressure on local county Medicaid offices, which are already struggling to meet application deadlines. With less time to gather records and process claims, errors and delays may increase, making timely, accurate applications more important than ever.
2. Home Equity Cap Will Increase to $1 Million in 2028
Beginning January 1, 2028, the Medicaid home equity limit will be limited to $1 million. At Law Offices of Cheryl David, our legal team is seeing this as a favorable change for most of our North Carolina clients, given that this new threshold is higher than the previous cap, offering more flexibility for those seeking Medicaid coverage while wishing to retain their homes. However, for those other states that had caps over $1 million prior to this bill, this limit may cause challenges.
3. Nursing Home Staffing Requirements Will Be Eliminated
A troubling development is the removal of federal minimum staffing requirements for nursing homes. Without mandated staff-to-resident ratios, facilities may reduce staffing levels, which raises concerns about care quality and patient safety. This elimination is likely to worsen the ongoing staffing crisis and could lead to nursing home closures, especially in rural and underserved areas.
4. Regional Home & Community-Based Services (HCBS) Waivers Will Be Allowed
Previously, Medicaid home care programs had to operate at the state level, but the new bill allows for regional waiver programs. This change means areas like the Triad region could potentially design and implement their own community-based care models. While this opens the door for innovation, it may also result in uneven access to services depending on local leadership, resources, and infrastructure.
5. Medicaid Funds Will Shift Toward Home-Based Care, But Staffing Challenges Remain
The bill calls for “rebalancing,” meaning more federal Medicaid dollars will be directed toward home and community-based services (HCBS) and away from institutional facilities. While this supports aging-in-place, it does not come with a solution to the severe staffing shortages that already plague in-home care. The shift may result in families being approved for services they cannot actually find providers to deliver.
6. Federal Estate Tax Exemption Is Increasing, With No Sunset Date
One of the most impactful changes affects the federal estate tax exemption. The previously scheduled 2026 sunset, which would have reduced the exemption from over $13 million to about $7 million per person, is no longer happening.
Instead, the exemption is being increased to $15 million per person, and the legislation describes this as a “permanent minimum.” However, it’s important to understand that “permanent” only means there is no automatic expiration. Future Congresses and administrations can still pass laws to reduce or alter the exemption.
The main takeaway from this change is that the exemption is no longer set to decrease in 2026, giving high-net-worth individuals more certainty in estate planning, at least for now. However, just because the exemption is set to increase does not mean the home is protected. The homes are still subject to Medicaid estate recovery at death. With proper planning, our elder law team can protect your home.
What the “Big Beautiful Bill” Changes Mean for You
The changes made in the “Big Beautiful Bill” don’t all take effect immediately, but they signal a clear direction: care is getting more expensive, harder to access, and more dependent on proactive planning.
For the average person, the changes will mean that:
- Future care and estate planning are more critical than ever to secure care, preserve assets, and reduce stress.
- The demand for skilled care is rising, but the number of available beds and workers is shrinking.
- Nursing homes will likely continue to close, especially outside major metro areas.
- Families will now need to assess not just eligibility for Medicaid, but availability of care.
- Continuing Care Retirement Communities (CCRCs) and private-pay facilities may become more important as traditional options decline.
The Bottom Line: A Good Plan Can Be the Difference Between Care & Chaos
We’re entering an era where eligibility for benefits alone isn’t enough. A comprehensive plan must also address where care will be delivered, who will provide it, and how to secure it in a competitive, resource-limited environment.
Now is the right time to review your options, prepare your documents, and position your family for stability, no matter how the laws continue to evolve. Law Offices of Cheryl David here to help you navigate it all.
If you live in North Carolina, contact us online or call (336) 717-0375 to discuss your options with our estate planning attorneys, especially now that the “Big Beautiful Bill” is poised to significantly change the landscape of long-term care planning.