Immigrant Caregiver Burden: The Hidden Cost of the Five-Year Medicaid Wait

Why It Matters

The federal Medicaid restriction deepens caregiver burnout and financial hardship among immigrant families, threatening both elder health outcomes and workforce productivity.

Key Takeaways

• Five-year Medicaid wait bars immigrant elders from coverage
• Caregiver juggling full-time job faces productivity loss, burnout
• Financial strain from medical supplies persists despite employment
• Policy change needed to expand home‑care eligibility
• Community programs essential for immigrant caregiver support

Pulse Analysis

The United States’ five‑year Medicaid eligibility window for lawful non‑citizen permanent residents creates a hidden safety net gap for millions of immigrant elders. While the policy aims to control costs, it leaves seniors who have migrated for better health care without coverage for essential services such as home‑health aides, medical equipment, and prescription subsidies. Recent data from the Migration Policy Institute indicates that roughly 1.2 million immigrant seniors fall into this waiting period, amplifying disparities in access to long‑term care and inflating out‑of‑pocket expenses for families.

For family members like the Suresh father, the burden translates into measurable economic and health consequences. Remote‑work flexibility can mask the true cost of caregiving, but studies from the National Alliance for Caregiving show that employed caregivers lose an average of 6 hours per week in productivity, translating into $5,000‑$7,000 in lost earnings annually. The emotional toll—heightened stress, sleep disruption, and burnout—also raises the risk of chronic conditions, further eroding labor market participation. When caregiver support programs hinge on income thresholds, many middle‑class immigrant families remain ineligible, compounding financial strain despite steady employment.

Policymakers and community health agencies have a clear roadmap to mitigate these challenges. Eliminating the five‑year Medicaid bar for immigrant elders would align eligibility with that of U.S. citizens, immediately expanding coverage for home‑care services and reducing family outlays. Additionally, formal recognition of family caregivers—through tax credits, paid family leave, or direct stipends—can preserve workforce productivity and protect caregiver health. Local health departments can play a pivotal role by offering multilingual navigation services, simplifying grant applications, and partnering with NGOs to deliver culturally competent support. Addressing this policy blind spot not only safeguards vulnerable seniors but also strengthens the broader economy by retaining skilled workers who would otherwise be sidelined by caregiving demands.

Immigrant caregiver burden: the hidden cost of the five-year Medicaid wait

Ranjita Suresh · Policy · February 12, 2026

Every night I spend at home, I wake up to the sound of Für Elise by Ludwig van Beethoven. If you asked my dad, who works remotely, he would grimace and tell you he hears it at least 10 times a day. It’s a classic piano piece, don’t get me wrong, but we don’t have a piano, nor are we a family of Beethoven fanatics. My dad probably loved Beethoven a lot more before he programmed my grandmother’s medical alert button to play it instead of a blaring alarm. He definitely didn’t foresee having to interrupt his daily work and home life multiple times a day because a classical tune was calling him to help his mother walk to the bathroom, adjust her position in bed, or feed her snacks and coffee.

My father is a provider and a family man at heart, which is why when his siblings in India talked about moving my grandmother to a home, he insisted she come stay in America. That was almost five years ago, and as her age progresses, life gets harder. Although she is healthy for a 95‑year‑old, she is hard of hearing, fragile, and can’t walk on her own. Her hospitalizations over the past few years have accumulated a myriad of diagnoses including vertigo, vascular Parkinson’s, and vasovagal syncope. She needs help with everything from sleeping to showering. All this on top of full‑time employment. My father’s choice to care for his 95‑year‑old mother has undoubtedly taken a toll on him, but such is the life of a caregiver. That is not to say that I’m not worried about his well‑being or that he doesn’t need or deserve better support, but more so that he has come to accept it because that is who he is.

The remote work trap

Personally, I believe he is stuck in a place where he feels like he can’t ask for more help, and he can’t quit his job because he can’t afford to retire yet. He is stuck at home because my grandmother can’t be left without him for more than 30 minutes, and he is lonely and burnt out. His company has relied on his leadership and technological skills for 20 years, and his work is very much valued despite maintaining his remote status post‑COVID.

So, although he can’t afford or justify taking 12 weeks of unpaid leave to support his mother, his team is very understanding of his situation; they tolerate the constant interruptions during important meetings. While the flexibility of his workplace has maintained his productivity enough to keep his job, studies have shown that employed caregivers generally experience productivity loss in their work environments, which can hinder them economically.

Not everyone is as lucky as my father is to be able to stay employed, although I’m sure that doesn’t feel like luck to him. However, his employment doesn’t make up for the time and money that goes into taking care of my grandmother, and despite financial assistance being available, many grant programs aren’t easy to find and apply for without the help of community health departments and caseworkers. Paying for her medicine, diapers, hospital bed, insurance, hospital visits, walkers, wheelchairs, home health aides, and other necessities takes a toll on his financial well‑being.

The immigrant health care gap

While Medicaid usually provides compensation for some of this medically necessary equipment and services, she does not qualify for Medicaid yet because she is in a five‑year waiting period as a qualified non‑citizen (my dad was able to get her green card a few years ago, a process that generally requires translation). He also does not get compensated as a caregiver due to his income; many caregiver support programs are based on a sliding scale for income even if they don’t include income requirements for eligibility. My family lives a well‑off life here in America, and my dad rightfully thought she’d live a lot more comfortably here than in India, where health care was suboptimal during the COVID‑19 pandemic. And yet ever since she arrived, it has been nothing short of a struggle to provide for her.

My dad’s story is not entirely unique. So many immigrant families found a way to bring their loved ones to a safer place during the pandemic, so I can only imagine how many other people relate to our situation. Caregivers of immigrant elders face a multitude of barriers. However, those barriers are hidden and often overlooked in times of urgency and emotion. Federal policy imposes a five‑year waiting period before lawful non‑citizen permanent residents can qualify for Medicaid benefits.

My grandmother turns 96 soon, and we are hopeful to say she may even make it to the end of that waiting period. But five years of struggle have put a toll on my father and our family. Working full‑time on top of an unpaid caregiver role has increased his stress in ways that have negatively impacted his health in the past three years, as it does for many.

A call for policy change

The systemic and political framework that has exacerbated caregiver burden for my father shows us what needs to change. We should be voting and advocating for policies that expand eligibility for home‑care coverage, eliminate the five‑year bar for immigrant elders with a need for home‑care service coverage, and formally recognize family caregivers regardless of employment status and income level for financial and medical caregiver support. Community health departments should be developing programs that educate and assist with caregiver resources and immigrant document filing. My father has worked too hard to get to this country and provide for his family only for his efforts and health to be overlooked.

Ranjita Suresh is a medical student.