Policy Changes Reshaping Family Caregiving

Health Affairs
Health AffairsMay 27, 2026

Why It Matters

Policy decisions now will determine whether America can sustain its aging population without overburdening family caregivers, directly affecting labor markets, health costs, and economic productivity.

Key Takeaways

  • Medicaid cuts threaten home‑based services for millions of caregivers.
  • Bipartisan support fuels a surge in state‑level paid family‑leave laws.
  • ACL reorganization leaves federal caregiver programs in prolonged limbo.
  • Washington’s social‑insurance model offers a blueprint for long‑term care.
  • Employers increasingly adopt flexible work and caregiving benefit programs.

Summary

The podcast episode examines how recent policy shifts are reshaping family caregiving in the United States. Host Katherine Ornstein and expert Allison Baroff discuss the growing reliance on unpaid family caregivers, the $1 trillion annual economic burden, and the absence of a comprehensive long‑term‑care system. Key insights include a historic 50 % rise in caregivers over the past decade, bipartisan momentum that has produced more than 60 % of caregiving bills with cross‑party support, and looming threats from massive Medicaid cuts—most notably HR 1, which would slash state Medicaid funding by nearly a trillion dollars and impose work‑requirement hurdles for many caregivers. State innovators are stepping in, with 13 states and D.C. adopting paid family‑leave policies and Washington launching a social‑insurance long‑term‑care program to cover home care for the “missing middle.” Baroff highlights that the Administration for Community Living (ACL) remains in limbo after a failed HHS reorganization, leaving critical federal programs understaffed yet protected by congressional language. She cites Washington’s tax‑funded insurance scheme and Virginia’s new paid‑leave law as concrete examples, while noting that employers are beginning to offer flexible schedules, caregiving leave, and subsidies, echoing a Milin Institute report on private‑sector responses. The implications are clear: without decisive federal action, caregivers risk losing Medicaid support and essential home‑based services, while state and employer initiatives may provide partial relief. Sustained advocacy, coordinated federal‑state strategies, and broader private‑sector adoption are essential to safeguard the health of caregivers and the older adults they support.

Original Description

Welcome to a new, limited podcast series exploring major policy changes affecting older adults. This episode is part of our Age-Friendly Health ( https://www.healthaffairs.org/topic/pt_2503 ) series, which explores topics at the intersection of aging, health, health care, and health policy.
In our third and final episode for the series in 2026, host Katherine Ornstein welcomes Alison Barkoff of George Washington University to the program to discuss the rising economic and social importance of family caregiving, recent federal policy shifts affecting Medicaid and caregiver programs, and new interventions at the state and private‑sector levels.
Support for the Age-Friendly Health series is provided by The John A. Hartford Foundation.
Related Links:
* Reflections On Caregiving Policy: Progress, Challenges, And Opportunities ( https://www.healthaffairs.org/content/forefront/reflections-caregiving-policy-progress-challenges-and-opportunities ) (Health Affairs Forefront)
* History Repeats? Faced With Medicaid Cuts, States Reduced Support For Older Adults And Disabled People ( https://www.healthaffairs.org/content/forefront/history-repeats-faced-medicaid-cuts-states-reduced-support-older-adults-and-disabled ) (Health Affairs Forefront)
* Long Term Services and Supports Initiative ( https://exploreltssinitiatives.org/ )
* Nation Alliance for Caregiving's Caregiver Nation Coalition ( https://www.caregivernationcoalition.org/ )
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May 27, 2026
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