July 14, 2026
DEEP DIVE: Making Medicaid Work Requirements Work for Home-Based Child Care Providers
Since the One Big Beautiful Bill Act (OBBBA) was signed into law in July 2025, federal policy changes have created new challenges for child care providers who rely on public benefit programs to support themselves and their families. Among the most significant are new Medicaid work requirements enacted through OBBBA, which will affect many child care providers who rely on Medicaid for their basic health coverage. These changes may have a particularly significant impact on home-based child care providers, who are often self-employed, among the lowest-paid workers in the country, and more likely to lack traditional employment documentation such as pay stubs, contracts, or formal timesheets.
In Making Medicaid Work Requirements Work for Home-Based Child Care Providers, Katie Hamm and Mario Cardona analyze how new Medicaid work requirements and recent federal implementation guidance may affect home-based providers’ ability to maintain health coverage. This new Deep Dive resource provides background on the importance of home-based child care, explains considerations related to documenting income and work hours, identifying exemptions, and demonstrating compliance with new requirements. The piece also highlights opportunities to reduce administrative burden during implementation specifically as it relates to home-based child care providers. With states required to implement work requirements by January 1, 2027, and currently making key policy decisions about documentation, eligibility verification, and compliance processes, these choices will play an important role in determining whether eligible home-based providers can maintain Medicaid coverage and continue providing critical child care services in their communities.
Click here to access the Deep Dive and click here to download a PDF version.
