Big changes are coming to the Medicaid system this time next year — and I fear they will quietly but profoundly decimate the unpaid workforce that already props up our long-term care system.

At first glance, the new requirements seem like a no-brainer: force non-disabled adults on Medicaid to work or volunteer at least 20 hours a week to encourage employment and reduce public spending.

But many of the 39.2 million adults on Medicaid have a very good reason not to be working or volunteering.

According to the AARP, nearly 8 million people who work as unpaid caregivers to a loved one rely on Medicaid for their insurance. These caregivers are not disconnected from work; they are performing essential labor every day. By forcing people to choose between going back to work or providing lifesaving care to their loved one, the end result is going to be higher health care costs for everyone, thanks to an increased demand for paid caretakers and institutional care.