- Written by Roseann Martoccia, Executive Director
- Published: 26 June 2017
Much of the country is focused on the debate around repealing and replacing the Affordable Care Act as we look to the Senate’s version of the bill. However, what hasn’t received nearly as much attention is that the House also passed deep cuts to the federal-state Medicaid program as part of the ACA repeal bill, despite that having nothing to do with repealing or replacing the ACA. The Senate is also now considering these deep Medicaid cuts that will jeopardize critical care for older adults and directly affect their caregivers. Should the Senate adopt – in-part or in-full – the House-passed changes to Medicaid, this could have devastating consequences for seniors and families in every state.
Most people think Medicaid, our nation’s safety net health care program, only serves very low-income children and mothers and, increasingly, low-income working adults. In reality, the majority of Medicaid spending provides services and supports to help people with disabilities and older adults simply live their lives.
For older adults and caregivers, Medicaid is the country’s only guaranteed provider of the critical long-term care services that most of us will need as we age. Nearly two-thirds of long-term care provided in nursing homes is paid for by Medicaid. With nursing homes averaging nearly $90,000 per year, without Medicaid, millions of older adults and families would be financially overwhelmed if these services were limited or no longer available.
However, Medicaid is also important to helping our country address the challenges of a rapidly aging nation. The population of older adults is growing at an historic pace, and over 90 percent of seniors say they would rather age at home and in their communities, where care is often less expensive and often more effective. While less expensive than nursing home care, in-home services are often cost prohibitive for families as well.
This is also where Medicaid comes in – and why cuts to the program could be especially harmful to older adults who want to age with independence and dignity at home and in the community for as long as possible. Medicaid has been a primary driver of expanding long-term care options in communities. For over 30 years, states have increasingly moved toward providing “waiver” services that allow Medicaid-eligible seniors to get the care that they need in their homes instead of in institutions. These services, which are often a fraction of the cost of nursing home care, can include, but are not limited to, in-home help with bathing, dressing, meal preparation and other activities of daily life. Several Medicaid programs have also successfully moved tens of thousands of people from institutional settings back into their homes and communities, offering consumers more independence while saving taxpayer dollars.
LifePath serves several hundred people each year who would otherwise live in a nursing home. Often their ability to stay at home is unlocked through the home and community based waiver. Massachusetts has several other waivers to serve persons with disabilities, acquired brain injury and intellectual and/or developmental disabilities. These waivers help individuals remain in the community or transition back home to live with their friends and family as well as provide federal resources to offset total cost. They are cost-effective and provide options for independence.
Unfortunately, the House-passed health care bill could change the trajectory of providing long-term care in homes and communities instead of institutions. The American Health Care Act would slash long-term Medicaid funding by $834 billion over 10 years by capping the federal government’s share and pushing these costs on to states. That’s unfair and simply not sustainable, so states will have to make terrible choices that will hurt those who depend upon Medicaid for their health and safety. Older adults could lose the amount of in-home care they receive or could be required to pay for services despite being poor enough to qualify for Medicaid. Families seeking care for a loved one will encounter long wait lists for services, and cuts to provider rates will harm the long-term care workforce.
It makes no sense to undermine the only long-term care option available to most Americans just as our country undergoes a transformational demographic shift to an aging nation. If we really want to save federal health care dollars, we should expand the most cost-effective care options instead of eliminating them. Not only do these Medicaid-funded programs preserve the dignity and independence of older adults in Western Mass and across the country, they also save taxpayers tens of billions of dollars each year in avoided nursing home costs.
Our seniors deserve better. Senator Elizabeth Warren and Senator Ed Markey of Massachusetts have spoken out against the House-passed cuts to Medicaid, but also to start over and engage in a bipartisan, collaborative process to address the real health care challenges that we face. You can help, too. Get in touch with your Senators and encourage advocacy from friends and family in other state, telling them to reject any Medicaid cuts that could be devastating to older adults and families.