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Medicaid is a state-federal partnership that guarantees federal financial support to every state to provide essential health and long-term care to older adults and other people with limited income and savings. As the number of older adults who need long-term care grows and state Medicaid costs increase, the federal government helps meet those rising costs by matching a percentage of each dollar the state spends. Here are three ways proposed “reforms” would cut Medicaid funding:
Under block grants or per capita caps, states would receive a fixed amount of federal Medicaid funding, regardless of actual costs. This means federal funding would no longer keep up with increased costs, shifting those costs to states. Medicaid would shrink over time for all populations, including older adults, and would not be able to adequately respond during emergencies such as pandemics or natural disasters when Medicaid has historically been a key resource.
Reducing the federal match (Federal Medical Assistance Percentage or FMAP), including removing the minimum 50% FMAP, would shift costs to states, forcing them to cut overall Medicaid spending. Ending the enhanced 90% FMAP for Medicaid Expansion, which covers millions of older adults under age 65 as well as paid and unpaid caregivers, would automatically end expansion in several states and force other states to scale back Medicaid programs and services that older adults rely on.
Restricting allowable provider and insurer taxes, which every state uses to help fund all of their Medicaid programs, would reduce state budgets and force Medicaid cuts.
All of these proposals would starve Medicaid, forcing states to reduce spending by cutting programs and services that federal law does not require to be covered. The first target will be the home and community-based services (HCBS) that older adults and people with disabilities rely on daily because these programs account for a large share of Medicaid spending. Other benefits like dental, vision, and hearing, as well as expanded eligibility for Medicare Savings Programs and nursing facilities would also be on the chopping block.
With reduced Medicaid budgets, states would also cut provider payment rates, reducing provider access and worsening direct care workforce shortages. As a result, older adults would have a harder time finding HCBS providers and people living in nursing facilities would be at increased risk of poor care.