About 12 million older adults and people with disabilities are enrolled in both Medicare and Medicaid. For most services, Medicare is the primary payer and Medicaid secondary. For services that Medicare does not cover, such as long-term care in a nursing home or at home, Medicaid is the exclusive payer. Republican plans to slash Medicaid spending will inevitably have devastating consequences for hundreds of thousands of older and disabled people with Medicare who rely on Medicaid for their long-term care needs.
N.B. If Republicans want to cut $1 trillion from the budget, they should stop giving billions in handouts to corporate health insurers and end the $1.2 trillion in Medicare Advantage HMO waste and abuse.
How many people with Medicare and Medicaid receive long-term care through Medicaid? Of the 12.8 million people with Medicare and Medicaid, more than one million older adults and people with disabilities rely exclusively on Medicaid for their long-term care needs.
What is the income of people with Medicaid and Medicare receiving long-term care through Medicaid? In 44 states, people with incomes no greater than 300 percent of the SSI level or 226 percent of the federal poverty level, $2,829 a month (2024), are eligible for Medicaid long-term care. MACPAC reports that more than 60 percent have annual incomes below the poverty level; 94 percent have annual incomes below 200 percent of poverty. A high proportion do not have a high school diploma and are African American or Hispanic.
What is the health status of people with Medicare and Medicaid? More than one-third of dual eligibles are enrolled in Medicare because of a disability, and 14 percent are over 85 years old. According to MACPAC, they are more likely to have cognitive impairments and mental disorders than others. They also have higher rates of diabetes, pulmonary disease, stroke, and Alzheimer’s disease than non-dual-eligibles.
What services does Medicaid provide in nursing homes? Medical services, nursing care, and rehabilitation services. Medicaid also provides help with activities of daily living such as bathing, dressing and toileting.
How much does the federal government spend on Medicaid relative to the states? The federal government spent about 69% of Medicaid’s total costs, including nursing home care–around $606 billion–out of a total of $880 billion in FY 2023. About 34 percent of Medicaid spending is for long-term services and supports, including institutional and home-based care. The federal government provides support for Medicaid long-term care to different degrees in each state.
What happens to nursing home residents if Medicaid money is cut? Medicaid covers 63 percent of nursing home residents. The vast majority of dual eligibles receiving institutional or home-based care are covered through an “optional eligibility group.” The states could end their eligibility. Most nursing home residents may be forced to go without long-term care. Medicaid coverage is available only to people with low incomes, who could not otherwise afford to pay for their nursing home or home care. In 2024, the average cost of a nursing home stay in a semi-private room was over $111,000.
What will states do if Congress cuts federal Medicaid significantly? States would likely end optional Medicaid home and community-based long-term programs and would stop providing Medicaid long-term care for millions of Americans. They might reduce long-term care services considerably. They might pay less for nursing home care, which could lead to nursing home staff shortages, as well as poor quality of care and poor health outcomes for patients.
Here’s more from Just Care:
- Congress could end overpayments to big insurers in Medicare Advantage and save $1 trillion, without gutting Medicaid
- Medicare and Medicaid: How they work together
- People with both Medicare and Medicaid can get Traditional Medicare at little cost
- Medicaid is a benefit for the middle-class
- Beware of chain nursing homes
