As many seniors are aware, the Better Care Reconciliation Act has been proposed by Senate Republicans to replace the Affordable Care Act (ACA). It is predicted to cut Medicaid spending by about $772 billion through 2026 – or about 25 percent over the next decade. Supporters, primarily targeting programs and care for pregnant women and children, claim that the changes won’t affect nursing home subsidies. On the other hand, opponents state that elder care, including long-term nursing home stays, amounts for about two-thirds of Medicaid payouts, so seniors will eventually see the effects – even if they’re not immediate.
Ultimately, the proposal would reduce current Medicaid expenditures 35 percent by 2036 and would cut down what’s considered a costly entitlement program. While House and Senate Republicans claim Medicaid is only for the extremely poor and gets abused by those attempting to game the system, figures show that:

  • One in four people using Medicaid currently are elderly or disabled. With more Baby Boomers entering retirement age, this percentage is predicted to increase.
  • In several states, Medicaid is the primary payer for as many as three-quarters of all seniors.
  • Currently, two-thirds of Medicaid spending goes toward elder care. Forty percent from total expenses goes toward nursing home stays.
  • Of the 1.3 million seniors in nursing homes, half use Medicaid in some form.

concerned senior couple looking at medical billsAlong with the proposed changes, which would reduce federal spending by $4.2 trillion, the plan shifts more of Medicaid’s management to the states. This would result in more autonomy for a state to adjust and operate its programs. Proponents claim doing this would help the most vulnerable, while opponents believe it would push affordable care out of the reach of seniors and the disabled.

With all of these factors considered, seniors and the disabled could be facing:

Stricter Qualifications

Currently, under federal law, state Medicaid programs must cover nursing home stays and can assist with an in-home aide. Yet, with states assuming more control, health care experts predict that Medicaid could shift from its present open-ended model to one that’s capped. As a result, states would be able to decide how much or how little they could pay nursing facilities and access to Medicaid could become restricted. Potentially, it may turn into a program only for the disabled, not seniors needing insurance.

Greater Financial Responsibility

In many cases, seniors could have to pay more out-of-pocket costs. As a result, older individuals could find themselves evicted from nursing facilities.

The proposed changes would essentially make Medicaid more like Medicare. For nursing care, this could turn into states requiring a resident or family member to pay for a larger portion of a nursing home stay. Currently, Medicare does not pay for long-term nursing home care and daily assistance, such as a home health care aide. While seniors going into homes may have money saved up, the high costs eventually deplete their savings. As a result, staff members automatically sign patients with insufficient funds up for Medicaid to continue receiving care.

These changes could limit the types of service and nursing home care Medicaid pays for and may require families and patients to shoulder a much larger financial burden than they currently do. As the alternative, homes may reject patients outright or simply discharge them once they can no longer pay.

Forced Institutionalization

Through potentially reduced coverage, Medicaid may only be applicable to nursing home services, rather than offering in-home care as an option. The result, to continue current federal standards while cutting other care choices, would lead to forced institutionalization. Essentially, because seniors would have no other options for long-term care, they’d be forced into a nursing facility to receive this benefit.

Fewer, Understaffed Homes

Medicaid’s payments to nursing homes are already fairly low and, with at least a quarter of this spending cut and more patients to accommodate, these facilities could find themselves stretching already-minimal resources or charging more for care. In response, nursing homes may need to cut their staff, reduce the number of beds or lessen the quality of services offered.

Additionally, according to the American Health Care Association (AHCA), homes with higher percentages of Medicaid patients could end up hundreds of thousands of dollars in debt. As a result, a facility that is unable to break even may need to close. As such, regions may have fewer facilities and beds available, all while more Baby Boomers enter retirement age.

Even with current Medicaid regulations, seniors face the possibility of lower-quality care and eviction. If you’ve experienced this or another degree of negligence in a nursing facility, understand your rights and take action with Trantolo & Trantolo’s lawyers. To learn more, contact our team today.