How cutting Medicaid would affect long-term care and family caregivers : NPR

Medicaid is in the spotlight as Congress is looking for ways to reduce the federal deficit. Last week, the GOP-led House passed a budget framework that would allow both chambers of Congress to tackle major budget plans that are expected to pass without a Democrat vote. Some House Republicans have called for the inclusion of cuts in Medicaid spending.

Family caregivers and those who need long-term care can be hit hard by reducing the program.

Jointly funded by federal and state governments, Medicaid is a national health insurance program for low-income people. But it is also the single largest source of funding for long-term care for people with disabilities and seniors, paying more than $415 billion spent on these services each year.

Medicare, a program for people over the age of 65, does not pay for long nurse stays or ongoing home assistance.

For those with low incomes and those with little assets beyond home, Medicaid picks up tabs for long-term or permanent nursing care. It pays 60% of the stays of the country’s extended nursing home, including around 1 million people.

Approximately half of Medicaid spending on elders covers “home and community-based” services, with approximately 4.5 million chronically ill or elderly people in the United States receiving care from home.

Medicaid pays wages to caregivers, friends, family members, or professional caregivers who support important needs.

Reducing Medicaid services “It will have a major impact on their health,” says David Grabowski, a health economist at Harvard Medical School. “These are the services they need every day to bathe daily, dress themselves and get to the kitchen.” Reductions can lead to hospitalizations, emergency room visits, and in some cases early deaths, he adds.

Medicaid also funds Adult Day programs, Social Work Help, Caregiver Training, Rest Programs, and other services that help people stay home.

Services and funding help family caregivers grow thinly through responsibility. The average American caregiver spends Over $7,000 AARP research shows that it’s been a year since pocket.

Sacramento resident Sharon Ducessi cares for his partner who has diabetes and a bad back. She says there is no way the two can manage without Medicaid support. The program pays her to help him. Both rely on it for health care. Still, they are growing.

Sharon Ducessi and her partner

Sharon Duquesy

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Sharon Duquesy

As a loan processor, Duchessi paid a good salary. Currently, she earns $18.65 per hour, closing at 189 hours a month. She estimates that at least 250 hours a month will be needed to care for her partner. This program compensates her for just 30 minutes spent on laundry, for example, every week. However, he is prone to dangerous skin infections, so he has to even rub his washer and dryer every time he does the laundry.

If she doesn’t care about him, she expects him to come and go to the hospital.

Medicaid home caregivers in California and several other states are unionized, and Ducessi is currently the 2015 Regional Vice President of the SEIU District.

The family will pay the costs

Earlier this year, the House introduced a budget resolution that requires effective trimming of up to $880 billion in Medicaid spending over the next decade. Last week, the blueprint still passed This directive is includedthe Senate and House of Representatives will need to negotiate what will ultimately be included in the budget.

President Trump and House Speaker Mike Johnson promise to target fraud and abuse. But the federal government My own investigation We see that only about 5% of Medicaid payments are “inappropriate” and the term includes both fraud and documentary errors, and that it estimates that complete fraud will only increase around $6.5 billion a year. The rest of the cuts should come from reducing registration, suppressing services, or reducing provider payments.

States could raise taxes to cover the differences. However, most observers believe that the state is likely to reduce payments and change eligibility requirements or reduce services.

“It’s going to put a huge strain on the family,” he says. “There may be savings from a budget perspective, but the family will pay for this.”

Technically, the proposed budget would not be a cut to Medicaid budgets, noted Michael F. Cannon, director of health policy research at the Cato Institute, a libertarian think tank. It means that it grows slowly.

The Congressional Budget Office predicts that Medicaid budgets will need to grow from 4% to 6% each year, in line with increasing annual spending from private insurance to maintain its current services. To cut federal spending by $880 billion over a decade, the program’s budget could only increase by 3% per year.

Limiting Medicaid spending could have other consequences. For many years, the federal government has promoted policies to stabilize people with disabilities rather than bringing elders and people with disabilities like elderly people and home partners into nursing homes. It’s usually something people like and it’s cheap. Medicaid spends Approximately $47,000 a year According to the Research and Voting Group KFF, long-term care residents average around $11,000 more than they would spend on providing community-based and home care.

Medicaid rules require nursing home stays to be covered for qualified individuals. However, they do not need compensation for personal care within the home. If money is tough, nursing homes still get paid, but home caregivers and other support services may not, says Nicole Jorwic, Chief Program Officer at Caring across generations, an advocacy organization that supports care work.

“There is a possibility of unnecessary institutionalization because of what the state has to do,” says Yorwick. People with disabilities or elderly people may need to enter nursing homes if they may have been at home with some assistance.

The financial burden of long-term care

State can also change eligibility rules to make it more difficult for middle-income people to qualify for Medicaid. Eligibility varies by state and program, but in many states, you need to earn less than $34,812 a year, with assets under $2,000. To qualify, some families will reduce their savings. Currently, there are legal ways to protect some of your assets if you prepare in advance.

If these loopholes are eliminated, some middle-income earners may pay for the services themselves.

“If we change the eligibility rules so that fewer people are eligible, we’ll have more resources for the poorer people,” Cannon says. For this reason, he predicts that Medicaid reductions will not have a dramatic impact on long-term care. “Some people can take advantage of the equity of their homes and rely on savings.”

However, some of the older people who are now eligible for Medicaid were among the poor. Paying for long-term care can lead to bankruptcy even for middle-class people. Assisted Living is Key research Of providers in 2024, private rooms in nursing homes average $127,750.

It is expected that more than half of all people over the age of 65 will require long-term care at some point. Only 4% of people have long-term care insurance to cover the costs.

Many states already have a long waiting list for people asking for Medicaid funds for home care, Yorwick notes. “Cutting means the list grows. Some people are cut from services. That has a major impact on unpaid caregiving that has already filled the gap.”

Trimming Medicaid payments could encourage more people to purchase long-term care insurance for themselves, Cannon argues. The fact that Medicaid now acquires costs for people who have exhausted their money means there is very little incentive to buy insurance.

However, the change does not address the needs of families who are currently relying on Medicaid to support long-term care.

In Duchessi’s case, she wants to return to work and find someone who can help her partner while she’s at work. That may not be easy. “Careers – we’re a different breed,” says Duquesi. “That’s not something that encourages anyone to do unless they want to do it. It’s a tough job.”

The Senate budget resolution passed April 5th does not include the same cuts as the House version, and some Republican senators say they are opposed to Medicaid trim. Details and ultimate scale of the Medicaid budget for the next decade will be hashed between the two chambers later this year.

Kat McGowan I am a care reporter based in Berkeley, California.