Even with the federal government covering more than half its costs, Medicaid doesn't always pay for nursing home stays or home health aide visits for elderly people who can't afford them.
If Congress passes a law that reduces federal funding for Medicaid, those pressures will worsen, patient advocates say. They say states would also likely tighten asset and income restrictions before allowing seniors to enroll in Medicaid.
"Over two-thirds of Medicaid spending is considered optional under federal law," said Jennifer Goldberg, an attorney for Justice in Aging, during a media call by patient advocates on Tuesday. "If the federal government starves Medicaid through per capita caps, optional services will be the first to be cut."
As part of legislation aimed at repealing and replacing the Affordable Care Act, Republicans in Congress have proposed capping the annual growth of federal payments to each state at the medical component of the Consumer Price Index for most beneficiaries, and at M-CPI plus 1 for the elderly and disabled. Payments would be based on each state's spending for fiscal 2016.
Even though nursing home coverage is mandated in Medicaid, because of low reimbursement rates, some nursing homes don't accept Medicaid patients. Others do, but restrict how many beds are available to Medicaid patients. Some ask that you move out once you exhaust your assets.
Home-based care is optional under Medicaid. In Florida, there are tens of thousands of people on a waiting list for those services, Goldberg said. She added that California tried to eliminate state funding of adult day care, and only a lawsuit saved the program.
Leading Age, which represents almost 6,000 not-for-profit organizations that run nursing homes, community-based senior care and low-income senior housing, has been one of the organizations trying to stop the Medicaid cuts.
Marsha Greenfield, vice president for health legislation at Leading Age, said that half of seniors have median assets below $100,000. According to Genworth, which sells long-term care insurance, nursing home care averages $82,000 a year while 44 hours per week of home-health care aide coverage costs $46,000 a year.
Ann Burgunder was on the call speaking about the patient experience. She said it would cost her about $7,500 a month to replace the services that Medicaid currently provides to her partner of 25 years, Robert "Ti" Randall.
Randall started having memory problems 11 years ago. Five years ago, he exhausted his savings, and Medicaid began paying for his home-health services, which comprise 12 hours a day during the week and five hours on Saturday.
Republicans want to scale back spending on Medicaid because it's one of the federal government's largest expenses. Federal estimates show current proposed legislation would reduce federal Medicaid spending by $834 billion over 10 years, or about 25%.
The recent Senate bill makes the biggest reductions in federal funding for elderly Medicaid patients in 2025, just as the first baby boomers turn 80. About half of Americans older than 85 have dementia.