How Medicaid Cuts Could Affect Older Adults
By JCA on March 25, 2025
Medicaid Cuts Still Are On The Table. Here’s How They Could Affect Older Adults
by Howard Gleckman for his blog
In a seemingly off-the cuff television remark, President Trump said he’d protect Medicaid from government spending cuts. Don’t count on it, especially since at nearly the same time, and after dithering for months, Trump endorsed a draft House Republican budget framework that anticipates cuts of as much as nearly $900 billion in Medicaid over the next decade.
Supporters of deep Medicaid cuts have two goals: to help pay for tax cuts and to end what they say is widespread abuse by requiring recipients to work. More than 90 percent of non-disabled Medicaid recipients already work. But their pay is low, or they work part time, often because they are caring for loved ones.
A Tough Task
Is there waste in the program? Sure. The Centers for Medicare and Medicaid Services estimates it made about $85 billion in improper payments in 2024, though that was less than 10 percent of all payments. And much of it could be due to insufficient or inaccurate paperwork rather than actual fraud or abuse.
House Republicans have set a difficult—some would say impossible—goal for themselves. To finance $4.5 trillion in tax cuts, they’d need to make deep cuts in domestic spending.
Some of those reductions could explicitly target Medicaid long-term services and supports (LTSS), such as personal assistance at home or nursing home care.
Other cuts. aimed at the Medicaid program broadly, still would have a significant impact on those receiving Medicaid LTSS.
Direct Cuts To Seniors
The biggest direct risk could come from cuts to Medicaid home-based care or other optional services. States are required only to provide Medicaid LTSS in nursing homes. Other benefits are provided through voluntary waivers. Congress or HHS could limit those home-based services.