Proposed Budget Slashes Could Devastate Senior Services
In the quiet town of Newaygo, Michigan, Dr. Fred Levin manages the medical care of around 100 older adults at the Community PACE center. For these seniors, Medicaid isn’t merely a safety net—it’s their lifeline.
“If left to see to their own needs, a lot of them would slowly die,” Levin explains with grave concern. “They wouldn’t be able to get to their doctors’ appointments unless they had a family member to help. They wouldn’t get social care. They wouldn’t have people coming into their homes and seeing the bed bugs or the lice in their hair. They wouldn’t get their medications.”
The Critical Role of Medicaid for Seniors
The Community PACE center operates as a comprehensive facility that combines funding from Medicaid and Medicare. This one-stop shop provides essential medical and social services to older adults during the day, enabling them to continue living safely in their homes rather than requiring institutional care.
If the proposed congressional cuts to Medicaid funding materialize, Levin believes his center would likely close. Unlike traditional nursing home care, which state Medicaid programs must cover by federal law, the services provided at PACE centers represent an optional benefit that only 33 states have chosen to include.
National Concerns Growing
Across the United States, healthcare professionals, legislators, advocates, and patients are watching anxiously as Republican lawmakers consider proposals to slash billions from federal Medicaid funding to offset trillions in proposed tax cuts. While the specific nature of these funding cuts remains under negotiation, any reduction in federal Medicaid spending would inevitably shift those costs to states.
“There are a lot of people who don’t pay attention to this because they think it doesn’t affect them personally,” Levin noted. “But 1 in 4 people in Michigan are on Medicaid. It’s very likely you have friends or family on Medicaid.”
The Medicare-Medicaid Distinction
While nearly all Americans over 65 receive Medicare coverage—a program Republicans have pledged not to touch—Medicare does not cover most nursing home or long-term care services. Neither does typical private insurance.
Medicaid, however, does provide this crucial coverage.
“If you have an older adult in your life who has been in a nursing home or received help at home with cooking, bathing, dressing, chances are Medicaid was involved,” explained Natalie Kean, director of federal health advocacy for Justice in Aging. “Many of us have a connection to the program or will one day.”
Republican Dissent on Cuts
Not all Republicans support these drastic cuts. Nevada Governor Joe Lombardo publicly urged Congress not to slash Medicaid funding. Washington Republican state Representative Michelle Caldier expressed concern about the large number of military retirees and senior citizens in her district who rely on the program.
Even within Congress itself, some Republicans with high percentages of Medicaid recipients in their districts have vowed to vote against any budget plan that reduces program funding.
Public Opinion and Presidential Stance
According to a February 2025 poll from KFF, a majority of American adults—including two-thirds of Republicans—want Congress to either maintain current Medicaid spending or increase it. President Donald Trump has stated he won’t touch Medicaid, yet House Republicans recently pushed through a budget plan calling for approximately $880 billion in cuts over the next decade.
State-Level Impact
If facing cuts of this magnitude, states would need to determine which benefits to eliminate to maintain balanced budgets—a constitutional requirement in most states. Older adults and people with disabilities already account for more than half of states’ Medicaid spending on average.
Idaho State Senator Melissa Wintrow expressed concern about potential reductions in the federal match rate—the amount the federal government contributes to help states pay for Medicaid. In Idaho, federal funding covers about $3 billion of the state’s $4.2 billion Medicaid budget.
“It is all a domino effect,” Wintrow warned. “If the feds start chopping that off, it’s going to impact everything.”
Home-Based Care at Risk
Experts worry that because federal law doesn’t require state Medicaid programs to cover home-based care, such services might be sharply reduced or eliminated entirely. These include essential services like home health aides who assist with bathing, toileting, and other daily activities, as well as transportation and adult day care.
The median cost of a full-time aide is approximately $62,400 annually, far exceeding the median income for Americans over 65, which is about $36,000. Paying for these services out-of-pocket would exhaust the median Medicare recipient’s savings in less than two years.
Workforce Implications
Cutting Medicaid could also exacerbate the already critical shortage of long-term care workers. Over the past two years, most states increased their Medicaid payment rates for these services to combat nationwide shortages.
“There’s already a direct-care workforce crisis,” Kean noted. “Even if eligibility isn’t directly cut or programs aren’t cut, there wouldn’t be enough workers to provide that care. At home and in nursing facilities, the quality of care will go down.”
The impacts would be felt not just by patients but by communities as a whole. In rural areas like Newaygo, Michigan, the closure of facilities like the PACE center would eliminate jobs and leave patients struggling to access necessary services.
“Everybody’s going to be responsible for taking care of the people who don’t have health insurance, in some indirect way or another,” Levin concluded. “It’s going to affect us all.”
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