Washington, D.C. – As Congress embarks on the budget reconciliation process, the nation’s largest association representing long term care facilities, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is urging lawmakers to protect Medicaid from potential cuts. The program is the primary source of coverage for residents of nursing homes and intermediate care facilities, as well as a critical option for many assisted living residents.
“One of Medicaid’s core functions is to protect our nation’s most vulnerable. It is a critical safety net for America’s seniors to make sure they can access the long term care they need,” said Michael Bassett, Senior Vice President of Government Relations for AHCA/NCAL. “It’s no secret that Medicaid is already underfunded, so any further cuts would be devastating. We will continue to urge lawmakers that there’s a better way to create government efficiencies while upholding the promise made to our nation’s seniors.”
Learn more about the role of Medicaid in long term care:
Fact: Most nursing home residents rely on Medicaid to cover their daily care.- Across the country, Medicaid is the primary provider of coverage for nearly two out of every three (63 percent) nursing home residents. There are approximately 1.3 million nursing home residents on any given day.
- Of the more than 800,000 assisted living residents, almost one in five (18 percent) relies on Medicaid to pay for daily services.
- Virtually all 55,000 individuals with disabilities residing in an intermediate care facility (ICF) are on Medicaid, since it is an optional Medicaid benefit.
- According to research, one in five individuals enrolled in Medicaid is a senior or an individual with disability.
- Medicaid covers long term services and supports (LTSS) to help individuals with basic activities of daily living, like bathing, dressing, and walking. Many of these critical services are not covered by Medicare or private insurance.
Fact: Medicaid has been chronically underfunded for decades.- For nursing homes, Medicaid reimbursement rates in many states fail to cover the actual cost of care, leaving providers with a significant financial shortfall. As of 2019, Medicaid only covered about 82 cents per every dollar of care costs.
- As a result, the average nursing home operates in the red (-1.4 percent total all-in margin).
- In assisted living, Medicaid programs vary by state, typically through a home- and community-based waiver program. Medicaid does not cover room and board costs in assisted living like it does for nursing home care.
Fact: Without adequate Medicaid reimbursement, nursing homes and other long term care facilities struggle to compete for workers, enhance care services, and keep their doors open.- Nursing homes still need more than 60,000 workers to return to their pre-pandemic workforce levels. Proper funding could assist with staff recruitment and retention efforts.
- Access to nursing home care has declined in recent years, as more than 775 nursing homes have closed, nearly half have had to limit admissions, and 20 percent have had to downsize.
- The number of ICFs has declined by more than 16 percent over the last 10 years, from nearly 6,400 facilities to now 5,300 (CMS QCOR).
Fact: The demand for Medicaid and LTSS will continue to increase.- Over the next five years, the U.S. population of individuals aged 80 years and older is expected to increase by more than four million people to 18.8 million.
- More than 17 million (roughly one in three) older adults aged 65 and older are economically insecure, with incomes below 200 percent of the Federal Poverty Level.
Fact: The American public is largely in favor of Medicaid, including two-thirds of Republicans.- According to research, large majorities of the public view the Medicaid program favorably and think the program works well. This remains true across party lines and has remained consistent for years.
- Favorability of the program increases as individuals have personal experiences with Medicaid through their own needs or those of a loved one.
Bottom line: For the sake of our seniors and states, Medicaid must be protected from cuts.