Much of the country is focused on the debate around repealing and replacing the Affordable Care Act. However, what hasn’t received nearly as much attention is that the House also passed deep cuts to the federal-state Medicaid program as part of the ACA repeal bill, despite that having nothing to do with repealing or replacing the ACA. The Senate is also now considering these deep Medicaid cuts that will jeopardize critical care for older adults and directly affect their caregivers, which will have devastating consequences for seniors and families in every state.

Most people think Medicaid, our nation’s safety net health care program, only serves very low-income children and mothers, and increasingly low-income working adults. In reality, the majority of Medicaid spending provides services and supports to help people with disabilities and older adults simply live their lives.

For older adults and caregivers, Medicaid is the country’s only guaranteed provider of the critical long-term care services that most of us will need as we age. Nearly two-thirds of long-term care provided in nursing homes is paid for by Medicaid. With nursing home care averaging nearly $90,000 per year, without Medicaid, millions of older adults and families would be financially overwhelmed if these services were limited or no longer available.

Medicaid is also important to helping our country address the challenges of a rapidly aging nation. The population of older adults is growing at an historic pace, and over 90 percent of seniors say they would rather age at home and in their communities, where care is usually less expensive and often more effective. While less expensive than nursing home care, in-home services are often cost prohibitive for families as well.

This is also where Medicaid comes in—and why cuts to the program could be especially harmful to older adults who want to age with independence and dignity at home and in the community for as long as possible. Medicaid has been a primary driver of expanding long-term care options in communities. For over 30 years, states have increasingly moved toward providing “waiver” services that allow Medicaid-eligible seniors to get the care that they need in their homes instead of in institutions.  Several Medicaid programs have also successfully moved tens of thousands of people from institutional settings back into their homes and communities, offering consumers more independence while saving taxpayer dollars.

Senior Resources, an Area Agency on Aging, serves adults 60 and older, and people with disabilities, in Muskegon, Oceana and Ottawa counties. We have served 876 people in our three-county area through the MI Choice Waiver program since Oct. 1, 2016. MI Choice is a Medicaid-funded program that provides services to help a frail older adult or person with disabilities remain living in their own home or choice of residence. These services, which are often a fraction of the cost of nursing home care, can include, but are not limited to, in-home help with bathing, dressing, meal preparation and other activities of daily life. In addition, individuals must meet Medicaid eligibility guidelines for income.

One other item that is often overlooked is that significant changes in Medicaid can lead to a loss of jobs for those providing these vital services. In Senior Resources’ case, we contract with over 90 local businesses and agencies to provide the direct care.  Loss of the MI Choice program could mean a $20 million economic hole due to loss of work hours or positions in our three counties.

Unfortunately, the Senate health care bill could change the trajectory of providing long-term care in homes and communities instead of institutions. The Better Care Reconciliation Act (BCRA) would slash long-term Medicaid funding by $772 billion over 10 years by capping the federal government’s share and pushing these costs on to states. It would also deepen Medicaid cuts after 10 years. That’s unfair and simply not sustainable, so states will have to make terrible choices that will hurt those who depend upon Medicaid for their health and safety. Older adults could lose the amount of in-home care they receive or could be required to pay for services despite being poor enough to qualify for Medicaid. Families seeking care for a loved one will encounter long wait lists for services, and cuts to provider rates will harm the long-term care workforce.

It makes no sense to undermine the only long-term care option available to most Americans just as our country undergoes a transformational demographic shift to an aging nation. If we really want to save federal health care dollars, we should expand the most cost-effective care options instead of eliminating them. Not only do these Medicaid-funded programs preserve the dignity and independence of older adults in Muskegon, Oceana and Ottawa counties and across the country, they also save taxpayers tens of billions of dollars each year in avoided nursing home costs and they create local jobs.

Our seniors deserve better. We know that Michigan Senators Debbie Stabenow and Gary Peters are not in favor of this plan, but we need to continue to educate other lawmakers, especially in the House, about the dangers of these proposed changes.

If you’d like to remain informed about this issue, and others facing older adults, consider joining our Senior Advocates Coalition. For more information,, or call me at 231-733-3521, or email


Pam Curtis, CEO


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