Protecting Medicaid, Americans' Only Long-Term Care Safety Net
The Medicaid program was established by the Social Security Amendments of 1965 and plays a critical role in providing long-term services and supports in our nation. Click on the links below to learn more about the role Medicaid plays in long-term care:
Also, please watch our video on Why Medicaid Matters, featuring nursing home resident and consumer advocate Brian Capshaw:
Congress and President Obama face the difficult challenge of coming to agreement on a balanced approach to reducing our nation's deficit. Undoubtedly, tough budgetary decisions will have to be made in the future to resolve the fiscal issues our nation is facing, but one thing is certain: we cannot allow any budgetary agreement to harm long-term care consumers' access to needed services!
We must ensure that strong federal funding and the traditional structure of the Medicaid program - the largest single payer of long-term care in our nation - is preserved in any proposed budgetary deal. Implementing large-scale funding reductions to Medicaid would harm consumers' access to long-term care and the quality of care that consumers receive in nursing homes and other long-term care facilities. Check back with us for updates!
Medicaid is a national public health insurance program funded by both the federal government and states and operated at the state-level. Medicaid pays for health services and long-term care for low-income Americans, including the elderly and persons with disabilities. To qualify for Medicaid, individuals must meet certain income limits set in place by the federal government and by states, as well as other requirements.
Although Medicaid is operated at the state level, every state Medicaid program must comply with federal statute and cover certain mandatory services. However, states can choose additional services to include under their Medicaid programs.
Approximately 60 million Americans rely on the Medicaid program for the care, treatment and services they need, including long-term services and supports.
Medicaid Remains the Largest Single Payer of Long-Term Care in Our Nation: Medicaid is the primary payer of long-term services and supports, accountable for nearly half of all long-term care financing and covering nearly half of all nursing home expenditures. Sixteen million seniors and people with disabilities—1 out of every 4 people—rely upon Medicaid for their long-term care needs. Any funding reductions made to the Medicaid program would hurt these individuals.
Medicaid is the Only Way Most People Can Afford Long-Term Care: Long-term care is extremely expensive. According to a 2012 Met Life Survey, the average annual cost of nursing home care was $90,520 for a private room and $81,030 for a semi-private room. Few people can afford these rates for very long or at all. If they don’t have enough money or run out of money, many individuals will turn to Medicaid for assistance. For these consumers, Medicaid is the only option for receiving the long-term care they need.
Medicaid Allows Long-Term Care Consumers to Stay in Their Homes: Medicaid helps nearly one out of five individuals stay out of nursing homes and receive the services and supports they need at home. It continues to play an important role in strengthening consumer access to home and community-based services through various grant programs and waiver options, such as the recently authorized Community First Choice option that grants states the ability to provide long-term services and supports to Medicaid beneficiaries with disabilities.
Medicaid Pays for Services Not Covered by Medicare and Private Insurance: Unlike Medicaid, Medicare and standard private insurance plans do not cover ongoing long-term services and supports such as helping someone to dress, bathe, walk, eat, take medications, prepare meals, do the laundry and shop for groceries. In fact, Medicare only pays for a very small amount of nursing home care – and does not pay for assisted living at all. Although there are a limited number of private long-term care insurance plans that do cover these services, fewer than 10% of older adults have purchased such policies.
For these reasons, Medicaid remains the only coverage option for the majority of individuals that cannot afford to pay out-of-pocket for long-term care. Without the Medicaid program, many of these consumers would go without needed care, or the financial burden of providing care would be placed on family caregivers and loved ones.
Medicaid Helps to Ensure Safety and Quality in Our Nation's Nursing Homes: Medicaid establishes standards for more than 16,000 nursing homes and requires annual inspections that help to protect some of our most vulnerable citizens. Nursing homes that want to begin or continue participating in the Medicaid program are required to meet certain regulations put in place by the Centers for Medicare and Medicaid Services (CMS), known as Requirements of Participation. These rules play an integral role in helping to protect and ensure quality of care and life for residents over the past twenty-five years, and nursing homes are normally inspected once every 9 to 15 months to ensure compliance with these regulations.
Decreasing Medicaid funding would reduce inspections and quality assurance in nursing homes, increasing residents' susceptibility to neglect and abuse. Furthermore, reductions in federal funding for Medicaid would likely result in less staffing at long-term care facilities and even lower worker wages, both of which would undoubtedly compromise quality of care.
Medicaid is crucial in funding many individuals' long-term care needs. The following stories from advocates in various states illustrate the importance of preserving Medicaid and the difference this integral program makes in the lives of long-term care consumers and their loved ones:
California: “My uncle is in a nursing home and Medicaid pays his bill. He was brain damaged at birth. He lived with my parents all of my life until my father died and eventually my mother couldn't care for him on her own. Now it is my privilege to be his family caregiver. My uncle can't walk or talk. He needs to be in the nursing home, but there is no way we could afford it if it wasn't paid for by Medicaid. As a family, we've done the best we can by him, but now Medicaid is his only option to get the care he needs. Please don't take that away from him.”
Vermont: “We already see providers cutting corners due to budget shortages, meaning below minimum staffing levels that result in residents not getting the care or attention that they need. This will explode as a problem if more cuts to their reimbursement come down the pike. We will see more pressure ulcers, more pain issues, more avoidable falls, waiting longer for help, etc...the list could go on forever. My concerns are too numerous to list.”
Maryland: “As Co-Chair of a family council, we are keenly aware of the need for Medicaid funds to support care for nursing home residents. Almost 67% of residents in our facility receive Medicaid. Although there is extensive fundraising in the community to supplement the budget, without Medicaid, the level of care will decline drastically and impair the health and quality of life for these most vulnerable seniors.”
Pennsylvania: “In my nursing home, I see many residents who would not get basic needs such as food and housing if it were not for Medicaid. I am pretty certain that many of these people would be on the streets if not for Medicaid.”
Ohio: “Seniors and disabled people on Medicaid/Medicare are already at poverty level. Long-term care facilities already spend as little as possible on their residents. If Medicaid/Medicare and Social Security are reduced, the care for these people will only get worse. It's a tough fight getting facilities to pay for what the law says they should provide for these people now. Reducing benefits will make it harder to get good care for our long-term care residents."
Arizona: “As both a volunteer Long-Term Care Ombudsman and a Hospice Volunteer, I know firsthand how many individuals and families would be adversely affected by a reduction in Medicaid support. For many, their lives, and certainly their limited quality of life, literally depend on it. Many of them have lost their ability to express themselves, so I must add my voice to those that are speaking out on their behalf.”