Planned Medicaid cuts a threat to nursing homes, middle class

Medicaid, targeted by the Republicans’ health-care bills, pays for most of the 1.4 million elderly people in nursing homes, some of whom do not know they are on it.

ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands.

But years in an assisted-living center drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home in Orange.

“You think you’ve got enough money to last all your life, and here I am,” Jacobs said.

Medicaid pays for most of the 1.4 million elderly people in nursing homes, like Jacobs. It covers 20 percent of all Americans and 40 percent of poor adults.

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On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly health-care entitlement. But little has been said about what would happen to older Americans in nursing homes if these cuts took effect.

Under federal law, state Medicaid programs are required to cover nursing-home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

“The states are going to make it harder to qualify medically for needing nursing-home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing-home care they pay for, as Medicare already does.

The 150 residents of Dogwood Village include former…

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