Midterm Election Winners Could Determine Medicaid’s Future

It’s not an exaggeration to say that the survival of Medicaid as it stands today will be in the hands of the state and federal officials we elect this fall.

For 53 years, Medicaid has served as a safety net for millions of people who needed assistance as their ability to care for themselves declined. In 2010, Medicaid’s health care role grew with the passage of the Affordable Care Act, which called for the expansion of health coverage to more low-income families. So far, 33 states and Washington, D.C., have expanded the program.

But Medicaid, Social Security  and  Medicare often are targeted for  cost cutting  in times of rising deficits. Medicaid is particularly vulnerable, says David Certner, AARP’s legislative policy director, “because it services populations such as low-income seniors and people with disabilities, who don’t have as strong a voice.” 

Most people think of Medicare as the health program for older adults and people with disabilities, which it is. But while Medicare covers medicines, tests, doctor visits and hospital procedures, it’s Medicaid that pays to help a frail elderly person get dressed,  bathe  and eat — either at home or in a nursing facility.

So, what many Americans also don’t realize, is that when you put Medicaid funding on the chopping block, you are jeopardizing benefits for millions and millions of seniors and people with disabilities who get their long-term care through Medicaid. More than 17 million older adults and people with disabilities account for 60 percent of all Medicaid spending.

With a rising federal deficit — due in large part to the 2017 tax cuts — and a number of states pursuing greater barriers to beneficiaries who are seeking care, it’s clear that Medicaid is facing strong headwinds in the coming years.

Seventy-four percent of Americans have a favorable view of Medicaid, according to a February tracking poll by the Kaiser Family Foundation (KFF). That may be due to Medicaid’s long reach. For example, the program covers 6 in 10 nursing home residents in America, a KFF report shows.

The federal government sets general Medicaid guidelines, but each state designs and runs its own program. In recent years there have been calls in Washington and in state legislatures to change Medicaid’s rules, usually to save money.

In just the past year, 10 states have applied to add new work requirements to their Medicaid programs, and several have gotten federal permission to do so. Several states have also asked to impose lifetime limits on Medicaid benefits, but so far these requests have not been approved.