Medicaid Cuts and the Future of Health Access for Older Adults
As the dust settles on the passage of the One Big Beautiful Bill, Americans face seismic shifts in health care access—especially those who rely on Medicaid. With nearly $900 billion in projected cuts over the next decade, the ripple effects will land hardest on older adults, safety-net providers, and underserved communities.
What This Means for Older Adults
Medicaid is the primary funder of long-term care in the U.S., covering nursing homes, home health aides, and programs like PACE. The new legislation threatens:
Reduced funding for home- and community-based services, pushing more older adults into institutional care.
Longer waitlists for aging-in-place programs, slowing progress toward independence and quality of life.
Closure or scaling back of innovative models like PACE that deliver value-based care with dignity.
Stress Points for Providers
With reimbursement rates slashed and cost-sharing pushed to the states, health systems will feel the crunch:
Safety-net hospitals and rural clinics may scale back services—or shut down.
Mental health and substance use care, largely funded through Medicaid, will likely be cut.
Providers may reduce their Medicaid patient load, increasing wait times and limiting care access.
Coverage Loss & Health Risk
The Congressional Budget Office estimates 11.8 million fewer Americans will have coverage by 2034. This translates to:
Higher risk of delayed diagnoses, preventable complications, and poorer outcomes.
A widening gap in health equity, particularly for low-income, disabled, and older populations.
Case Studies & Real-World Examples
Aging in Place at Risk
Home- and community-based services (HCBS) are optional under Medicaid and often the first to be cut. Over 700,000 people are already on HCBS waitlists.
In Colorado, Medicaid covers 3 in 5 nursing home residents and 1 in 3 children. Proposed cuts could remove $27.2 billion from the state’s health system over 5 years.
Rural Hospital Closures
Cobre Valley Regional Medical Center in Globe, AZ, serves a population where 1 in 3 patients are on Medicaid. The CEO warned that cuts would “jeopardize a third of our payer base”.
In Iowa, Medicaid cuts could cost hospitals $3.5 billion over 10 years, forcing closures and service reductions like ending maternity care.
Mental Health & Caregiver Strain
Medicaid is the largest payer for mental health and substance use services.
Cuts to HCBS often shift the burden to unpaid family caregivers, increasing burnout and reducing workforce participation.
Older Adults & Long-Term Care
7 million older adults rely on Medicaid for long-term services and supports.
Medicaid paid $190 billion for long-term care services in 2022.
62% of nursing home residents are covered by Medicaid.
2 million older adults are projected to lose Medicaid coverage under the new bill.
Rural & Safety-Net Providers
Nearly half of rural hospitals operate at a loss and rely heavily on Medicaid.
In Arizona alone, rural hospitals could lose $1.2 billion over 10 years.
More than 300 rural hospitals are at immediate risk of closure due to Medicaid cuts.
Health Outcomes
Medicaid expansion saved 19,200 lives among adults aged 55–64 between 2014–2017.
Cuts could lead to 51,000 additional deaths per year due to reduced access to care.
CBO projects 11.8 million fewer insured by 2034, disproportionately affecting older adults.
If aging in place is a national priority, Medicaid needs reinforcement—not erosion. These proposed changes challenge the very systems that support autonomy, dignity, and preventive care for older adults.
