Proposed Medicaid Cuts and Work Requirements Could Impact Millions of Older Americans
Recent proposals by Republican lawmakers on the U.S. House Committee on Energy and Commerce seek to implement significant changes to Medicaid, the federal-state joint program providing health coverage to over 17 million low-income Americans aged 50 and older.
These changes come amidst broader federal budget negotiations aimed at offsetting tax breaks from the 2017 Tax Cuts and Jobs Act. Medicaid offers essential services including doctor visits, hospital stays, prescription drugs, and long-term care, covering diverse populations such as seniors, adults with disabilities, pregnant women, and children with income eligibility varying by state.
Under the Affordable Care Act, states could expand Medicaid coverage to adults earning less than 138% of the federal poverty level, a provision some states adopted to broaden access. The new Republican bill proposes cuts totaling approximately $715 billion over ten years, incorporating new work requirements, more frequent eligibility checks, delayed nursing home staffing standards, reduced retroactive coverage periods, and added copays for certain Medicaid beneficiaries. Notably, the bill would impose an 80-hour monthly work requirement for able-bodied adults aged 19 to 64 beginning in 2029, with exemptions for individuals with disabilities or serious medical conditions and certain caregivers, though the caregiver exemption is narrowly defined. These administrative changes risk causing coverage gaps as some beneficiaries may lose access due to difficulties in compliance or paperwork submission, particularly older adults with unstable work or income.
The proposal also plans to reduce retroactive coverage from three months to one month and introduce copayments capped at 5% of income for services, potentially raising out-of-pocket costs for recipients near the poverty line. AARP, alongside the Modern Medicaid Alliance, is actively advocating against these provisions, emphasizing the importance of Medicaid for older Americans and rural communities and urging lawmakers to adjust exemptions and administrative requirements to prevent coverage losses.
The group highlights prior research indicating that work requirements implemented in states like Arkansas resulted in significant benefit losses due to administrative barriers rather than eligibility changes. State-level responses to Medicaid and work requirements vary, with some states expanding Medicaid permanently and others resisting work requirement policies. AARP's data-driven fact sheets illustrate Medicaid's critical role in supporting older adults nationwide, underscoring the potential adverse impacts of the proposed federal changes.
If enacted, these modifications to Medicaid could reduce coverage for millions, increase state financial burdens, and destabilize local healthcare systems, underscoring the significance of ongoing legislative debate and advocacy efforts.