Middle-class seniors may think their interests have been protected in President Donald Trump’s 2018 budget, since his plan wouldn’t touch Social Security retirement benefits and Medicare.
Sure, Medicaid is slated to be cut $800 billion over 10 years. But that program is the safety net for poor people, right? Not entirely.
Medicaid is also the primary support for 65 percent of nursing home residents.
In order to qualify for Medicaid, nursing home patients must first spend down their assets to just this side of zero ― which is terrifyingly easy to do ―- and then contribute whatever income they have, like Social Security, to the nursing home for payment. Medicaid thus serves as a safety net for the middle class who have worked hard all their lives and then see their savings wiped out by old age and illness.
In a further piece of worrisome news, the Trump budget assumes that the Republican-proposed American Health Care Act, the Obamacare replacement that has so far passed the House, will become law. If that happens, more decisions on how to spend Medicaid dollars will shift from the federal government to individual states.
In states that agreed to expand Medicaid under Obamacare ― that’s about two-thirds of them ― coverage is provided to all applicants who meet federal eligibility standards. The American Health Care Act would provide states with block grants and allow each state to decide how to spend the money, which, given the cuts to the overall program, would force states to make hard choices.
AARP and others worry that the elderly would be harmed if states had to choose between covering a nursing home stay and paying for care for a sick child. Currently, Medicaid spends more than five times as much on each senior in long-term care as it does on each poor child.
The president’s budget — which is better thought of as a messaging document than a set of marching orders ― is already facing steep challenges in Congress. Even some Republicans are reluctant to jump on board. Rep. Mark Meadows (R-N.C.), chair of the conservative House Freedom Caucus, said that the idea of cutting a program like Meals on Wheels would be too much even for a fiscal hawk like himself.