Before nursing home patient Carmencita Misa became bedridden, she was a veritable “dancing queen,” says her daughter, Charlotte Altieri.
“Even though she would work about 60 hours a week, she would make sure to go out dancing once a week—no matter what,” Altieri, 39, said. “She was the life-of-the-party kind of person, the central nervous system for all her friends.”
A massive stroke in March 2014 changed all that. It robbed Misa, 71, of her short-term memory, her eyesight and her mobility—and it left her dependent on a feeding tube for nourishment. Altieri, who has two small children, is unable to provide the 24-hour care her mother now gets at a Long Beach, Calif., nursing home three miles away—all of it paid by Medi-Cal, California’s version of the Medicaid program for low-income people.
But advocates for the elderly now worry that Misa and other low-income seniors who receive long-term care in facilities or at home could see their benefits shrink or disappear under Republican-proposed legislation to cap federal Medicaid contributions to states. The proposal is part of a broader GOP plan to repeal and replace former President Barack Obama’s Affordable Care Act.
“My mom is getting the basic of basic care,” Altieri said. “If they cut it, I don’t know what to do.”
Nationwide, Medicaid provides long-term care and support to more than 2 million low-income seniors. The program, funded jointly by the federal government and the states, pays more than half of all long-term care in the country—“more than Medicare, private long-term care insurance and out-of-pocket spending combined,” said Matt Salo, executive director of the National Association of Medicaid Directors.
And, he said, it’s the only public program that offers such care on an ongoing basis. The Medicare program—for people 65 and older—provides only limited long-term care to those who need it after being hospitalized.
The GOP bill, scheduled for a vote on the floor of the House on Thursday, would transform Medicaid from an open-ended system, in which the federal government matches state spending, to one in which it provides a fixed amount to each state, either through a lump-sum payment or on a per-capita basis.
In an attempt to overcome opposition to the bill among some Republicans, GOP leaders agreed Monday to add the option of a lump-sum payment, known as a block grant.
They also amended the bill to allocate additional money for elderly and disabled people on Medicaid. But Eric Carlson, an attorney in the Los Angeles office of the nonprofit group Justice in Aging, said such an allocation would not offset the wide funding gap created by caps on federal spending.
“It doesn’t matter whether it’s a block grant or per-capita cap,” Carlson said. “Either way the federal government is setting a hard limit on federal funding available, and states are going to be forced to make due with whatever is sent to them, and it’s not going to be enough.”
Carlson is co-author of a paper released by Justice in Aging that says capping federal Medicaid spending, with either per-capita funding or block grants, would harm older Americans, in part by forcing states to cut services for them “to the bone.”