Washington is buzzing with speculation about how President-elect Donald Trump and the Republican majority in Congress will remake Medicare and Medicaid. But neither the incoming administration nor the Hill GOP is giving much thought to what those changes would mean for frail older adults and younger people with disabilities. By failing to do so, they are creating a potential crisis and missing an opportunity.
About 12 million Americans require long-term supports and services (LTSS), a number expected to double in two decades. More than 80 percent of that care is delivered to people in their own homes.
Family members provide both unpaid care and support for paid assistance. But Medicaid spends as much as $140 billion annually on long-term care—about one-third of its total budget. Ignoring this reality would be a huge mistake.
Medicare and Long-Term Care
There is no Medicare LTSS benefit, but the program foots the bill for the medical care of those who don’t get good personal assistance. Absent those services, frail older adults are more likely to suffer acute medical episodes and end up in the hospital—on Medicare’s dime.
People with multiple chronic conditions are the highest cost Medicare recipients. And those who also need help with daily activities cost Medicare twice as much as those who just have chronic conditions. So while LTSS is not a Medicare program, it is a big Medicare problem. Ignoring this reality would also be a big mistake.
How could all this fit with the changes Trump and Congress may make to Medicare and Medicaid? Here are a couple of examples.
House Speaker Paul Ryan (R-WI) has proposed capping the federal contribution to both programs. He’d push more Medicaid responsibility on to the states but give them more program flexibility. And he’d shift more out-of-pocket Medicare costs on to seniors through higher premiums and copayments.
At the same time, the GOP is likely to expand the use of managed care for both Medicaid and Medicare.