Many of you may have met Earl’s mother Delma during the year she lived with us. She could no longer remain living alone in her home because of dementia. After a year, her disease had progressed enough that we placed her in assisted living. Gradually we liquidated her assets to pay for her care. First, savings and CDs. Investments. Sell car. Cash out life insurance. Sell house and land. After a stroke she was partially paralyzed, and assisted living no longer provided enough care. She was moved to a nursing home. Her assets are gone, and we rely on Medicaid to pay for part of her monthly bill. Her income from Social Security and retirement pays for the rest. She is allowed $60 a month for personal items like haircuts and clothing. Medicare continues to pay for doctor’s visits or hospitalization should she need it.
According to information from the Nebraska Health Care Association, around 60% of Nebraska nursing home residents rely on Medicaid to pay for their care, meaning a significant portion of the state’s nursing home population uses Medicaid as their primary payment source.
Last week the House of Representatives passed a budget resolution, directing the Energy and Commerce Committee to cut at least $880 billion in costs through 2034. Based on previous House proposals, most people believe this means major cuts to Medicare and Medicaid. States rely on these federal matching funds to help finance their state programs.
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. In 1965, Congress added Medicare and Medicaid to the Social Security Act. The program provides free health insurance to about 80 million low-income and disabled people. In Nebraska 341,081 people are enrolled in Medicaid as of October 2024.
In 1997, Medicaid was expanded with the Children’s Health Insurance Program (CHIP), providing coverage for children whose household did not qualify for Medicaid, but whose income was low enough that they could not afford health insurance.
Who qualifies? Adults whose income is 138% or less of the federal poverty level. Pregnant women with incomes less than 194% of the federal poverty level. CHIP benefits, for children through age 18, whose household income is less than 213% of the federal poverty level. Medicaid recipients must be U.S. citizens or qualified non-citizens. Children make up 37% of the enrollees. Seniors and disabled persons account for 21% of Medicaid recipients.
What benefits do people receive if they qualify for Medicaid? Hospital services, doctor’s office visits, laboratory and x-ray services, and home health care. Nebraska Medicaid covers speech, physical, and occupational therapies in provider’s office, in the client’s home, hospital, nursing facilities, or other facilities. Nebraskans on Medicaid can also receive prescription drugs, over-the-counter drugs, dental and vision services. Institutional services are provided for people with intellectual disabilities.
Medicaid also provides services in nursing homes, like the one where Delma lives. The nursing home must be Medicaid certified and provide three types of services: skilled nursing and medical-related services; rehabilitation needed due to injury, disability, or illness; and long-term care, needed due to a mental or physical condition. The most recent statistic I could find was from 2020. Of the 7.7 million Americans in nursing homes in 2020, about 5.6 million were covered by Medicaid.
Medicaid covers more than 40% of the births in rural communities. Rural hospitals rely on Medicaid income! They are obligated to treat everyone. Without federal Medicaid funding, our local taxpayers will foot the bill.
If Congress proceeds with the plan to cut Medicaid, this is how it will affect us. Our Congressional district, represented by Adrian Smith, has 112,731 constituents covered by Medicaid/CHIP. Our CD3 funding would be decreased by $1.41 billion, meaning about 25,000 people would have to be dropped from the program. Costs to Nebraska taxpayers will go up.
Members of Congress will continue to discuss proposals, specifically which programs to cut. Medicaid is efficient and effective. Medicaid increases diagnosis and treatment of chronic conditions, improves educational achievement and future earnings for children, and provides comprehensive care while costing less per enrollee than private insurance. Medicaid addresses disparities and is an important source of health coverage for rural communities like ours.
Medicaid provides health care to so many people! Cuts to Medicaid will harm Nebraskans, hospitals, nursing homes, and health care providers. Contact Nebraska’s Senators and Representatives! Let’s hope that Congress finds a better solution.