“The undeniable fact is: America’s infrastructure of services to support older people was inadequate and unsustainable before the passage of the 2025 Budget Reconciliation Act,” said LeadingAge President and CEO Katie Smith Sloan. “The changes called for in the act—and now law—will weaken the existing system at a time when demand for services and supports is growing.”
The massive cuts that will result from the 2025 Reconciliation Bill come at a time when demand for long-term care and services is growing. Americans over the age of 65 now make up nearly 20% of the total population. As this number rises, aging services providers are already stretched thin—facing persistent workforce shortages, financial pressures, and growing demand for care.
Sanders, Ranking Member of the Senate Health, Education, Labor and Pensions (HELP) Committee, warned that the bill will intensify the nation’s long-term care provider crisis, noting that in 2023, 55% of nursing homes already turned away residents due to staffing or financial strain, and over 700,000 people remain on Medicaid waitlists for home and community-based services—likely an undercount of the need or desire for HCBS. Sanders underscored that forthcoming funding reductions will likely leave nursing homes with little choice but to close, downsize, or pivot away from Medicaid funded long-term care, and will force HCBS providers to reduce capacity or may even face elimination of their Medicaid-funded services since HCBS benefits are optional. These outcomes will leave older adults and families scrambling for assistance and shifting caregiving burdens primarily onto unpaid women caregivers.
This law will lead to:
- Millions of Americans losing health insurance, including older adults and their caregivers;
- Potential cuts to Medicare provider payments of 4% annually for the next decade, due to budget deficit triggers;
- Significant reductions in federal Medicaid contributions, forcing states to scale back eligibility, benefits, and provider payments;
- Increased burdens on family caregivers, who may lose access to coverage themselves while absorbing new responsibilities;
- Threats to home and community-based services, including home care, personal care, assisted living, and adult day programs.
The chief executives of two LeadingAge-member organizations—A.G. Rhodes’ Deke Cateau and Heather Turbyne-Pollard of Circle Center Adult Day Services—shared their on-the-ground experiences providing nursing home care and services in adult day, respectively, to illustrate the drastic impact these cuts will have on real people in our country.
“Medicaid has become and is the backbone of our health care system,” said Cateau. “For aging and senior services, it is the health care system. It is the only payer or the only real payer of long-term care … so any cuts, any changes, whether you disguise them as adjustments are going to have a very immediate impact. And it’s an impact that I cannot imagine.”
“Currently the reimbursement rate for the state of Virginia for Medicaid is $64.17. It is $150 a day for me to deliver that care,” said Turbyne-Pollard. “Now when we’re faced with the chance of it getting reduced or eliminated, you can see if you do the math along with me, how it may put home and community-based care folks like me out of business. … We should all be turning up the dial on all the services across our continuum that can support older adults and their caregivers caring for them as they age. It’s not the time to take that away from folks.”
These sweeping cuts will not just destabilize providers—they will disrupt the lives of millions of older adults and their families.
LeadingAge opposes the Medicaid policies and cuts enacted in this law as well as many other components of this law. We will continue to advocate for policies that strengthen—not dismantle—our nation’s safety net, and ensure all Americans can age with dignity, health, and purpose.
Budget Reconciliation 2025
