July 31, 2025 Washington, DC–As reality of the 2025 Reconciliation Bill, enacted July 4, 2025, sets in, aging services leader Katie Smith Sloan and the CEOs of two nonprofit providers–all representing the national association LeadingAge–joined in a Capitol Hill press conference Wednesday, July 30 hosted by Senator Bernie Sanders (I-VT), Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions (HELP), to shed light on the impact of the legislation’s nearly $1 trillion in cuts to Medicaid for older adults and their families.
“We are an aging country,” said Sen. Sanders, as he kicked off the event. “Seniors will need some kind of long term care in their lifetimes. … Families throughout the country seek our support,” he noted, referring to the help made possible via America’s social safety net–funded by Medicaid and delivered via home health care providers, senior centers, nursing homes and more. Now, “when you cut Medicaid by over $900 billion, as this bill does, nursing homes and long-term healthcare providers will be losing a major source of their revenue,” he said.
Sloan, LeadingAge’s president and CEO, explained the critical role Medicaid plays as the primary payer of long-term services and supports, and the public program relied on by millions of older adults and families who cannot afford to pay out of pocket and have no long-term care insurance. “There simply is no other option to pay for the services provided in a range of care settings, including nursing homes.”
Need for these supports, she noted, will not wane: “older adults over age 65 represent nearly 20% of our population and that percentage is steadily increasing. And as it does, the demand for services and care will grow. … The undeniable fact is America’s infrastructure of services and supports for older people was inadequate and unsustainable before passage of the 2025 Budget Reconciliation Act. 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 supply of available caregivers is not keeping up with the growth of the older population.
“This is not a math problem,” she continued. “It is a reality that directly impacts our families. Financially. Emotionally. Practically. Medicaid cuts–which have been framed as a cost savings–will result in an enormous expense to America’s families.”
Although the full details of H.R. 1’s implementation still to be determined, what is known, Sloan shared, “is that this legislation will establish more hurdles for providers–whether through shortened retroactive eligibility or limits on the provider taxes states rely on to fund Medicaid or by, by the financial decisions states are forced to make. We can only look to history to understand this. Historically, states’ response to budgetary pressures have been to cut Medicaid eligibility, to shave benefits, or to cut provider payments to cover the costs of delivering care, which means fewer dollars to pay staff.”
Relating on-the-ground insights, Deke Cateau, president and CEO of LeadingAge member A.G. Rhodes, a nursing home serving older adults in three Atlanta locations, said: “Seventy percent of the residents we serve are on Medicaid. Medicaid is the only payer for them, and we are already vastly underpaid from Medicaid for taking care of them.
“We serve about 1300 individuals a year,” Cateau said, sharing details of his homes’ population: “I don’t know, not one of them that wasn’t a teacher, that wasn’t a nurse, that wasn’t an engineer. They have worked most of their lives and now they’re sick. Quite frankly, they’re ill and they’ve spent their money down because of that illness. So Medicaid in the nursing home setting has become not only who pays for them to live with us, but who takes care of their medical needs.
“So any cuts, any changes, are going to have a very immediate impact … .This is certainly not about politics. It is about policy and what is and should be sound policy in a society that is aging, that we should be preparing for more.”
Speaking on H.R. 1’s potential blow to providers of home-and-community-based services, Heather Turbyne-Pollard, president and CEO of Circle Center Adult Day Services in Richmond, VA, explained that Circle Center services are “elective and optional services for states [to cover under Medicaid], who then doles out [funds] to local communities, services like [ours].” Currently her organization, which serves 130 older adults, the majority of whom are diagnosed with moderate to severe dementia, are able to do so largely because of Medicaid supported services–though Medicaid reimbursement rates cover less than 50% of the cost of care Circle Center provides. “The state of Virginia pays $64.17 and my cost for each of those I serve is $150 a day for me to deliver that care,” she explained.
“Now when we’re faced with the chance of it getting reduced or eliminated,” she said, it is happening at a time when “ …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.”
Following a Q-and-A, Senator Sanders wrapped up with a summary: …“It seems to me and I think to all of us that in the richest country in the world that we should take care of our most vulnerable citizens with the respect and compassion and dignity that they are entitled to often after working their entire lives helping our society and that is not the case today.”
