For the budget category of domestic discretionary programs, which includes senior housing and home- and community-based services, the 2020 Trump budget invokes the draconian spending caps imposed under the Budget Control Act of 2011. In recent years, Congress has waived these caps because appropriators could not reasonably come up with sufficient program cuts to comply with the caps. 

The 2020 Trump budget would cut total funding for the Department of Housing and Urban Development by 16.4% below fiscal 2019 spending levels. The budget request calls for a five percent cut to the Section 202 program and the complete elimination of the Public Housing Capital Fund, the HOME program, and the National Housing Trust Fund. Funding for Section 811 housing for people with disabilities would be cut by almost one-third. President Trump’s budget once again asks Congress to raise rents for HUD-assisted households, including elderly households. These kinds of proposals run directly counter to the need to preserve and maintain our present affordable housing stock and step up production to meet the needs of a growing senior population. More information

On health care, the President’s budget proposals for Medicaid would cut federal spending on the program by $1.48 trillion over the next ten years. The Administration’s budget resurrects the call for the transformation of Medicaid into a block grant or system of per-capita capped payments to the states. We remain strongly opposed to this proposal, which would take billions of federal dollars out of the program at a time when many states are struggling to fund essential long-term services and supports covered by Medicaid. The budget would eliminate state provider taxes. It also brings back the idea of imposing user fees on nursing homes for resurveys.

Medicare spending would be reduced under this budget by $811 billion over ten years. Cuts to providers include the establishment of a unified system of post-acute care payment by 2025, with reduced annual payment updates to skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities every year from 2020 through 2024. This proposal is projected to reduce Medicare post-acute care spending by $101.2 billion over 10 years. In addition, reimbursement for bad debt would be cut from the current 65% to 25%.

In the area of research, the budget would cut funding for the National Cancer Institute by $897 million and the National Institute on Aging by $429 million.

For home- and community-based services under the Older Americans Act and other aging services programs, the budget proposes to zero out falls prevention and chronic disease self-management programs. Supportive services and nutrition services would be flat-funded at 2019 levels. Family caregiver support would be cut by $31 million, Alzheimer’s Disease programs by $4 million, and Lifespan Respite Care by $1 million. Aging and disability resource centers would be cut by $2 million and assistive technology programs by $4 million. State Health Insurance Programs (SHIPs), which help older people navigate the health and long-term services and supports system, would be cut by $13 million. Social Services Block Grants, which many states use to fund home- and community-based services, would be zeroed out. These are all small, cost-effective, chronically underfunded programs that help older people live in community-based settings as long as possible. With the growth in the over-65 population, these programs need increased resources, not cuts.

Fortunately, the President’s submission of a proposed budget is only the first step in setting a budget and spending levels for the fiscal year that will begin on October 1, 2019. It is now up to Congress to determine spending levels for federal programs in fiscal 2020. We are urging Congress to reject this budget and to ensure that aging services providers have the resources essential to meeting the needs of people as they age.