By Rolonda Donelson, Kiera Peoples, Katherine Gallagher Robbins, and Gelila Selassie
From supporting healthy pregnancies and children to helping disabled people flourish, from providing critical health care for low-income families to supporting older Americans in their final years, Medicaid helps Americans thrive. Medicaid is essential for the 72 million people who rely on the program for health care. Additionally, it is a critical contributor to our economy by directly supporting the jobs of millions of U.S. health care workers, in communities across the country, especially in rural areas.
Yet, Congressional Republican leadership and the Trump administration intend to slash Medicaid funding by implementing unnecessary and costly work requirements and reducing essential federal funds through per capita caps and block grants – all of which amount to cuts to the essential health care people rely on.
The federal government plays a crucial role in financing the Medicaid program and any reductions in those funds has the potential to threaten the health and wellbeing of Medicaid enrollees, particularly older women and disabled women. Almost 1 in 5 Americans ages 50 to 64 receive their health insurance through Medicaid, and almost half of these beneficiaries are disabled. Medicaid is also crucial for millions of low-income people dually enrolled in Medicare, 60 percent of whom are women. Slashing Medicaid cuts access to affordable Medicare for millions of older and disabled women. This especially impacts Long-Term Supports and Services (LTSS), which help people with disabilities, older adults and those with chronic conditions live their daily lives. An estimated 56 percent of people age 65 or older will require LTSS throughout their lifetime. Medicaid is currently the payer of 44 percent of LTSS and is the primary payor for 63 percent of all nursing home residents.
Older women, including women of color and disabled women, could be especially impacted by Medicaid cuts
The Trump administration has proposed trillions of dollars in radical cuts to federal spending, including Medicaid, and House Republicans have directed the committee which oversees Medicaid to slash spending by $880 billion over a decade to pay for tax cuts. To illustrate the potential harm of cuts to Medicaid, Jeanne Lambrew translated the potential impact of Medicaid cuts into programmatic impacts, including cutting the number of program participants. We extend her analysis to illustrate how cutting $880 billion from Medicaid could harm older women of color, veterans and disabled women.
We estimate that an $880 billion cut to Medicaid over the next decade is the equivalent of cutting the number of annual Medicaid beneficiaries by nearly 4.8 million recipients ages 65 and older. Of these 4.8 million seniors:
- Nearly 60 percent – 2.8 million – are women.
- More than 1.3 million older women of color would lose benefits, including 462,900 Black women, 512,900 Latinas, 238,000 Asian American, Native Hawaiian and Pacific Islander women and 18,300 American Indian/Alaska Native women.
- Nearly 1.7 million disabled women ages 65 and older would lose benefits.
- Nearly 448,000 older veterans, including 29,500 women, would lose benefits.
- We also find that women account for the majority of seniors receiving Medicaid in every state. Older Medicaid recipients are especially likely to be women in Alabama, Connecticut, New Jersey and Maine.
Cutting Medicaid harms the health care workforce and the economy
Given its critical role in funding the health care workforce, cutting Medicaid would harm the economy. Direct care workers – key supports to seniors and their families – are overwhelmingly women and disproportionately women of color whose work is dramatically undervalued and underpaid. Yet the direct care workforce is also one of the fastest growing industries, increasing from 3.5 million workers in 2014 to over 5 million workers in 2023. Coupled with America’s aging population, we are facing a shortage in direct care workers.
Medicaid is critical for the direct care field. These workers not only frequently rely on Medicaid for their health insurance, it also supports their livelihood. Yet we estimate that the House majority proposal to cut $880 billion from Medicaid could pay the salaries of more than 1.9 million full-time personal care providers on average each year. Thus, reductions in Medicaid could end up costing workers their jobs, thus increasing unemployment and likely reducing GDP, all of which harms local economies.
Medicaid allows older American women to live fulfilling lives and supports the direct care workforce. Funding Medicaid is an investment in our country’s future and efforts to cut Medicaid harm us all.
Methods note: This analysis extends the work of Jeanne Lambrew at The Century Foundation who “converts the possible ten-year Medicaid budget targets into average annual amounts and then their equivalents in terms of numbers of enrollees, percents of current-law services and supports, and state support and revenue.” Her estimates do not assume programmatic or policy changes, nor do they assume state interventions, they are rather illustrative examples of how Medicaid cuts could impact the program in different ways. See the original analysis for additional details. We use her approach to estimate how many seniors would lose coverage on average each year if Medicaid were cut by $880 billion over the next 10 years and all of those cuts were applied to senior’s benefits based on the CBO-projected cost for enrollee released in June 2024. The National Partnership and Justice in Aging used American Community Survey 2023 1-year data via www.ipums.org to estimate the demographic impacts of these cuts, which assumes equivalent spending per enrollee across all demographic groups. Figures are annual averages across 10 years. Illustrating the cuts across the states also relies on the distribution of Medicaid recipients in the American Community Survey and assumes the cuts are distributed across states in proportion to the current distribution of Medicaid enrollees. The estimate of the number of full-time personal care providers whose salaries could be funded on average each year by $880 billion over a decade is based on the 2023 Kaiser Family Foundation estimate that median payment rates for personal care providers for Home- and Community-Based Services under Medicaid are $19/hour adjusted for inflation using the CBO CPI projections for 2025-2034 released January 2025.
The authors are grateful to Lorena Bonet Velazquez, Sarah Combs, Mona Papillon and Jessi Leigh Swenson for their thoughtful advice.
