Taking Grandma Home
How the biggest Medicaid cut in history will turn you into a cargiver
Well, they did it. They cut nearly $1T from Medicaid. There are many implications of that decison but I thought I would focus on just one - the imapct on American families with elderly loved ones in long term facilities.
How many Americans live in nursing homes?
🏥 Nursing Home Residents
There are roughly 1.3 million Americans living in nursing homes on any given day singlecare.com+14ahcancal.org+14pbs.org+14.
About 63% of them rely on Medicaid as their primary payer en.wikipedia.org+2kff.org+2verywellhealth.com+2.
– That equals approximately 820,000 nursing home residents supported by Medicaid.
🏡 Assisted Living Residents
Approximately 800,000 Americans live in assisted living facilities teenvogue.com+15ahcancal.org+15axios.com+15en.wikipedia.org+3singlecare.com+3ahcancal.org+3.
Around 18% of these are on Medicaid ahcancal.org.
– This translates to about 144,000 assisted living residents covered by Medicaid.
🧑🦽 Other Long-Term Care Settings
Nearly 55,000 individuals with disabilities in Intermediate Care Facilities (ICFs) are almost entirely covered by Medicaid washingtonpost.com+15ahcancal.org+15ahcancal.org+15.
In 2020, about 7.7 million Americans used long-term services and supports (LTSS), with roughly 5.6 million of them covered by Medicaid en.wikipedia.org+3en.wikipedia.org+3ahcancal.org+3.
📊 Total Estimate
Combining these known figures across major institutional settings (nursing homes, assisted living, ICFs, plus broader LTSS), we estimate:
Nursing homes: ~820,000
Assisted living: ~144,000
ICFs: ~55,000
Community/home-based LTSS enrollees: included in the 5.6 million total
Therefore, at minimum 1 million+ Americans in institutional long-term care are on Medicaid, and when including community-based LTSS, the number is well over 5 million.
✅ Summary
Nursing Home Medicaid Recipients: ~820,000
Assisted Living: ~144,000
Intermediate Care Facilities: ~55,000
Community LTSS: Bringing total Medicaid long-term care users to roughly 5.6 million out of 7.7 million LTSS recipients
As many as 5.6 M Americans residing in long term care stand to lose Medicaid. Do you have a relative in long term care? Get ready, you may soon be getting a phone call to come and get them. Ever been a full time caregiver for a disabled nursing home resident? You are about to find out just how much fun it is to carry grandma to the bathtub after she soils herself. I know what it’s like. My mom died recently. She was almost 93 and had gotten to the point where she couldn’t take care of herself anymore. She had long term care coverage but even with that, the lowest cost for assisted living was $5000 per month and went up from there. So I took care of her myself until she passed away. It was hard but she was my mother. She cared for me. So I cared for her. Well, now you will soon get to take care of your parents and grandparents.
Addendum 7/5/25: The White House Denies that seniors will be impacted. They are lying.
Key Provisions Affecting Elderly & Disabled
1. Deep Medicaid Funding Cuts
The bill authorizes up to $800–$1 trillion in federal Medicaid cuts over 10 years theguardian.com+15americanprogress.org+15time.com+15.
Although not reducing eligibility by group, slashing provider tax revenue (–$191B), payment restrictions (–$149B), and work/verification requirements (–$326B) will disrupt services for 50+ and disabled beneficiaries americanprogress.org.
2. Provider & Nursing Home Instability
States will lose significant Medicaid funding tied to provider taxes—a key funding stream for nursing homes, hospitals, and home‑care agencies thetimes.co.uk+15americanprogress.org+15time.com+15.
Time reports: over 600 nursing homes may close, straining emergency and long-term care in rural areas time.com.
3. Administrative & Cost Barriers
New work/volunteer reporting, $35 copays, 6-month re-verification, and one-month retroactive coverage cap add complexity and cost .
AARP labels this a bureaucratic burden likely to cause coverage churn among seniors and people with disabilities theguardian.com+11marketwatch.com+11sfchronicle.com+11.
4. Rural Health & Hospital Strain
Medicaid cuts hit rural hospitals and long-term care facilities first ctinsider.com+6theguardian.com+6cbsnews.com+6.
With reduced capacity, elderly and disabled patients could face limited options or increased travel for essential healthcare services.
I cannot think of a harder job than being a caregiver for someone you love.
I am so thankful I live in Canada…