A recent report from the Center for an Urban Future is a reality check on a looming crisis for many states: providing adequate services and support for older adults.
The report found that the proportion of older people living in poverty in New York State increased by 50% over the past decade. Just as concerning, hundreds of thousands of older New Yorkers appear to have no stable source of retirement income.That will affect everything in their lives including, housing, nutrition and health care.
Why this matters
What’s happening in New York is a snapshot of an increase in elder poverty and foretells a greater need for many seniors to get help paying for health care and other basic needs. As Congress debates a proposed $880 billion in Medicaid cuts, the health of older adults, their ability to remain in their homes and communities, and their means to pay for care will be seriously affected, according to Renuka Tipirneni, M.D., an internist and an expert on Medicaid and healthy aging at The Institute for Healthcare Policy and Innovation (IHPI) at the University of Michigan.
Journalists in every state have a similar story to tell. Find out whether the older population and the poverty rate among seniors have increased in the past few years, the proportion of older people who rely on Medicaid in addition to Medicare, known as the dual eligibles, and how cuts in programs and services will impact their health, ability to remain in their homes, and programs that can assist older adults and their family caregivers.
What is your state doing to address this issue and what will happen if Medicaid payments are significantly reduced?
Higher poverty, plus higher living costs
About 3.56 million adults, or about one in five, New Yorkers are 65 and older. This number is at an all-time high and a nearly 30% increase over the last 10 years. Yet, a staggering 49% of the state’s older adults reported no retirement income at all in 2022, according to the Center for an Urban Future report. Nearly one in eight New Yorkers over 70 were not receiving Social Security benefits, further exacerbating elder poverty.
Many of these older residents qualify for Medicaid, the joint federal-state program that provides health care and services for people at or near the poverty level. New York expanded eligibility to seniors who qualify for 138 % of the Federal poverty level. New York caps Medicaid eligibility income at $$21,597 per year for a single individual over 65 (2025) with assets under $31,175.
Older New Yorkers comprised 13% of Medicaid enrollment in 2021 according to KFF, but totaled nearly one-third (31%) of all Medicaid spending researchers from Georgetown University’s McCourt School of Public Policy found.
What Medicaid pays for
Medicaid pays for five in eight nursing home residents in New Yor, and about six in 10 nationally. , The program also helps fund home and community-based programs like the Program of All-Inclusive Care for the Elderly, or PACE. These efforts allow seniors to avoid or delay nursing home care by providing health care and social supports at home.. In spite of the cost savings generated through these programs, many states are cutting back their Medicaid programs as federal matching funds wind down,
Medicaid pays for a wide range of care including preventive visits and vaccinations to chronic disease management, medical devices and equipment like wheelchairs and walkers. It also pays for about 60% of all nursing home care. Medicaid also helps fund caregiver supports and services, including direct payments in some states, respite care, and adult day centers.
If Medicaid spending cuts are approved by Congress, direct effects for older adults likely include cutbacks or elimination of crucial wraparound services to help people stay in their homes or have other needs addressed to make things safe and functional if they have any limitations, according to Tipirneni.
“As a practicing physician, I worry about keeping people healthy and functioning in their families and communities,” she said. People will likely be hospitalized for preventable issues and enter their senior years sicker if Medicaid funding is cut.
Her research shows that people who received regular health care — whether through Medicaid or the ACA Marketplace before age 65 — had better outcomes on several measures after entering their Medicare years. ”When people are in this midlife to older adulthood transition, the more important factor seems to be having any health insurance to be able to access care,” Tipirneni said.
Tipirneni and colleagues compared groups who had access to preventive care through the Affordable Care Act or Medicaid before enrolling in Medicare at 65, to those who enrolled in Medicare before the ACA became law. Seniorswith insurance coverage before Medicare enrollment had lower health care costs and fewer hospitalizations later in life. The number of people with limitations on daily activities of living, such as bathing, dressing, and toileting, was lower in states that expanded Medicaid.
Access to care, especially among lower-income older adults, could impact longevity, as well as quality of life in later years, Tipirneni said. Proposed cuts could mean older people are likely to have fewer years with high quality of life and possibly premature death. “I sincerely hope that Medicaid supplemental coverage for those lower-income older adults is preserved because we know what a big difference that makes Medicare on its own, the cost-sharing expectations mean that an older adult would have to spend so much to get basic medicines to see the doctor,” she said.
She’s hopeful that Congress will preserve Medicaid supplemental coverage and some of the affordability provisions for Medicare that were enacted under the Inflation Reduction Act, such as caps on out-of-pocket prescription costs. “Let’s make sure we preserve that health insurance and basic access to care to help people thrive.”
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