Medicaid cuts jeopardize the right to age at home

If you or someone you love wants to age at home — and nearly 90 percent of older Americans do — there’s a number you should know: $2.3 trillion. 

That’s how much could be cut from Medicaid under current budget proposals. And while headlines often focus on how these cuts would affect nursing homes, what’s less understood but equally devastating is what they would mean for home-based care.

These cuts would strike at the heart of the support system that allows millions of aging adults to remain where they most want to be: at home.

Medicaid isn’t just a safety net for the most vulnerable; it’s the largest single payer of home- and community-based services in the U.S. These services include home health aides, adult day care, transportation, personal care assistance, and respite for family caregivers. For many older adults, these are the only things standing between them and institutionalization.

And yet, even with current funding, the system is stretched thin. More than 700,000 people are already on waitlists for Medicaid home- and community-based services programs across the country. Many wait years to receive services — years they may not have.

Slashing federal funding by nearly a third would not just deepen the crisis; it would fundamentally dismantle the infrastructure that makes aging in place even remotely possible for low- and middle-income Americans.

Let’s be clear: These aren’t luxuries. In many cases, they are a means of survival. 

Medicaid-funded home-based services help a retired school bus driver in rural Arkansas stay in her home with regular help bathing and cooking. They let a veteran in Pennsylvania recover from surgery with at-home nursing instead of a long rehab stay. They support a daughter in New Mexico caring for her aging father, who can no longer be left alone but doesn’t yet need a nursing home.

When these supports disappear, the burden doesn’t just vanish — it shifts. It lands on unpaid family caregivers who must step away from work, on hospitals that see higher readmission rates, on state budgets already grappling with workforce shortages and demographic shifts. 

It’s the worst kind of false economy: short-term savings that lead to long-term costs, both financial and human.

Yes, we should talk about how to improve Medicaid and make home-based care more efficient. But we cannot begin that conversation by pulling out the foundation. If anything, we should be expanding home-based care, because it’s not only what people want, it’s often what works best.

We have innovative tools and models ready to scale: remote monitoring that helps catch problems early, home modification programs that prevent falls and hospitalizations and caregiver support that helps families stay afloat. These approaches save money and improve quality of life. But they don’t run on good intentions. They require sustained, stable funding.

Aging isn’t a partisan issue. It’s personal. It’s all of us — our parents, our neighbors, ourselves. 

And when the time comes that we or someone we love needs help, the question will be: Did we invest in a system that honors independence and dignity, or did we dismantle it when it was needed most?

Medicaid-funded home-based care isn’t just about staying out of a facility. It’s about staying home. With the right support, that’s possible. But if these cuts move forward, for millions of Americans, that option could disappear.

Let’s not let that happen.

Geoff Gross is the founder and CEO of Medical Guardian.