In nursing homes across Florida, elderly residents have much to lose from the spending cuts proposed in Washington, D.C.

Medicaid is the primary payer for nursing-home care in Florida — and the only way that two-thirds of nursing-home residents can afford help with daily tasks such as eating, bathing and dressing.

What would happen if Florida no longer had the money to pay for senior care? Would family members need to step in and provide the care, or pay the bill? Would some nursing homes close?

These questions are top of mind in Florida as Congress looks at where to make federal cuts.

Medicaid offers health coverage for people with limited income and resources. Any federal-government cuts to Medicaid could affect about 700,000 seniors in Florida now covered, including those in long-term care facilities, as well as those who may need skilled nursing or home health care in the future.

Most of Florida’s elderly don’t have the means to pay for their care, with the average annual cost of a nursing-home bed ranging from $104,000 to almost $117,000 in 2023, according to KFF, a nonprofit providing health policy research and polling. Some residents start in nursing homes on Medicaid or use it once they have exhausted their private funds.

“Loss of Medicaid coverage poses unique challenges for seniors and people with disabilities, people who are likely to live on fixed incomes, have high health care spending, and rely on Medicaid for coverage of long-term care,” KFF notes in its article, “5 Key Facts about Medicaid Eligibility for Seniors and People with Disabilities.”

While the depth and scope of potential Medicaid cuts are unknown, House Republicans can’t meet their target of $880 billion in savings to pass President Donald Trump’s legislative agenda without making significant cuts to programs like Medicaid. All states rely on federal matching funds to finance their Medicaid programs.

In Florida, the federal government pays for 57% of the cost of traditional Medicaid, and the state pays 43%. If the federal match were decreased, state legislators would have to figure out how to operate their program with less federal funding. The state gets $19.5 billion annually from the federal government for Florida Medicaid, according to a Georgetown University analysis.

For now, questions and uncertainty cloud Medicaid’s future while Florida’s elder-care advocates watch closely for what’s ahead.

A nursing-home owner’s perspective

Shawn Corley, president of Solaris HealthCare Properties, worries about the day he cannot accept a new Medicaid resident at one of his 20 long-term care facilities in Florida. It has him tuned in to every federal action focused on spending cuts and their impact on Medicaid.

“Any significant cuts could devastate the care we provide,” Corley said. “You could see financial instability for providers like us, and that can lead to closures of buildings, then displacement of residents, or a population that is under-serviced by limited beds available.”

The repercussions of cuts also could affect nursing-home employees, as well as residents’ family members, he notes.

“If their family member doesn’t have access to Medicaid funding, they could have to stop work to take care of them at home,” Corley said.

Nick Van Der Linden, senior director of operations for LeadingAge Florida, a statewide association representing all types of care for seniors, said each nursing-home owner sets the percentage of Medicaid residents they take.

“Some owners would be impacted more than others,” Van Der Linden said. “It would be logical to assume some owners would end up getting out of the Medicaid business.

“That doesn’t mean residents would be put out of nursing homes, but it could mean increased needs for residents that won’t be able to be met,” he added. “It means some people would not be able to access medically necessary long-term care.”

Seniors who get care at home

Over 90% of seniors say they would rather age at home than in a long-term care facility. The cuts, however, could threaten the amount of in-home care they receive, their access to adult daycare and medical equipment coverage.

Seniors could also be required to pay for all types of medical services now covered by their Medicaid plans.

“We don’t know where they are aiming the cuts right now, but the impact could be a senior at home, who is getting Medicaid funding for an aide to help them make a sandwich or shop for groceries or help them brush their teeth, could see those services eliminated,” said Pam Wiener, president of the nonprofit Palm Beach County Partnership for Aging.

Wiener said cuts to those services could lead to social isolation: “For a lot of people at home, the only people they see are the aides who come in once, twice or three times a week.”

Why seniors are at risk

Although Medicaid funds myriad programs for other age groups in Florida, the highest spending is on seniors and people with disabilities (78%). The U.S. average is 51%, according to the Georgetown University Center for Children and Families.

“If the state has to reduce Medicaid spending and most of the money is going to older adults, you can expect a big target on older adults and people with disabilities,” said the center’s Leo Cuello.

Cuello said if Medicaid cuts happen, Florida lawmakers would most likely consider three options:

—Make it more difficult for Floridians to become eligible for Medicaid

—Reduce covered services such as home care or certain prescription drugs

—Cut provider reimbursement rates, making it less appealing to accept Medicaid

If reimbursement rates were cut, seniors would face an extremely limited choice of providers, Cuello added. They could find it challenging to access a specialist, hire a home health attendant, or get an appointment with a gerontologist.

In Florida, Miami-Dade County has the highest percentage of seniors covered by Medicaid (58.8%) followed by Broward County (21.6%), according to Georgetown University’s study “Medicaid Coverage in Florida Counties, 2023.” Palm Beach County has a much lower percentage, about 12%, likely due to a more affluent population.

“These aren’t just numbers on a spreadsheet — they represent real Florida families who could lose access to essential medical care,” said Alison Yager, executive director of the Florida Health Justice Project, which provides analysis of health policy on Florida communities. “In Miami-Dade County, nearly three in five seniors rely on Medicaid.”

“With fixed dollars from the federal government, the state will be squeezed,” Yager said. “The costs don’t go away; they’re just shifted onto the state, the hospitals, the providers and the residents.”

Wiener, of the Palm Beach County Partnership for Aging, said community leaders who work with the elderly already face challenges, even without cuts in services.

“We are already up to our ears keeping people safe who are struggling with housing and care,” she said. “Many retirees here are getting older, so it’s a significant issue. Florida seniors have a lot to lose.”

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