LGBTQ+ Older Adults Can’t Afford Cuts to Medicaid

Medicaid is a lifeline for LGBTQ+ older adults. Over 7 million low-income older adults age 65+ are enrolled in Medicaid, together with at the very least 1.2 million LGBT^[1] older adults.^[2] Medicaid is the one possibility for paid home-based care, and fills in gaps in Medicare protection. It additionally helps LBGTQ+ older adults who’re underneath age 65 or in any other case not eligible for Medicare entry fundamental well being care. Any cuts to Medicaid harm LGBTQ+ older adults by stopping them from accessing mandatory healthcare at a time once they want it probably the most.

Why is Medicaid Vital to LGBTQ+ Older Adults?

LGBTQ+ older adults expertise inequities because of discrimination on the idea of sexual orientation or gender id (SOGI), which end in well being and financial disparities. For instance, LGBTQ+ people could also be much less more likely to safe employment because of discrimination, which creates obstacles to accessing well being care insurance coverage, even in older age.^[3] Inequities on the idea of SOGI enhance with age, and together with excessive charges of poverty, imply that many LGBTQ+ older adults depend on Medicaid for well being and long-term care.^[4]

Medicaid is a medical insurance program accessible to sure folks with restricted incomes and property, enabling them to entry important well being and long-term care to age with dignity.^[5] Whereas most older adults who’re 65 and older in addition to folks underneath age 65 who’ve sure disabilities are eligible for Medicare, Medicare alone is insufficient to fulfill the well being wants of LGBTQ+ older adults.

Medicaid Supplies Financial Assist and Companies for LGBTQ+ Older Adults with Medicare

Medicaid pays Medicare premiums and cost-sharing for a lot of seniors dwelling on mounted incomes, together with LGBTQ+ older adults, which in flip helps them pay for lease, meals, and different requirements. For these with out ample work histories free of charge Half A, Medicare’s hospital profit, these premiums could be unaffordable with out Medicaid.^[6] LGBTQ+ older adults additionally depend on Medicaid for providers that Medicare doesn’t cowl, reminiscent of long-term care at residence and in services, in addition to dental, imaginative and prescient, and listening to.

Medicaid Allows LGBTQ+ Older Adults to Reside with their Communities

Most LGBTQ+ older adults want to stay at residence as they age and infrequently expertise higher psychological well being and social outcomes with home-based care.^[7] The choice of institutional long-term care could current a risk of discrimination, isolation, or denial of important look after LGBTQ+ older adults.

Nevertheless, LGBTQ+ older adults typically face obstacles to remaining at residence, together with that they could not have conventional sources of unpaid care from household. For instance, LGBTQ+ older adults are twice as more likely to be single and 4 instances much less more likely to have kids.^[8] These dwelling in rural areas are much less more likely to have assist from household and mates.^[9]

Medicaid fills this want by empowering LGBTQ+ older adults to obtain assist in their very own houses with every day actions and different care. Medicaid is the first funder of residence and community-based providers (HCBS) in america—serving 4.2 million folks.^[10] HCBS consists of an array of providers, starting from private care aides who assist older adults with their every day actions (like consuming and bathing) to residence modifications that assist older adults to maneuver round their houses independently.

Medicaid is Important for LGBTQ+ Older Adults Who Don’t Have Medicare

LGBTQ+ older adults with restricted earnings ages 50-64 and others who are usually not eligible for Medicare could rely solely on Medicaid for all of their well being care.^[11] Given the numerous obstacles that LGBTQ+ folks face in accessing different types of medical insurance in older age, Medicaid will also be a crucial useful resource to assist LGBTQ+ older adults entry HIV care^[12] and gender-affirming care. ^[13] Gender-affirming care consists of well being care providers and inclusive approaches that assist a person’s gender id, together with hormone therapies, psychiatric providers, and first care—all of which enhance high quality of life, notably for transgender and gender expansive folks, together with older adults.^[14]

How Would Medicaid Cuts Hurt LGBTQ+ Older Adults?

Slicing federal funding to Medicaid would shrink Medicaid for everybody, however the results could be vital for LGBTQ+ older adults. Any funding caps or cuts would restrict states’ talents to maintain up with elevated healthcare prices for the rising variety of older adults, resulting in decreased state budgets and finally cuts to crucial packages like HCBS.^[15] As a result of Medicaid is commonly the one supply of home-based care—paid or unpaid—accessible to LGBTQ+ older adults, cuts to Medicaid funding in any kind threaten the way forward for long-term care choices and would drive many LGBTQ+ older adults into institutionalization or to forgo mandatory care.

Federal funding cuts would additionally probably lead states to scale back supplier reimbursement, which is already low, and will trigger the already restricted variety of suppliers serving adults to cease accepting Medicaid. This might notably hurt LGBTQ+ older adults by limiting their entry to suppliers whom they could belief, culturally competent suppliers of gender affirming care, and to specialists. States might also attempt to restrict protection for gender affirming care or pricey therapies for continual circumstances reminiscent of HIV and hepatitis C.

Different proposed pink tape on Medicaid, reminiscent of work necessities, additionally threaten LGBTQ+ communities.^[16] LGBTQ+ older adults underneath age 65 could be vulnerable to having their solely supply of well being protection taken away as a result of they can not discover or preserve work, because of discrimination and/or continual well being circumstances and incapacity. In comparison with non-LGBTQ+ friends, LGBTQ+ individuals are over 3 times as more likely to be caregivers to mates and make up 9% of all caregivers in america.^[17] Caregiving duties restrict caregivers’ availability for paid employment or could result in office discrimination.^[18] The specter of Medicaid work necessities additionally jeopardizes the wellbeing of the older adults who depend on unpaid caregiver assist from the LGBTQ+ group.

Assets

To be taught extra about healthcare for LGBTQ+ older adults, state Medicaid packages, and federal advocacy to guard Medicaid, please see the sources beneath:

Endnotes

1. All through this difficulty temporary, we use the time period LGBTQ+ to check with the lesbian, homosexual, bisexual, transgender, queer, and gender expansive group. Nevertheless, we often different acronyms—reminiscent of LGBT—to replicate the cited sources. ↑

2. Medicaid.gov, Seniors & Medicare and Medicaid Enrollees; MACPAC, Entry in Temporary: Experiences of Lesbian, Homosexual, Bisexual, and Transgender Medicaid Beneficiaries with Accessing Medical and Behavioral Well being Care (2022). ↑

3. LGBT Getting older Heart, Shining a Mild on Medicare: Demystifying Medicare for the Elder LGBT Group 1 (2024); Nik M. Lampe et al, Well being Disparities Amongst Lesbian, Homosexual, Bisexual, Transgender, and Queer Older Adults Structural Competency Strategy, 98 Int. J. Getting older and Human Growth (2023); Brad Sears et al., Williams Institute, LGBTQ Individuals’s Experiences of Office Discrimination and Harassment (2024). ↑

4. Denny Chan, Justice in Getting older, Fulfilling the Promise of Fairness for Older Adults: Alternatives in Legislation and Coverage (2023). ↑

5. U.S. Dep’t of Well being & Human Companies, What’s the distinction between Medicare and Medicaid? (2022). ↑

6. SAGE, Marriage, Medicare & Medicaid (2023). ↑

7. SAGE, Understanding Points Dealing with LGBT Older Adults 16 (2017). ↑

8. SAGE, Info on LBGT Getting older 1 (2021). ↑

9. LGBTQ+ Social Community, Getting older, and Coverage Research (McKay et al., 2024) ↑

10. KFF, How Many Individuals Use Medicaid Lengthy-Time period Companies and Helps and How A lot Does Medicaid Spend on These Individuals? (2023). ↑

11. See typically Arielle Bosworth et al., Asst. Sec. of Planning & Analysis, Well being Insurance coverage Protection and Entry to Look after LGBTQ+ People: Present Tendencies and Key Challenges 5 (2021) (noting that 17.2 % of the LGB+ inhabitants accesses Medicaid, in comparison with solely 10% of non-LGB+ inhabitants). ↑

12. KFF, Medicare and Individuals with HIV (2023). ↑

13. KFF, Replace on Medicaid Protection of Gender-Affirming Well being Companies (2022). For state-by-state details about Medicaid protection of gender affirming care, see LGBT Map, Medicaid Protection of Transgender-Associated Well being Care. ↑

14. See, e.g., Xiang Cai et al., Advantage of Gender Affirming Medical Therapy for Transgender Elders: Later-Life Alignment of Thoughts and Physique (2019). ↑

15. See Justice in Getting older, Slicing to Medicaid Harms Older Adults No Matter How It’s Sliced (2025). ↑

16. For extra details about Medicaid work necessities, see Justice in Getting older, Medicaid Work Necessities: Purple Tape That Would Reduce Well being Protection For Older Adults (2025). ↑

17. Id. ↑

18. AARP, 2020 Report Caregiving within the U.S. 70 (2020). ↑