On July 4, the President signed into legislation the 2025 Price range Reconciliation Act (H.R. 1), beforehand often known as the “One Massive Lovely Invoice Act.” The legislation contains the biggest cuts in historical past to Medicaid and the Supplemental Diet Help Program (SNAP), all to develop tax cuts for the rich. The legislation endangers the well being and monetary safety of hundreds of thousands of older adults throughout America by slicing these packages by effectively over $1 trillion and taking well being protection from 15 million folks.
These cuts break a promise to everybody in America that we will rely upon help as we age. They weaken the inspiration of our well being and long-term care system and can influence us all, however the worst impacts will fall on those that can least afford them and who already face the best boundaries to staying wholesome and assembly their wants.
Justice in Getting old is dedicated to offering advocates with the instruments they should reduce hurt because the legislation is applied and assist older adults preserve entry to important providers and helps. This useful resource offers a high-level define of the influence of H.R. 1 on well being care, long-term care, financial safety, and civil rights of low-income older adults. Over the approaching weeks and months, we will probably be releasing extra evaluation, academic sources, and instruments.
For extra detailed data on the well being and long-term care impacts, please see Justice in Getting old’s chart, Price range Reconciliation Act of 2025: Medicaid and Medicare Provisions Impacting Low-Earnings Older Adults.
Reduces Entry to High quality Lengthy-Time period Care
The legislation makes it tougher for older adults and other people with disabilities to acquire high quality long-term care—whether or not at dwelling or in a nursing facility—by limiting eligibility for long-term care and slicing again on staffing protections.
Locations Entry to At-House Care and Different Non-obligatory Advantages at Important Threat for Cuts[1]
The legislation restricts funding mechanisms that states use to fund their Medicaid packages, reminiscent of supplier taxes and state-directed funds (SDPs) in managed care. Dealing with important reductions in federal funding, states will probably be pressured to chop advantages or eligibility classes which can be “non-compulsory” beneath federal legislation, enrollment, or supplier charges. Since House-and Group-Based mostly Companies (HCBS) account for almost all of non-compulsory Medicaid spending, these providers are prone to be minimize first, resulting in longer ready lists and extra institutionalization. Whereas the legislation does embrace a brand new restricted possibility for states to cowl HCBS for folks with decrease care wants, states are unlikely to take this up in mild of the numerous lack of funding. In the course of the Nice Recession, for instance, each state minimize HCBS to fill finances shortfalls. With diminished Medicaid funding, states are additionally prone to minimize non-compulsory providers like grownup dental, imaginative and prescient, and listening to that Medicare doesn’t cowl.
Pauses Minimal Staffing Necessities for Nursing Amenities[2]
For the following ten years, the legislation blocks the federal authorities from shifting ahead with new guidelines that might have elevated staffing in nursing services —together with requiring a registered nurse on-site 24/7. Continual understaffing places each residents and staff in danger, resulting in preventable accidents, sicknesses, and deaths. Specialists estimate that 13,000 lives will probably be misplaced every year on account of understaffing.
Limits Medicaid Eligibility for Lengthy-Time period Care[3]
The legislation caps the quantity of dwelling fairness a person can must qualify for Medicaid protection of long-term care at $1 million – and doesn’t alter this quantity for inflation. As we speak, twelve states enable increased than the $1 million restrict —so folks in these states will lose eligibility upon this provision turning into efficient in 2028. Over time, as dwelling values rise, fewer folks will qualify for long-term care throughout the nation. This alteration will power many older householders to delay wanted long-term care or promote their properties to get Medicaid.
The legislation additionally shortens retroactive Medicaid protection from three months to 2 months for older adults, folks with disabilities, and most different Medicaid populations (see under). This alteration jeopardizes entry to take care of these in medical disaster who usually are unable to right away full burdensome enrollment paperwork, particularly for these in search of long-term care, and can result in elevated medical debt.
Takes Away Well being Care Protection
The Congressional Price range Workplace estimates that 15 million folks will lose their medical insurance due to cuts to Medicaid in H.R. 1 and the expiration of the Reasonably priced Care Act Market subsidies. Older adults will lose well being care protection in a number of methods:
Pauses Guidelines that Simplify Medicaid Enrollment for Older Adults and Disabled Individuals[4]
The legislation halts the Streamlining Medicaid Eligibility & Enrollment Guidelines for ten years. This can make it tougher for older adults to get and preserve Medicaid protection by permitting states to keep up bureaucratic necessities, reminiscent of complicated revenue verification paperwork and frequent renewals that at the moment stop eligible folks from gaining and sustaining protection. Older adults who depend on Medicaid to assist pay their Medicare premiums and cost-sharing by Medicare Financial savings Applications may even proceed to face this crimson tape, placing hundreds of thousands vulnerable to dropping important monetary assist that makes Medicare inexpensive.
Places in Place New Work Necessities and Price Sharing for Medicaid Growth Inhabitants[5]
The legislation requires adults ages 19 to 64 eligible for Medicaid enlargement to work or volunteer at the very least 80 hours a month to enroll in and preserve their protection. Those that can not doc that they meet these necessities could have their protection terminated. Whereas there are exemptions for fogeys of minor kids as much as age 13, some household caregivers, and a few folks with disabilities, these are narrowly outlined and would require verification. Consequently, many individuals who can not work due well being points or who present caregiving will nonetheless have their protection terminated.
Older adults ages 50 to 64 are particularly vulnerable to turning into uninsured. Many are retired or face difficulties securing work. They’re extra prone to qualify for an exemption, however much less probably to have the ability to show it or navigate the crimson tape to report their work. An estimated 1.8 million folks on this age group are anticipated to have their Medicaid terminated.
The legislation additionally makes it tougher to remain coated by requiring states to recheck eligibility for the Medicaid enlargement inhabitants at the very least each six months. It additionally requires states to cost folks with enlargement protection out-of-pocket prices for some providers and limits retroactive protection to only one month earlier than somebody applies—making it extra probably folks will face gaps in care and elevated medical debt.
Undermines Medicare
Along with slicing Medicaid help, thereby making it harder for low-income older adults to make the most of their Medicare advantages, the legislation additionally places Medicare’s future in danger. As a result of the legislation will increase the deficit, the legislation triggers future large cuts to Medicare because of the Statutory Pay-As-You-Go Act of 2010 (S-PAYGO). This legislation kicks in when laws will increase the deficit, and Medicare cuts are set to start in fiscal 12 months 2026 except Congress acts.
Reduces Meals Help for Seniors and Households
The legislation slashes billions of {dollars} from the Supplemental Diet Help Program (SNAP), and can power states, whose budgets are already stretched skinny, to make tradeoffs that can depart older adults and households hungry. People and households who obtain SNAP will obtain much less cash due to across-the-board cuts—all at a time when meals costs are rising. The legislation additionally introduces work necessities and different measures that can stop folks from making use of for, qualifying for, and conserving their advantages, together with many older adults between the ages of 55-64 who would in any other case be eligible.
Reduces Funding for SNAP[6]
The legislation’s modifications in Supplemental Diet Help Program (SNAP) funding for states signifies that states will lose $186 billion in federal SNAP funding by 2034–a 20 p.c discount. Additional, the legislation eliminates the usual utility allowances and different measures that simplify eligibility determinations for SNAP and utility help. Greater than 40 million folks, together with 8 million seniors, will probably be impacted. Meals advantages will probably be minimize by a median of $100 monthly for about 600,000 low-income households.
Expands Work Necessities for SNAP[7]
The legislation additionally expands the classes of people that should show, by extra paperwork and reporting, that they meet sure “work necessities” as a way to stay eligible for SNAP. Particularly, work necessities are expanded to households with kids ages 15 and above, older adults ages 55-64, former foster youth, veterans, and other people experiencing homelessness. Due to this extra crimson tape, greater than two million folks, lots of whom would in any other case be eligible, will probably be minimize off from SNAP advantages, together with 900,000 adults between the ages of 55 and 64.
Gives a Tax Deduction for Some and Will increase the Insolvency of the Social Safety Belief Fund for All
The modifications within the tax code within the legislation present a modest deduction for some seniors whereas creating an enormous price in the long run. This momentary deduction will overwhelmingly go to increased revenue older adults and won’t profit decrease revenue folks over 65 or folks with disabilities. The change will damage the solvency of the Social Safety Belief Fund for everybody.
Places in Place a Short-term Tax Deduction[8]
The legislation offers a short lived tax deduction of as much as $6,000 for sure folks age 65 and over for the years 2025 by 2028. As a result of it’s a deduction and never a credit score, it doesn’t present any monetary profit for almost all of older adults, whose revenue is simply too low to pay revenue tax. Nevertheless, the cash misplaced from the Social Safety Belief Fund will have an effect on its solvency for everybody. The legislation is estimated to maneuver up the date of Social Safety insolvency to 2032, a 12 months sooner. At that time there can be inadequate funds to cowl all profit funds and with out congressional motion, all advantages can be minimize by 20%.
Cuts Immigrant Entry to Well being Care and Meals
Over eight million immigrants over 65 reside in the USA. Over 1.6 million noncitizens are enrolled in Medicare. This legislation cuts well being care and meals help for individuals who are lawfully current, approved to work, and have lived within the U.S. and paid taxes for a few years. These cuts will depart all immigrants, together with older immigrants, poorer and sicker.
Restricts Medicaid Eligibility for Lawfully Current Immigrants[9]
The legislation eliminates Medicaid eligibility for lawfully current immigrants who are usually not Lawful Everlasting Residents (LPR) (after a five-year or longer ready interval); sure Cuban and Haitian immigrants; people residing within the U.S. beneath a Compact of Free Affiliation; or lawfully residing kids and pregnant folks. It additionally removes Medicaid eligibility for many humanitarian immigrants, together with refugees and asylees.
Restricts Medicare Eligibility for Lawfully Current Immigrants[10]
The legislation limits Medicare eligibility for lawfully current immigrants to a few classes: Authorized Everlasting Residents, Cubans and Haitians who entered beneath a household reunification program, and Individuals residing beneath the Compacts of Free Affiliation (residents of Micronesia, the Marshall Islands, and Palau). This alteration within the legislation breaks a longstanding promise by taking away Medicare protection from many lawfully current immigrants who’ve lived, labored, and paid Medicare and different taxes within the U.S. for many years. Along with the Medicaid restrictions and comparable restrictions that restrict enrollment and monetary help to buy Reasonably priced Care Act Market protection, these new modifications imply that many older immigrants who are usually not Authorized Everlasting Residents are prone to change into uninsured.
Restricts SNAP Eligibility for Lawfully Current Immigrants[11]
The legislation limits Supplemental Diet Help Program (SNAP) eligibility for lawfully current immigrants to a few classes: Authorized Everlasting Residents, Cubans and Haitians who entered beneath a household reunification program, and Individuals residing beneath the Compacts of Free Affiliation (residents of Micronesia, the Marshall Islands, and Palau). This implies it takes away meals help from refugees and asylees who fled persecution and are attempting to rebuild their lives.
Conclusion
In sum, the legislation rips away well being care and meals help from the individuals who most want them, together with caregivers and immigrants who’ve lived and labored legally right here for many years. Placing nursing dwelling residents’ lives in danger whereas jeopardizing the power of older adults to age at dwelling leaves households with few choices for long-term care—simply because the inhabitants is getting old. Justice in Getting old will proceed to offer instruments for advocates to know the legislation, mitigate the hurt, and establish openings to repeal and rebuild, in order that we will all age with dignity and justice.
Endnotes
-
An Act to offer for reconciliation pursuant to title II of H. Con. Res. 14, Pub. L. No. 119-21, §§71115, 71116, 71121 (2025) [“H.R. 1”]. ↑
-
H.R. 1, §71111 ↑
-
H.R. 1, §§71108, 71112 ↑
-
H.R. 1, §§71101, 71102, 44101 ↑
-
H.R. 1, §§71119, 71107, 71112, 71120 ↑
-
H.R. 1, §§10101 – 10108 ↑
-
H.R. 1, §10102 ↑
-
H.R. 1, §70103 ↑
-
H.R. 1, §71109 ↑
-
H.R. 1, §71201 ↑
-
H.R. 1, §10108 ↑
