Aging at Home and Defending Medicaid: A Conversation During Uncertain Times

• Pages: 69-70
• Date: 01 March 2025
• Published date: 01 March 2025
• Author: Nicole Shannon, J.D.
• Subject Matter: Derecho Público y Administrativo

Bifocal

46 Issue 4

69

Aging at Home and

Defending Medicaid:

A Conversation During

Uncertain Times

By Nicole Shannon, J.D.

Though much is uncertain in our current era,

at least one thing is unchanged: the desire of

Americans to age in place. In an AARP report

published just a few months ago, 75% of adults 50-

plus wish to remain in their homes as they age, with

that number even higher among adults 65-plus.1 But

with Medicaid on the chopping block, the primary key

to aging at home is on shaky ground. 2

Aging at home is not a high-minded ideal—it is a

1 Binette, Joanne, and Fanni Farago. 2024 Home & Com-

munity Preferences Among Adults 18 and Older. Washington,

DC: AARP Research, December 2024. https://doi.org/10.26419/

res.00831.001

2 Kapur, Sahil, Republicans can’t meet their own budget

target without cutting Medicare or Medicaid, budget oce says,

NBCNews.com, March 5, 2025, https://www.nbcnews.com/

politics/congress/republicans-cannot-meet-budget-target-cut-

ting-medicare-medicaid-budget-rcna195042.

legal imperative. Last year, we celebrated 25th anniver-

sary of Olmstead v L.C., the landmark decision that

held that the American with Disabilities Act prohibits

certain institutional segregation of people with disabil-

ities.3 Even after over 25 years, the dream of commu-

nity integration is far from realized. Dozens of states

have active consent decrees, settlement agreements,

litigation, or similar under Olmstead, including nu-

merous cases involving needless institutionalization of

adults in nursing homes who could instead be living in

the community.4

We are facing an existential crisis. In “normal” times,

advocacy for aging in place has focused on expand-

ing Medicaid Home and Community Based Services

(HCBS) through policy advocacy, Olmstead litigation,

and traditional estate and Medicaid planning. But

today, advocates are ghting to defend the very exis-

tence of Medicaid—and with it, the ability to age in at

home.

Medicaid is the main funding source for the HCBS

that enables low-income older adults and adults with

disabilities to live in the community. Though federal

Medicaid law requires that states cover mandatory

benets such as nursing home services, HCBS can

be limited by states. With a cut in Medicaid funds,

discretionary programs such as HCBS are likely to be

rst on the chopping block. States may choose to cut

provider payment rates to make up for the shortfall.

The existing direct care workforce shortage will be ex-

acerbated, with fewer people willing to work for even

more meager wages.

Without these HCBS vital programs, people who want

to age at home will face potentially insurmountable

barriers that jeopardize both their safety and auton-

omy. The remaining choices will include relying on

friends and family members to ll in the gaps, going

without necessary care, or ultimately moving into an

institutional setting. Many people will nd themselves

in risky situations with under-trained (or untrained)

caregivers. Those caregivers will give up paid work,

go without respite, and be more susceptible to burnout.

All this, to attempt to age at home.

Those of us in the law and aging network have a

responsibility to protect Medicaid. Elder and disability

rights organizations across the country are sounding

the alarm and putting together resources. Justice in

3 527 U.S. 581; 119 S. Ct. 2176 (1999).

4 Substance Abuse and Mental Health Services Adminis-

tration, Update on Olmstead Litigation, May 2023, https://www.

samhsa.gov/sites/default/les/update-olmstead-litigation.pdf.