Webinar recap: Understanding the budget bill’s toll on older adults, and how to tell the story

The Budget Reconciliation Act of 2025 (H.R. 1) enacts sweeping reductions to Medicaid, Medicare and nutrition programs. Advocates say these changes will profoundly affect older adults’ ability to access health care, food and basic support — despite administration claims that seniors won’t lose benefits. 

Rachel Werner, M.D., Ph.D., executive director of the Leonard Davis Institute of Health Economics, University of Pennsylvania, and Amber Christ, managing director of health advocacy at Justice in Aging provided a deep dive into the fallout of these cuts in an Oct. 9 AHCJ webinar. 

“This bill paid for tax cuts for the wealthiest by cutting public programs for those with the lowest incomes,” said Christ. “Most older adults live on very limited resources and will be harmed by its passage.”

And the budget eliminates or restructures many programs that have supported aging in place. The Congressional Budget Office (CBO) estimates that by 2034, more than 1.3 million adults over 65 could lose Medicaid coverage due to changes in key registration and eligibility rules. Major reductions include approximately $990 billion from Medicaid and $187 billion from SNAP, the nutrition program for low income Americans, over 10 years.  

These cuts also impact older people who are still working, family caregivers and the direct care workforce. Below are some key areas health journalists should pay attention to when covering these policy shifts in their communities. 

Who’s most affected

The dually-eligible population: About 12.5 million people are enrolled in both Medicare and Medicaid. They depend on Medicaid for premiums, cost-sharing and long-term care support.  

“These beneficiaries are disproportionately sick and vulnerable,” Werner said. Most have incomes below $20,000 and about half are people of color in poor health. Cuts to Medicaid will ripple through this group quickly — affecting home care hours, prescription access and transportation, she noted.

Pre-Medicare: Nearly 5 million adults between the ages of 50 to 64 receive coverage through Medicaid expansion or ACA marketplace subsidies. If enhanced premium tax credits expire at the end of 2025, monthly costs will rise significantly. Many near-retirees rely on ACA coverage to bridge to Medicare. Losing subsidies may delay retirement or push them into debt before they turn 65, according to Werner.

Everyone else on Medicare: Unless Congress acts, the deficits created by H.R. 1, about $3.1 trillion, are large enough to trigger cuts to Medicare under a wonky rule called the PAYGO Act. Under sequestration, an automatic 4% Medicare cut of about $500 billion will be put into effect. Congress has never before let this happen, but it’s unclear what action, if any, they may take this time.

How the cuts work

Much of the savings in H.R. 1 derive from rules that make participation harder, not from direct spending caps. These include new work requirements, complex redetermination processes and administrative barriers that discourage or disqualify eligible recipients.

Many people who qualify will simply lose access due to increased red tape, not because they stopped working or no longer qualify, panelists said. Historically, similar bureaucratic requirements have caused eligible participants — especially older or disabled adults — to drop off Medicaid rolls due to missed paperwork.

• Medicare savings programs — The Medicare Shared Savings Program helps low-income beneficiaries pay premiums and out-of-pocket costs. It faces a 10-year moratorium on simplified enrollment rules first proposed in 2023.
  • Without these streamlining measures, approximately 1.38 million low-income Medicare beneficiaries may lose dual coverage by 2034, leading to an estimated 18,200 additional deaths annually from the loss of prescription drug subsidies, according to researchers at the Penn Leonard Davis Institute of Health Economics.
  • “These are very sick people,” Werner said. “Losing the low-income subsidy that pays for Part D co-pays can substantially increase mortality.”

• Long-term care and home-based services — Medicaid finances most home and community-based services — including assistance with dressing, bathing, eating and transportation — which allow people to remain out of nursing homes. These services are optional under current law, making them a major target for cost trimming.
  • Scaling back home and community-based services (HCBS) often costs states more in the long term, as older adults enter nursing homes sooner, according to The Scan Foundation.
    
• Direct care workforce challenges — Funding cuts will also undermine efforts to stabilize the direct care workforce, a sector already confronting significant shortages. Advocacy groups say lower reimbursement rates will deter workers and could force agencies to limit services.
  • Journalists should ask local aging and home care agencies if they expect waitlists or worker shortages to worsen.
    
• Food assistance and nutrition access — The Supplemental Nutrition Assistance Program faces a $186 billion reduction and stricter eligibility requirements. New work mandates for recipients — including some adults over 50 — will likely disqualify mixed-age households that include seniors.
  • “Because SNAP is household-based, when able-bodied adults lose eligibility, everyone’s allotment shrinks,” Christ said. “That disproportionately affects seniors and disabled people, increasing their risk of hunger.” 
  • Reporters may want to examine how state agencies will manage these simultaneous Medicaid and SNAP cuts, since both depend on state implementation and eligibility systems.
    
• Eliminating federal aging programs — The administration’s FY2026 reorganization proposal dismantles the Administration for Community Living and relocates most of its programs to the Centers for Medicare and Medicaid Services, often with funding eliminated or sharply reduced.

Among the changes Werner and Christ highlighted:

• Preventive health and disease prevention programs like the falls prevention and chronic disease self-management initiatives have moved to CMS, but their funding under the Prevention and Public Health Fund was essentially zeroed out.  
• The Alzheimer’s Disease Initiative remains funded for now, but other community-based public health programs lose federal support.  
• Elder rights programs, including the Long-Term Care Ombudsman Program and Adult Protective Services, are significantly cut, resulting in elimination of most elder abuse prevention efforts.  
• The Direct Care Workforce Strategies Center and Aging and Disability Resource Centers are slated for closure.  
• Medicare State Health Insurance Assistance and Lifespan Respite Care are defunded.
• The Low-Income Home Energy Assistance Program (LIHEAP) and CDC falls prevention initiatives such as STEADI (Stopping Elderly Accidents, Deaths & Injuries) are defunded.

Since Medicaid is a federal-state partnership, states must decide how to manage the shortfall. They can raise taxes, reallocate funds, or reduce eligibility and benefits. The Center on Budget and Policy Priorities projects that between 9.9 and 14.9 million people could lose Medicaid nationally under expanded work and reporting requirements, with older adults and disabled individuals most affected.  

States with more limited budgets will be forced to make hard choices: reduce home care hours, narrow eligibility criteria for HCBS, or allow coverage lapses through administrative attrition.

What to ask policymakers

• How will state Medicaid agencies offset reduced federal support for home- and community-based services?  
• What plans exist to prevent coverage losses among dual-eligible seniors if the Medicare Savings Program ends?  
• How will SNAP’s new work rules affect multi-generational households with seniors or disabled members?  
• Which local aging programs risk closure as the ACL is integrated into CMS?  
• How are workforce shortages in home care agencies affecting hospital discharges or long-term care placements?

Additional story ideas 

• How cuts to Medicaid and SNAP disproportionately harm women and older adults of color.  
• Interview Area Agencies on Aging, senior centers, or Meals on Wheels coordinators about lost funding and what that means to local communities.
• Compare projected savings to the likely increase in nursing home or emergency care costs.  
• Note whether state lawmakers are supplementing reduced federal allocations through their own budgets.  
• Examine implications of eliminating SAMHSA-funded preventive mental health and wellness programs for seniors.  

Resources

• Federal Budget and Appropriations for Aging Services Programs National Council on Aging (2025)
 
• Disability and Aging Collaborative Joint Letter to HHS on Budget Restructuring, American Association on Health and Disability, (March 2025)
 
• Impact Report (includes sections on “Health Safety Net Programs: Will Older Adults Fall Through?” Alliance for Aging Research (2024) 
• How Many Older Adults Live in Poverty? Kaiser Family Foundation, (August 2025)
 
• Characteristics of SNAP Households, Fiscal Year 2023, U.S. Department of Agriculture (May 2025)
 
• Universal Direct Care Workforce Initiative and Data Hub, PHI National