The message from Washington D.C. to a group of aging advocates was blunt: survive 2025, then regroup for the fight ahead.
The political dynamics will change in 2026 with the critical midterm election according to Bob Blancato, a leading national expert on aging policy. He delivered a sobering overview of the future of aging programs under the Trump administration. In a Dec. 5 virtual briefing with members of Dignity Alliance Massachusetts, a coalition of disability and senior advocacy organizations, he outlined a legislative landscape filled with funding uncertainties, Medicaid cuts affecting millions, and the dismantling of protections for the most frail and vulnerable seniors.
“Our main job may be to survive the next two years with our democracy intact,” said Blancato, the former coordinator of the White House Conference on Aging under President Clinton.
The briefing came as Congress faces multiple deadlines that will shape the future of aging services:
- The enhanced Affordable Care Act premium tax credits affecting about 22 million Americans expire Dec. 31.
- A continuing resolution funding the government runs out Jan. 31.
- Critical Medicare-funded programs like telehealth and hospital-at-home face uncertain futures.
“The key to the solution is this has to be bipartisan,” Blancato said of the ACA subsidy debate. “Honestly, we’d be better off if [the president] stayed out of this whole thing.”
The impasse over aging services funding is a good opportunity for journalists to speak with employers, older workers, family caregivers and policy analysts about the challenges of these new requirements.
Why this matters
The budget issues and funding cuts will hit those over 55 and family caregivers especially hard. We previously reported on the most consequential change — nearly $1 trillion in Medicaid cuts over the next decade, passed in HR1 earlier this year. The Center on Budget and Policy Priorities estimates as many as 15 million people could lose coverage. Enhanced work requirements will also place additional burdens on those under 65 seeking assistance, as jobs in the 50-plus age group are frequently more difficult to find.
Starting January 2027, the 40 states that expanded Medicaid will impose work requirements on 20.1 million enrollees. Eligibility checks will shift from annual to every six months. By January 2028, home equity limits for nursing home care will be capped at $1 million regardless of inflation. What, if any, exceptions will be made for caregivers, or older workers who might have health issues but don’t qualify for disability?
States may respond to reduced federal funding by cutting optional benefits — including home and community-based services waivers that allow older adults to remain in their homes rather than entering nursing facilities. With wait lists for such services already averaging 36 months nationwide, advocates fear the impact will be devastating.
“These changes to Medicaid are serious,” Blancato said. “They will affect Democratic and Republican states.”
The most vulnerable at greater risk
In a decision Blancato called “very unfortunate,” CMS announced on Dec.2 that it would completely abandon the Biden administration’s minimum nursing home staffing rule—the first such standards after years of advocacy. The rule faced immediate legal challenges and legislative opposition. HR1 had already prohibited enforcement until 2034, but CMS went further, announcing a full rollback to previous regulations effective January.
“They completely walked away from the minimum staffing rule,” Blancato said. “I don’t know what the remedy will be.”
Another area journalists should keep an eye on are senior nutrition programs. One in three nutrition programs now have waiting lists, some for the first time in their history. Blancato said the National Association of Nutrition and Aging Service Programs is working with Meals on Wheels America to secure emergency supplemental funding for Older Americans Act nutrition programs. He urged webinar participants to reach out to their senators and congressional delegations to ensure this money is allocated.
Current funding stands at roughly $1 billion annually, split between congregate meals ($565 million) and home-delivered meals ($381 million), according to Blancato.
Meanwhile, the Older Americans Act itself remains in legislative limbo. The Senate passed a bipartisan reauthorization bill that would increase funding and maintain pandemic flexibilities like grab-and-go meal programs. But the House hasn’t acted, and uncertainty looms over whether it will accept the Senate version or draft its own bill — potentially delaying reauthorization indefinitely.
And the current administration proposed eliminating all funding for adult protective services and long-term care ombudsman programs at the start of 2025. Strong advocacy efforts reversed that proposal, but the threat revealed the uncertainty of elder abuse prevention programs, Blancato said.
Current funding for adult protective services stands at just $15 million nationally. Advocates are pushing for at least $100 million, plus significant increases for ombudsman programs serving assisted living and nursing home residents.
The Elder Justice Act, the first comprehensive legislation to address the abuse, neglect, and exploitation of older adults at the federal level. It was passed as part of the Affordable Care Act in 2010 with bipartisan support. It has “gone from being a bipartisan issue to a partisan issue,” Blancato said. Reauthorization remains stalled without Republican co-sponsors.
Journalists should also keep tabs on CMS transparency and prior authorization reform efforts, according to Kumar Dharmarajan, M.D., chief medical officer of World Class Health and an adjunct assistant professor at Yale University School of Medicine, who was not involved in the webinar. We previously reported on CMS testing this approach for specific procedures. Take a look at how prior authorization under traditional Medicare will influence which procedures are delivered, where they occur, and the outcomes expected, especially in high-cost specialty care.
Fighting misinformation
In response to my question on combatting health misinformation among the older population, Blancato emphasized the critical role of journalists and advocates in monitoring and reporting false claims. He pointed to the recent Advisory Committee on Immunization Practices decisions — including recommendations that older adults undergo “shared decision making” before receiving COVID vaccines — as examples requiring scrutiny.
“The media have a responsibility to report misinformation that you become aware of,” Blancato said. “Those kinds of things can lead to clarifications and changes and even rollback of false information.”
Despite the challenges, Blancato sees potential for change after the 2026 midterms. If Democrats retake the House, many HR1 provisions could be reconsidered.
He also urged advocates to expand their mission beyond policy work to include voter education — “the kind of education that has people voting in their best interest, not their worst instincts.”
Paul Lanzikos, co-founder of Dignity Alliance Massachusetts, noted the issues at stake are universal. “We could do it for very self-serving purposes because virtually all of us are aging,” he said. “If we’re not in advanced years or we have a current disability or are a current caregiver, we will be in the future.”
For aging advocates gathered on the call, the message was clear: the year ahead will test their resilience, but they must be prepared to keep fighting for the health and well being of older adults.
“We’re the voice for the people who don’t have a voice,” Blancato said. “And it’s probably more important now to raise that voice.”
Resources
- The US-born labor force will shrink over the next decade, a report from The Economic Policy Institute.
- Going Gray: National Aging Plans Gain Global Traction, Think Global Health.
- The future of aging policy in America, The Alliance for Health Policy.
- The future of aging policy: a snapshot of state priorities, National Academy for State Health Policy.
- Current federal budget and appropriations for aging services programs, National Council on Aging (September 2025).
