Modern Healthcare: Patient advocates say Medicaid per capita caps would demolish long-term care for elderly (7/11/2017) Justice in Aging’s Jennifer Goldberg discusses the harmful consequences of the recent Senate bill aimed to repeal and replace the Affordable Care Act. “Over two-thirds of Medicaid spending is considered optional under federal law. If the federal government starves Medicaid through per capita caps, optional services will be the first to be cut.” Optional services include home-based care and adult day care.