Protecting Medicaid for Older Adults: What’s at Risk & What Advocates Can Do

Amber Christ:

Hi, everyone, and welcome to today’s webinar, Protecting Medicaid for Older Adults: What’s at Risk and What Advocates Can Do. My name’s Amber Christ. I use she/her pronouns, and I am the managing director of Justice in Aging’s Health Advocacy. I’m joined today by my colleagues, Natalie Kean, director of Federal Health Advocacy, and Gelila Selassie, a senior attorney with our team. Together, we are closely monitoring what’s happening in Washington, DC. We’re meeting with lawmakers and collaborating with partners to protect Medicaid.

We want to thank you all for being here today for this webinar. We acknowledge that there is just a lot happening right now. A lot happening in our communities, in our organizations, and to us as individuals. And if you are on this webinar today, one of the things that you are deeply concerned about right now are the significant cuts to Medicaid being considered by Congress. This webinar is going to specifically focus on how these proposed Medicaid cuts would impact you as an older adult, the older adults in your lives and in your communities, and the older adults you serve.

But before we dive into content, just a few logistics here. All participants are on mute. If you have a question about the material being presented or a technical concern, please use the question function. We will also leave time at the end for some Q&A. If you experience any difficulty accessing the webinar, please email trainings@justiceinaging.org. The materials that we’re discussing today are available on Justice in Aging’s website and our resource library. A recording of the webinar will also be available there in the resource library and available on our Vimeo page. There are links to our resources have also been shared in the chat function, so you’ll see those there as well. If you would like to enable closed captioning, please hit the CC function on your Zoom panel. Next slide.

Just a little bit about Justice in Aging for those of you who might be new to us. We have a lot of folks on the call today. We are a national organization focused on eradicating senior poverty by increasing access to affordable healthcare and economic security for all low-income older adults, with a specific focus on older adults who have historically been marginalized and excluded from justice, including older adults of color, older women, LGBTQ+ older adults, older adults with disabilities, older immigrants, and those whose primary language is not English. To carry out this mission, we at Justice in Aging are deeply committed to addressing the enduring harms of racism and other forms of discrimination across all areas of advocacy, and we are committed to actively recruiting and retaining a diverse staff and board. If we go to the next slide.

Again, on today’s webinar, we’re going to focus on the specific threats to Medicaid currently being considered by Congress. We know that there are so many pressing issues right now, such as the recent federal funding freeze, policies affecting immigrants and LGBTQ+ communities, and so much more. These will not be the focus of today’s webinar. Today, Gelila and Natalie are going to provide you with an overview of the indispensable role that Medicaid plays for older adults. They’re going to provide you a summary of the current legislative proposals that would drastically cut Medicaid for older adults and all Medicaid populations. They’re also going to provide you a high-level overview of the legislative process that Congress is trying to use right now to make those cuts.

And then, we’re going to provide you with tips and resources to effectively fight back against these proposals to cut Medicaid and assure the program remains in place for the millions of older adults who rely on it. We are really grateful to have you all here today and in this fight with us, both today and in the coming months and even years. I’m going to turn it over to Gelila now to kick us off with an overview of the role of Medicaid for older adults.

Gelila Selassie:

Thank you so much, Amber. As Amber said, I’m Gelila Selassie with Justice in Aging. Before we get into some of these specific threats that are being proposed, it’s worth going over just how important Medicaid is for older adults and why any sort of cut or changes to the program is really dangerous for this population. Next slide.

More than 7 million older adults and 10 million people with disabilities rely on Medicaid. Medicaid is very unique. It doesn’t just cover medical services like you would think traditional health insurance does. It’s much broader than that. It covers long-term care, both in nursing facilities as well as in home and community-based services. It also covers things like non-emergency medical transportation, which allows enrollees to receive accessible transportation to doctor’s appointments and dialysis appointments and things like that. And then, it also provides financial assistance for Medicare beneficiaries who are duly enrolled in Medicaid under the Medicare Savings Program. Medicaid cover services that traditional Medicare doesn’t cover, things like dental vision and hearing.

It’s also important to note that states have pretty broad flexibility to add optional coverage through additional waivers or state plan amendments. So, states can, and often do, choose to write even more benefits and increase eligibility to meet the needs of individuals in their states. Medicaid is also really important because it works with Medicare to provide even more affordable comprehensive coverage for older adults and people with disabilities. 10 million plus duly-eligible individuals rely on Medicaid to pay Medicare premiums and/or out-of-pocket costs under the Medicare Savings Programs.

And they can also cover… Which is really important because that’s what helps make Medicare more affordable. As many of you know, Medicare has several hundred dollars in premiums every month, high deductibles, so Medicaid helps make Medicare more accessible for low-income older adults. This is especially crucial because duly-enrolled individuals usually have the highest health needs. They’re the ones that need to go to the doctors more often, need more labs, need more meds, just need more care overall. So making that affordable is really crucial, especially since people who are duly enrolled often have the most limited income and assets.

And then, Medicare coverage for long-term care is pretty limited. It only covers about 100 days in skilled nursing facilities. For that reason, Medicaid is often the only option for older adults to receive long-term care, and that’s why more than 60% of all nursing facility residents are on Medicaid. Medicaid HCBS, which is provided through those waivers as I mentioned earlier, cover a wide range of services, like personal care, home health aids, and respite care, allowing older adults to age in place if they don’t want to go to an institution and it’s often really their only option for aging in place. Next slide.

Now that we did an overview of why Medicaid is so important, we’ll dive into some of the proposed actions that Congress is intending to take to cut Medicaid. As we mentioned, we’re in very early days, so we’re just giving a breakdown of all the different ways that Congress could cut Medicaid based on things that we’ve been hearing out of Capitol Hill, as well as actions taken in the past. These are the five major methods, like a menu of options that Congress could take to cut Medicaid, and they’re divided into two broad categories. The first category would threaten Medicaid by cutting the federal funding for the program, so choking off the funding mechanisms for Medicaid. But the other side of it aims to cut Medicaid by cutting enrollment or services available to the population.

Some cuts to federal funding that could take place. The first is instituting block grants or per capita caps. They could cut the federal medical assistance percentage or FMAP, and then they could also restrict provider taxes that help fund the program. Cuts to enrollment or services could occur by either adding work requirements or sometimes work reporting requirements, and then also by repealing very important and crucial regulations and minimum requirements that have been in place through the previous administration that would strengthen and improve access to Medicaid. Next slide.

We’ll start with block grants, and if you are doing similar work in this area back in 2017 or maybe even before then, you’ve probably heard a lot about block grants. Under a block grant system, states would get a large lump sum of money for all Medicaid spending and the state would have to decide how to spend those funds. So, it’s putting pressure on states to determine which services and programs to cut. I think there’s already an expression that once you’ve seen one Medicaid program, you’ve seen one Medicaid program, because, again, there’s a lot of flexibility that states are given. Under block grants, that would be even widely.

There’d be massive variation across states, and even within a state between populations, because some of the standards that are given under the current system where the feds have to fund all of the Medicaid programs would now be all up to the discretion of the state, so you would see a large wide variety in what’s available to individuals. And then again, to meet their budget, states would likely significantly cut these programs.

The Congressional budget office projected that under a block grant system, Medicaid would be cut between 459 billion to 742 billion over nine years, which tells you that it is a cut. It’s a set amount of money intended to cut Medicaid access to individuals. This also tells you that any language that might be used, like reforming Medicaid or giving states discretion is actually just a euphemism for a multi-billion dollar cut to this program. Next slide.

Per capita caps are similar to block grants in that it limits the amount of money that states can spend on Medicaid. But while a block grant is sort of one big lump sum, per capita caps are limited based on the amount per enrollee. So instead of just one big pool of money, per capita caps give states little pools of money per enrollee, so an X amount of Medicaid dollars for enrollees who are 65 and older and X amount for children on Medicaid and X amount for disabilities, for pregnant women and so on. The problem with per capita caps though is that the caps are limited well below actual healthcare spending, and they’re made with the purpose of implementing deeper cuts over time.

So, the costs don’t keep up with actual healthcare costs, which are fairly unpredictable and generally increased significantly over the years. This is especially harmful for higher needs populations, like people with disabilities and older adults who have, again, high, very high, very unpredictable healthcare needs. Once these caps are spent, there’s no more money for this population, so states would have to come out of pocket or, again, make significant cuts to the services or enrollees who are eligible. Again, this is clearly a cut, as CBO projected. A loss of between 588 billion to 893 billion over nine years.

Both block grants and per capita caps would also end that federal funding guarantee. Right now, the federal government funds Medicaid to meet whatever the state’s needs are for older adults, and under these block grants, basically, once that funding is ended, then the cost shifts to the state and the state becomes responsible for all the costs. That is a massive burden to states and that’s why we’d be seeing these deep cuts to services and enrollment. I will turn it over to Natalie to dive into some of these other proposals.

Natalie Kean:

Thanks so much, Gelila. I am Natalie Kean, director of Federal Health Advocacy at Justice in Aging. I use she/her pronouns. Wonderful to be with so many advocates in this fight today and in the coming year.

Continuing on with the types of cuts that Gelila outlined. Next on our list is federal medical assistance percentage or FMAP cuts. As Gelila has mentioned, Medicaid is a state federal partnership, and that partnership in terms of most funding is at least 50/50, but it’s even higher for some states with lower per capita income. In Mississippi, for example, the federal government funds 77% of Medicaid state spending. The federal share is also higher for certain expenditures, most notably in all expansion states. The current law says that the federal government will cover 90% of costs for those adults enrolled through the expansion pathway.

There are two types of cuts to the FMAP that are on our radar, because they’re being discussed right now as potential targets in Congress. The first is removing that 50% FMAP floor, and to be certain, this would shift costs to all states, but it would be especially harmful for the states that are already at that floor with a 50% FMAP states, ranging from California all the way to Wyoming and Virginia. Ending the enhanced 90% FMAP for the ACA expansion population is another cut that’s being considered, and this would trigger an automatic repeal of Medicaid expansion in 12 states.

There are 12 states that have written this into their state laws, that if the federal funding falls below 90%, they will end their Medicaid expansion. But it will also make expansion unaffordable for other states. This means other states that have expanded Medicaid probably won’t be able to sustain that expansion for very long without the enhanced federal funding. Also, we aren’t going to see the remaining 10 states that haven’t expanded expand. It’s important to remember that many people with disabilities and older adults receive expansion Medicaid because they are not eligible for Medicaid under a disability or aging pathway. It’s also an important source of coverage for older adults who aren’t 65 yet and are not eligible for Medicare.

The third way that Congress is considering cutting Medicaid funding is by restricting provider taxes. Every state uses provider and insurer taxes to help fund their share of Medicaid costs. This has been part of the Medicaid program for decades and works really well. States are responsible for their costs of Medicaid above the federal share. As mentioned before, that federal share is at least 50% of the costs. The FMAP though, the federal share comes in the form of a reimbursement, so states have to spend their own money first to receive the federal match.

So, restricting the allowable provider taxes, the way the state gets their own revenue, will shrink states’ budgets. They’ll be forced again to cut their Medicaid because they won’t be able to fund their share of current costs, and these effects would worsen over time because the less states spend on Medicaid of their own dollars, the fewer federal dollars that they can draw down.

It’s also important to note that the extent of these cuts could impact state budget decisions beyond Medicaid. States have to balance their budgets every year, so a significant loss in federal funding will reverberate across the entire budget. This is true for all of the types of federal cuts that Gelila and I have discussed. Federal funding for Medicaid makes up almost half of all the federal funds that states receive, so this would really be impactful to state budgets.

Shifting to the second category of cuts that restrict eligibility and cut services more directly, the threat we are hearing the most about is work requirements. It’s important to know that these requirements are targeted towards people with very limited income who are in fact eligible for Medicaid. Enrollees would be required to submit paperwork on a regular basis. It could be as often as monthly to prove that they are working or meet an exemption. This extra paperwork to prove something that is already true is why these requirements amount to nothing more than red tape.

We’ll hear also a lot from policymakers about exemptions and that older adults and people with disabilities won’t be subject to work requirements. This just simply isn’t possible to carve them out from the harm or to make an exemption work. These policies, even with exemptions, would directly harm older adults and people with disabilities who are not eligible for Medicare or Medicaid under strict disability rules. It would also harm both paid and unpaid caregivers for older adults, many of whom rely on Medicaid for their own insurance.

It’s also a massive administrative burden on states, and that burden impacts all Medicaid enrollees including older adults. In Georgia, we’ve seen that the state has a work requirement program in place and it has spent 90% of the $26 million on this project on administrative costs just to implement the work requirements. This money could have covered a lot of healthcare for a lot more people, but instead it went to contractors implementing the monitoring systems. Even worse, news reports revealed that processing of Medicaid applications for older adults who needed help with their Medicare costs as well as SNAP applications were delayed because of the attention on administrative implementation of work requirements.

The final category of cuts we want to talk about today is repealing regulations. Congress is looking at repealing some protections passed by the Biden administration that have a federal cost to them. The three rules that we have seen related to Medicaid on the list are the Streamlining Medicaid Eligibility and Enrollment rule, the Nursing Home Minimum Staffing rule, and the Medicaid HCBS Access rule. All of these rules are aimed at improving access and quality of care. The Streamlining rule is removing barriers to enrollment, removing red tape, and helping people remain enrolled in coverage. Again, these are people who are already eligible for Medicaid. This is simply making it easier for them to get that coverage and stay enrolled. The Minimum Staffing and HCBS Access rule increased transparency and ensure that Medicaid funding is going to the actual provision of care.

While we’re focusing today on what Congress is considering and may be doing, we do want to note that with these changes, there could be administrative action as well. So, HHS could directly engage in rulemaking to rescind or delay these rules, but we could also see states looking to apply for waivers that restrict eligibility or benefits in their Medicaid program. This could be a way that they could implement work requirements, eliminate retroactive coverage, or charge premiums and cost sharing to Medicaid beneficiaries. These are just some examples.

To sum up, we don’t need to wait to know what policies are moving forward in legislation to fight back. That’s because all of these so-called reforms are cuts to Medicaid and all of them would harm older adults. The explicit goal is to generate federal government savings to pay for tax cuts or other priorities. States will lose money and be forced to fill the gap by cutting benefits and/or eligibility. Again, there is no way to carve out or shield older adults and people with disabilities from harm, and it’s important to remind policymakers that are promising to protect Medicare that a cut to Medicaid is a cut to Medicare. One in five people with Medicare rely on Medicaid to afford health and long-term care, as Gelila talked about, so any cuts to Medicaid would absolutely harm people with Medicare as well.

How would these budget cuts particularly impact older adults? States facing budget shortfalls would be forced to look at their Medicaid programs and they’re going to cut first from what they’re spending the most money on and what is available to them, as in so-called optional benefit or optional eligibility category. These include home and community-based services, which keep millions of older adults at home where they prefer to age. It includes restricting… They could eliminate pathways to eligibility for HCBS and for nursing facility care, such as the special income rule and the spend down or share of cost eligibility. This is in fact how most older adults are eligible for long-term care.

They could cut those optional medical benefits, such as dental, vision, and hearing, that Medicare doesn’t provide. They could also cut enrollment by eliminating expansions of aged and disabled Medicaid eligibility or expansions of Medicare Savings Program eligibility. They could also cut provider payment rates. As I’m sure many people know and probably have experienced firsthand, there’s a real crisis in our direct care workforce right now that’s keeping people who would be eligible for Medicaid home and community-based services off, not able to get coverage, preventing them from getting coverage. If those provider payment rates are cut, the direct care workforce shortage would only worsen.

We’re talking about these threats right now because they’re real. Republicans have majorities in both the House and Senate and can use what’s called budget reconciliation to fast-track these cuts. Budget reconciliation, unlike most legislation, only requires a simple majority to pass the Senate to become law. It does have some specific requirements, most importantly, that bills must relate to the budget and not add to the deficit. That’s why we keep talking about the dollar amounts of these cuts and why the cuts being considered are focused on slimming down, taking away coverage from people and slimming the federal budget towards Medicaid.

A quick overview of the budget reconciliation process. It starts with the House and Senate adopting a budget resolution. We’re still in fiscal year 2025, so that a budget resolution for FY 2025 is available to Congress right now. Once a resolution is out, it will have a bunch of spending and savings targets, a bunch of numbers, and it will be up to the committees to create legislation to achieve those targets. They’ll be working in committee to mark up bills, and then it’s expected that the House would vote first on a full reconciliation package, and this could happen as early as March before the package goes to the Senate.

We’re still in the preemptive strike phase and we’re having success in that phase in delaying this process from even starting. Speaker Johnson said that February is when he would like to introduce a budget resolution. This has already slowed from initial reports that said they would introduce a resolution before inauguration. There’s still a lot of discussion over how many times they will use the budget reconciliation process. As I mentioned, we’re still in FY 2025, so they can use that, but they could also repeat the process for FY 2026 later this year. So, that’s the discussion over one or two bills and the size of those bills.

Most likely, again, we’re hearing about work requirements, rollback of regulations, and then in terms of funding cuts, the chair of the Energy and Commerce Committee, Representative Guthrie, has been talking a lot about per capita caps. But regardless of whether any or all of these cuts are included in a reconciliation package, the size of that package, we really need to be on alert to know that they could, again, they could repeat the budget reconciliation process for FY 2026 or they could try to do some of these cuts through other legislation. So, we really want to be on alert when we’re looking at the legislation around the debt ceiling and appropriations to make sure that none of these cuts are included. Again, to prevent cuts, we need to engage before and during each step of the process.

Gelila and I have put together some tips on how to engage in this fight and save Medicaid from cuts. Starting with lessons learned. The first lesson and thing to keep top of mind is that Medicaid is popular. Polling shows it’s on par with Medicare in terms of popularity. Two-thirds of adults have a connection to Medicaid, either they themselves have received Medicaid, a family member, a close friend, so it’s important to lean in on that and make sure that people know what Medicaid is and how it’s helping them and their families and communities.

We also saw when we were fighting some of these same fights in 2017, the importance of connecting with other groups. So, talking about seniors with those partners and showing that we have a united. Front partners may be non-traditional folks that we’re not used to working closely with, but this is really the time to come together with providers, with insurance plans across disability and aging veterans and chronic condition advocacy groups, groups that are focused on people with HIV, people with Alzheimer’s.

Using those connections too to think about what your state policymakers care about. They may have a parent with dementia. They may have a child with a developmental disability. They are likely a family caregiver or will soon be a family caregiver. They may be a veteran or related to a veteran. And also to remember that everyone has seniors in their lives, and Medicaid is our long-term care system. Really, again, leaning in on this and starting with these as points of connection. And finally, taking every opportunity we have to raise awareness of the program, whether it’s with the press or in the day-to-day work that you’re doing, to talk about the importance of Medicaid in all of your work. The more Medicaid is on people’s minds, the better chance we have of protecting it from cuts.

What can you do in terms of direct advocacy? We need to be opposing any Medicaid cuts now, most importantly now and often. Again, this is going to be a long fight, but the sooner, the stronger we come out of the gate, the better chance we’ll have of stopping any cuts. There are narrow margins in both the House and Senate, so every single vote is critical. So even if both of your senators are strong supporters of Medicaid and think about members of the House in your state who maybe won by narrow margins, won their election by narrow margins, make sure that they know that you are watching and care about Medicaid. Again, our best opportunity to keep Medicaid cuts out is before the legislation is written.

We also hear from staff and congressional offices every time we meet about the importance of hearing directly from their constituents. That’s you, and it’s your clients and your community. So if you can help your clients contact their members of Congress, consider organizing a sign-on letter in your state or writing a letter from your organization. You can use our sign-on letter as a template. Speaking to your state officials is also really helpful. Asking your governor, your state Medicaid director, state legislators to weigh in with Congress and tell them what Medicaid cuts would mean for your state.

Education is another important role that everyone can play right now, even if you can’t lobby directly. We know there are a lot of new members of Congress and their staff who are new both to Congress, and particularly to Medicaid, and they don’t understand the role and importance of Medicaid for older adults. Again, even if you can’t lobby, helping with this general education is really important. Uplifting the importance of Medicaid for people with Medicare in your state within the context of work you’re already doing is really helpful.

Making sure your clients understand that they are enrolled in Medicaid and sharing their stories directly with members of Congress is always the most powerful. But if you have stories that you want to share that are more anecdotal or from someone who wants to remain anonymous, Justice in Aging is happy to take those stories to Congress and use them in our advocacy. Again, if you can’t lobby directly, we encourage organizations to be publishing stories and anecdotes on your website, social media sharing with partners just to educate and uplift the importance of Medicaid.

Finally, thinking about those press opportunities. We know this is hard to find the storytellers willing to talk to the press, but again, something that Justice in Aging is happy to help make connections on. All right. I’m going to hand it back to Gelila.

Gelila Selassie:

Thank you, Natalie. Just some additional advocacy tips for everyone. Think about ways to engage in efforts to protect Medicaid within any restrictions, like funding restrictions or otherwise, that your organizations may have. The work that you are doing to help make Medicaid available to older adults is really critical and important, so you can just think of examples from your day-to-day lives and the services you provide to think about how valuable Medicaid is, especially for the populations that you serve.

And then, just as a quick reminder, there are some groups, particularly legal services, corporation-funded groups that might not be able to engage in systemic advocacy or any kind of lobbying, but you can still collect stories, like Natalie mentioned, and you can also educate and provide information to the community, provide information to clients about what’s what’s going on. You can also refer individuals to other advocacy groups that can engage in any kind of systemic advocacy. So, be sure to keep those partnerships in place so that you still have that option for advocacy even if your organization has those restrictions.

We also talked about how important it’s to educate policymakers, but it’s really important to educate the community about what’s at risk, and educate them using specific program names that Medicaid is in your state. There are dozens of different names for Medicaid programs, so people often don’t realize that they’re Medi-Cal, or IHSS, or BadgerCare, Healthy Living waiver. These are all Medicaid programs. So, it’s really important to use specific language to make it more real to people that this is what’s being cut. Their Healthy Living waiver, they’re IHSS services, whatever it is in your state, use that language whenever you can to avoid confusion and make sure it’s very relatable to folks.

And then, it’s really, really important not to pit Medicaid groups against each other. The people who want to cut Medicaid will often use this narrative that they have to protect Medicaid for, quote, those who really need it. And that’s not appropriate. That’s not right at all. Medicaid is necessary for all populations. It provides really essential healthcare for people of all ages, from all walks of life. No group is less deserving of access to healthcare, and there is no reason to limit access to something so crucial for entire populations.

We’ve seen how all of these proposals, including work requirements or restricting Medicaid expansion, even if they have attempt to make carve outs for older adults and people with disabilities, they’re still very harmful for these groups too. So, it’s really important that we stand in alliance or that we work in alliance with all of our Medicaid enrollees to make sure that these cuts, these programs aren’t being made, and any cuts to the program hurts everybody, including older adults. I guess just two huge takeaways to sum up all of our advocacy tips is that all proposals will hurt, all proposals to cut Medicaid harm older adults and just fight against any misconception or any narrative to the contrary, and focusing on the impact Medicaid has on older adults is really crucial, because as we mentioned, not everyone realizes how important Medicaid is.

Additional messaging tips. Don’t assume that people know what Medicaid is or how it helps older adults. Like we said, the programs can be very broad, they can have very different names, so it’s really important to remind folks what it covers and the population that it serves. And then, these proposals are often being called as reforms or flexibilities or other types of euphemisms, but they’re clearly cut, so be sure to call them that. People tend to recognize how dangerous these proposals are when you refer to them as cuts as to something a little bit softer like limits.

And then, make sure to make it clear that older adults will be hurt. Some of these proposals can be very technical, can be very weeny. We know advocates are very knowledgeable and experts on all these things, but you can just take it back to, I don’t want to say bases, but take it back to what’s at stake and focus on the impact that these proposals will have rather than some of the finite policy or finite technical points, because that’s what it’s really about. It’s really about how badly this will hurt seniors in your community.

And then, anyway and on that thread of keeping it relatable to everybody is try to make those connections of what these cuts would mean with additional pressures due to cost of living and affordability, like the fact that people with these now may lose access to healthcare or also dealing with very high housing costs or significantly higher food costs, and now have this added burden of potentially not having access to really crucial healthcare for themselves or their family or their caregivers, et cetera. And then, next slide.

We’re just going to reiterate these very crucial topline messages again. All of these reforms are cuts and there is no way to carve out or shield older adults and people with disabilities from harm. There will always be an impact. Whether you’re talking about expansion or work requirements, there’s always going to be a way that seniors can be impacted. Crucially, a cut to Medicaid is a cut to Medicare. We’ve heard many times people promising to protect Medicare, but if you’re cutting Medicaid and cutting access to Medicare savings programs that are administered to Medicaid, you’re effectively cutting Medicare access. And then, finally, just cutting Medicaid is abandoning our seniors.

On the next slide, we have some Justice in Aging resources on Medicaid cuts as well as broader baseline information about Medicaid and information on the landscape of duly-eligible individuals in various states. So if you do need some of that state-specific data, that one’s really helpful. We have our sign-on letter, and we also have more information to come out soon. And then, the next slide after that is additional resources from our partners that are incredibly helpful looking at all these different proposals, and all these really crucial data to see how important Medicaid is for older adults as well.

And then on the next slide, before I turn it over to Natalie, we really want to encourage you to get involved by signing up for alerts. That’s how you can also get really up-to-date information about new resources that we’re going to be putting out on this issue, as well as news from DC about where Congress is throughout this budget reconciliation process. And then, we strongly encourage you to join the Protect Medicaid Space, where you can sign up to join Hill visits and then get on the listserv to get even more updated information. We also have that link there to the February 6th Day of Action. That is Thursday, yes. For folks to contact the representatives and remind the representatives how important Medicaid is and not to make those cuts.

February 6th is Day of Action, but we recognize a lot of people might be calling the members of Congress right now, so there’s always reason to continue making those calls even after February 6th as we proceed with these to protect these really important programs. With that, I will turn it back over to Natalie for our poll questions.

Natalie Kean:

All right. Thank you so much, Gelila. Now, as an opportunity to hear a little bit from all of you, we have two poll questions. Our first is, are you hearing concerns from your clients or community about cuts? This is a yes or no question. We realize there might be something in between, but do your best.

We’ll wait. Give everyone a moment to log your answers.

All right. Shelby, do you want to go ahead and show the answers? All right. Yeah. It looks like about 74% of you are hearing concerns from your clients or communities about cuts. All right.

Our other question, which we had flipped on the slide, sorry about that, is where are you getting the most information about Medicaid cuts? From national organizations like Justice in Aging, from local or state advocates, from news sources, or maybe you’re not hearing about cuts. Again, we’ll give everyone a few moments to respond.

Here are the answers. Looks like almost 40% of folks are hearing from national organizations, next is on the news, 35% then local or state advocates. It’s good to hear that only a few of you are not hearing about cuts. That’s encouraging to us that the word is getting out about these threats. All right. I think now we can bring Amber back and get to some Q&A.

Amber Christ:

Yeah. Thank you both Natalie and Gelila. I think cannot be overstated how big these cuts that are being proposed are, the magnitude of them, and then the significant harm that would place older adults, people with disabilities, their families, their communities in. And turning to question and answer, we’re not going to be able to get to all of your questions today. We’re going to focus on some, but as Natalie and Gelila said, with this rapidly-changing environment in Congress, we really encourage you to sign up for our alerts and connect with the other resources and the slides to receive the most up-to-date information. While the harm to older adults is clear and unchanging, what’s happening in DC is changing all the time, so we just want to make sure you have all the current information you need after you log off from this webinar.

Turning on to a question, I know you said this earlier in the presentation, but could you explain again why, right now, Congress is proposing to cut Medicaid? What’s the impetus for this cut?

Natalie Kean:

Yeah. As I mentioned, there is an opportunity when Congress controls both chambers, the House and the Senate, as well as the White House. When party controls all of that, there’s a unique opportunity to use what’s called the budget reconciliation process, which allows the Senate to bypass the normal filibuster rule. In this case, Republicans don’t need Democratic support to pass a budget reconciliation bill. That’s the moment we’re in.

We know that leadership in Congress right now, Republican leadership in Congress right now has made very clear they want to extend tax cuts that they passed last time President Trump was in office, and they also want to, quote, pay for those tax cuts. One of the easiest targets for them to generate those federal savings is the Medicaid program, but we want to make it not easy for them to target that program for cuts.

Amber Christ:

Right. To put another way, Medicaid is being used as the piggy bank to fund those tax breaks, and we’re saying, “No, you can’t use Medicaid. In fact, you shouldn’t do those tax cuts at all.” All right. A second question we had is, do you have to know all the details about the cuts in order to fight back against these cuts?

Gelila Selassie:

I’ll jump in on this one. The short answer is no. Like we said, some of these things are very technical, they can be very weedy. So as long as you have an overarching understanding of how important Medicaid is for your population and how dangerous these cuts would be, that is enough to advocate. In fact, some of the most powerful voices on Capitol Hill are self-advocates, are individuals who don’t necessarily know all the policy details, maybe didn’t study this in school or anything like that, but they’ve lived it. They know what it means to have a direct care worker come to their house and help them live independently. That’s what really resonates with people. The impact is really crucial. So, don’t feel you need to know all these technical points. It’s just helpful as a background reference in terms of knowing that any of those major things that policymakers are talking about are a type of cut.

Amber Christ:

We’ve gotten a lot of questions about how to influence lawmakers. Maybe I’ll pose a hypothetical. If you, Natalie and Gelila, you’re a state or local advocate and you have lawmakers in your state or in your district that you’re trying to influence, how would you do that? How would you go about doing that?

Natalie Kean:

Gelila, do you want to share your experience from North Carolina?

Gelila Selassie:

Yeah, yeah. I was working at a small legal aid organization in 2017 where we were allowed to do some little bit of systemic advocacy. We were meeting with a member of Congress who had previously made very big statements about wanting to cut Medicaid, wanting to cut ACA coverage when he was running for office in 2016. We worked with some local HIV advocacy groups. We worked with provider groups and met with the staffer. And particularly, when my colleague from the HIV advocacy group talked about the impact of prep through the ACA, which provides really crucial preventative services for people with HIV, as well as the importance of Medicaid with people with HIV, this staffer really resonated with that. Apparently, that’s been a deep passion project for this member of Congress.

They really sat with that. I can’t say that that conversation obviously alone changed their mind, but they definitely didn’t run in with pitchforks to cut Medicaid. They were much more subdued since then and even now. So, everybody has a connection to Medicaid, whether it’s a parent with dementia, whether it’s a sibling who works as a drug care worker, a child with a developmental disability. Everybody has a connection to something where Medicaid is really critical, so it’s all about finding what that point is. I think that’s a big thing. Medicaid overall might be very intimidating or might not be very relatable, but there is a piece of it that can be relatable to everyone, including members of Congress.

Natalie Kean:

I’ll just add to that we’ve been meeting with members of Congress, and in addition to finding those connections, the other thing that they really appreciate is district-specific information or state-specific information about the number of people who rely on Medicaid in their district, what it would mean for their hospitals, especially if they’re representing a more rural area. So, there are all kinds of things, but as Gelila said, it’s finding that point of connection first is really important.

Amber Christ:

I know a lot of people here had some questions about the sign-on letter that we did as a disability and aging collaborative. Are there ways to sign on to that now? Will there be other opportunities in the future? How to even take that 13 page sign-on letter and make that a template? Maybe just a few little pointers about the resources that they can use that we’ve provided and turn those around and use them in their own advocacy.

Natalie Kean:

Yeah. You are welcome to use any of our resources as a template or model to create your own. If you need help getting a Word version or something to make that even easier, please reach out. We’re happy to provide that. The sign-on letter that we’ve shared as a resource, we still are accepting sign-ons. We’re trying to get folks from every state and district represented, so I will get that link for you and share it, and we can share it in the follow-up materials as well. But yes, still open to engagement, and there will be future opportunities. The good news is that we have a lot of people in on this fight, so please stay tuned to our network, join the Protect Medicaid Space if you want to get even more regular updates and ways to take action.

Amber Christ:

Thanks, Natalie. I know we’re short on time. I saw somebody in the chat just comment on the fact that this is really hard. There’s a lot of things happening. There are a lot of attacks, and these attacks on Medicaid are really daunting and overwhelming, so how do we kind of keep the hope and the momentum? I think where we at Justice in Aging have found hope is focusing in on the impact to older adults in our communities and how devastating that would be. But also, and the wins. We’ve seen wins. We’ve seen Republican lawmakers who had been proposing these cuts start to walk back the cuts, recognizing that the threat to Medicaid is a place where they don’t want to have that battle, because we’re all showing up. So, I think us showing up is where I find hope in continuing to do this work.

I just want to, again, reiterate, we’re going to send out all of these materials and an email that will come post webinar to sign up for our alerts, to engage in the Day of Action on Thursday. There’s a lot of resources in that Day of Action link. I think, again, what we heard today cannot be overstated, so we appreciate you taking the time to participate in this webinar, to get more informed. Your questions help us be better informed and to identify where we need to learn more or provide more resources. In an environment where this information is changing every day, every hour, sometimes every minute, we are, Justice in Again, are committed, I think first and foremost, to being the voice, to being a voice for older adults and making clear how these cuts to Medicaid will harm older adults and their families.

And then, we’re committed to all of you as trusted and really important partners, that we’re sharing that the information that we have and getting the information that you have to help inform our advocacy and share with policymakers. Thank you for all you do to support older adults and your clients and for your partnership, and stay tuned from us with more resources and information moving forward. Thank you.