Speaking of Waste: House Budget Bill Undermines Efforts to Help Older Americans Get the Care They Need  

“And then you’re knocked off of Medicaid, and then you’re paying the premium, Part B, and the 20 percent [co-insurance] that Medicare won’t pay. My God, you couldn’t live.” This stark reflection from an older adult from Texas underscores how even small changes in eligibility rules or additional paperwork can lead to sudden loss of critical support. It also captures the reality faced by millions of older adults living on the thinnest of financial margins.  

The US House of Representatives–passed tax bill includes a provision that would delay implementation of a federal regulation designed to reduce paperwork burdens that limit older adults’ access to benefits.  

Currently, a patchwork of programs is available to help low-income older adults and people with disabilities afford the care they need. These include: 

• Full Medicaid, which covers care that Medicare does not, including long-term care  
• Medicare Savings Programs (MSPs), which offer help with for Medicare costs  
• Part D Low-Income Subsidy (LIS), which eliminates Medicare Part D premiums and lowers medication costs.  

Although these programs alleviate financial barriers to care and even save lives, accessing them can be a challenge. Each program has different eligibility rules, which often require individuals to fill out paperwork from separate entities to enroll (Medicaid and the MSPs are run by the states, while LIS is administered by the Social Security Administration). Older adults often have difficulty navigating this complex web of programs, and research shows that those with cognitive challenges, including Alzheimer’s disease and related dementias, are less likely to enroll in programs for which they are eligible. 

The tax bill would push the implementation of a new Centers for Medicare & Medicaid Services (CMS) regulation that would enable auto-enrollment in MSPs for those eligible for Supplemental Security Income (SSI), as well as streamline the enrollment process for eligible LIS recipients into MSPs. The House bill proposes to delay both policies, which were initially scheduled for implementation between 2024 and 2026, until 2035. According to the nonpartisan Congressional Budget Office, if the bill becomes law, over 1 million people will lose vital support.   

Delaying policies that ease the paperwork burden of enrolling in these programs is not just a technical matter: it would have real-world effects for older adults and their families. In 2023, 1 in 4 people enrolled in Medicare had an income of less than $25,000, and 10% had no savings or were in debt. Financial assistance gaps could push many older adults deeper into poverty, such as when they have an unplanned medical expense, or force them to forgo necessary or preventative care. Both outcomes run counter to the House’s stated goals of controlling costs and improving outcomes and can lead to a compounding cycle of financial stress and worsening health. 

As an older adult from Iowa noted in a video from the qualitative research organization, The People Say: “For every service, there’s an application. And if you’re chronically ill, you lose a lot of services because you don’t feel like it, or you don’t understand it. When I don’t feel good, I can’t understand anything either. So, it’s just not a friendly situation, and it seems like it’s set up so you won’t bother with it, and so it’s not used.”  

Administrative burdens also make it difficult for individuals to keep coverage they need. And if a person is dropped by one program, or is no longer eligible, there is a waterfall effect that has implications for enrollment other programs. For example, because enrollment in the LIS is linked to having Medicaid, individuals who are dropped from full Medicaid or the MSPs often lose LIS coverage. A recent study showed that individuals who lose the LIS after being dropped from Medicaid were 4% to 22% more likely to die.  

State policymakers can take practical steps to avoid these outcomes. States should prioritize public education and stakeholder engagement efforts that highlight the impacts of these administrative reforms on older adults, and ensure federal policymakers understand their value and urgency. In addition, Congress must consider the potential harm of delaying reforms that help low-income Medicare beneficiaries access essential medical and prescription drug assistance. 

We should make it easier — not harder — for older Americans to access the help they qualify for. While there has been some progress in aligning programs for this population, more work is needed. Going backwards could imperil access to care and lead to more deaths among some of the most vulnerable people in our country.