Exclusive: Where nursing homes rely most on Medicaid

Data: Assisted Living Magazine/Centers for Medicare and Medicaid Services; Map: Alex Fitzpatrick/AxiosNursing homes across the country rely heavily on Medicaid, with the safety net program covering more than 6 in 10 residents in 18 states, according to an analysis of federal data by Assisted Living Magazine shared exclusively with Axios. Why it matters: Congress is considering policies that would cut the federal Medicaid funding available to states or tighten program eligibility. Facility operators and some patient groups fear steep cuts could permanently transform aging services.State of play: Nationally, an average of about 56% of nursing home patients were covered by Medicaid in 2022, the most recent year of available data. About 32% is paid privately and nearly 12% is covered by Medicare.West Virginia facilities rely most heavily on Medicaid, with an average of 78% of patients covered by the program. Alaska and Mississippi facilities both have about 73% of patients on Medicaid.Catch up quick: Medicaid, which primarily covers low-income Americans, has become the main payer for nursing home stays because Medicare generally only covers nursing home care for short periods following a hospital visit. Older adults who need long-term care in a nursing facility can pay out of pocket — but that costs more than $111,000 annually on average.Many senior citizens, already living on relatively small fixed incomes, spend their life savings on medical expenses when they get sick until they qualify for Medicaid coverage. Vermont is the only state where the majority of nursing home residents are private-pay, according to Centers for Medicare and Medicaid Services data. Some proponents of Medicaid cuts have said they would stop waste and abuse in the program. President Trump has said he wants to get rid of fraud and excess in Medicaid without affecting people's benefits. But other health policy experts argue policy changes that shift Medicaid costs to the states could effectively force states into cutting back on benefits. Recent polling from firms with strong ties to the Trump campaign found that significant majorities of voters in battleground congressional districts support Medicaid — suggesting cuts to the program could be politically disastrous. What they're saying: Any cut to Medicaid would harm the nursing home industry's ability to provide care, said Linda Couch, senior vice president for public policy at LeadingAge, a trade group for nonprofit nursing homes and other aging services providers."We are not in a position, given the importance of Medicaid to the overall health of nursing homes and other aging services providers, to pick and choose among which cuts or access things are better than others. We don't like any of them," she said.

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