Threats to Medicaid: implications of the federal budget reconciliation bill for older adults and people with disabilities

Ensuring access to health care and long-term services and supports (LTSS) for older adults and people with disabilities has been a federal policy goal in the United States since 1965, when the Social Security Act was amended to create Medicare and Medicaid. Medicaid is a joint federal- and state-funded program that provides medical coverage for individuals who qualify because of their low income. Initially, Medicaid was “largely confined to the populations traditionally eligible for welfare” (Gruber, 2003, p. 16), such as low-income women and children and people with disabilities. Medicaid has become a de-facto payor of last resort for people who have catastrophic LTSS expenses, paying more than half of these costs. Medicaid provides health care coverage for approximately 15.5 million people with disabilities and older Americans (MACPAC, 2024). In 2010, the Affordable Care Act (P.L. 111-148, as amended) (Patient Protection and Affordable Care Act, 2010) expanded Medicaid eligibility to adults younger than age 65 without children with an income up to 138% of the federal poverty level (FPL) (KFF, 2025).