Federal cuts to Medicaid and policy changes to Medicare signed into law by President Donald Trump in July could force Mississippi nursing homes into dire straits and leave vulnerable adults on the streets, experts say. 

Costs previously covered by the federal government will shift to states and poor families under the law, and some nursing homes will be forced to close while residents are rendered unhoused, industry leaders said. The law also rolls back a Biden-era rule calling for increased staffing in nursing facilities. In conjunction with the staffing cuts most nursing homes anticipate having to implement under the new budget constraints, industry leaders expect drastic repercussions for those served by and employed in nursing homes. 

“This law is really going to reshape the face of health care across the United States, including long-term care,” said Sam Brooks, director of public policy at Consumer Voice, a national nonpartisan advocacy group for long-term care. “We fought this bill tooth and nail and just really see this as an existential crisis for disabled and older folks.”

Lawmakers in favor of the law argue it doesn’t make cuts to Medicare – the federal insurance program primarily for elderly adults – but long-term care advocates argue nursing homes and residents will be harmed by these changes. Nationwide, the majority of nursing home residents use Medicaid – a fact that becomes more pronounced in Mississippi, the poorest state.

“Nursing homes rely heavily on Medicaid,” Brooks said. “You can’t cut a trillion dollars in Medicaid and not affect all Medicaid budgets … Nursing homes are not going to be over here siloed.”

Vulnerable adults in Mississippi stand to lose more, with 74% of the state’s nursing home residents on Medicaid, significantly higher than the national average, said Sylvia-Nicole Cecchi, project coordinator with the Mississippi Health Advocacy Program.

“Ultimately, these cuts could disrupt care for roughly 69,000 seniors and people with disabilities in Mississippi who rely on Medicaid,” Cecchi said. “When states are forced to cut nursing home reimbursement rates, studies show that the quality of care declines — residents face fewer staff, less attention, and poorer health outcomes.”

Home- and community-based care is also likely to be affected, though the bill doesn’t make direct cuts to the service, explained Priya Chidambaram, a senior policy manager who focuses on long-term care at KFF, a health care research nonprofit. 

“It’s a significant source of Medicaid spending,” Chidambaram said. “It’s also optional, so that’s a place states kind of have to look at first when federal spending is cut.”

The majority of long-term care Medicaid users receive care at home in the U.S. In Mississippi, roughly 3 in 5 Medicaid recipients access care this way, according to a KFF analysis.

Elderly adults will also be subject to subtle but significant enrollment changes to Medicaid and Medicare programs, such as an increase in paperwork. 

One such example is the reversal of a Biden-era policy that made it easier for people to enroll in and remain on what’s called the Medicare Savings Program. That program allows low-income Medicare beneficiaries to supplement their plan with Medicaid to bring down out-of-pocket costs for premiums, deductibles and copayments. 

As a result of increased red tape, eligible beneficiaries are expected to get kicked off, denied or scared away from the savings program. Costs will increase for 1.3 million Medicare beneficiaries who are not able to take advantage of the supplemental Medicaid coverage, the Congressional Budget Office estimates. 

“A lot of what this law does is just adds paperwork for people,” said Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy. “There’s no reason to have an eligibility determination every six months for people that have no change in anything. These elderly residents are not getting new income.”

The law also changes Medicaid’s policy around retroactive coverage for nursing home residents from three months to two months. 

Retroactive Medicaid coverage for nursing home residents exists because going to a nursing home is not always planned. Sometimes an older adult will be discharged from a hospital to a nursing home after suffering a disabling condition, and oftentimes that person isn’t already on Medicaid. 

It might not seem like much, but paying out of pocket for one month in a nursing home can wipe out a person’s savings, Edelman explained. 

“The out of pocket costs for nursing homes these days are very, very high – $5,000 or $6,000 a month,” she said. “People just don’t have that kind of money – especially people who are eligible for Medicaid.”

Nursing homes are allowed to evict residents for unpaid bills, though it’s not clear how many evictions are wrongful – or how often unpaid bills are a result of a Medicaid enrollment error. The most frequent complaint against nursing homes is consistently related to evictions and transfers, according to the National Long-Term Care Ombudsman Resource Center. 

An increase in enrollment errors, at a time when facilities are facing tighter budgets, could lead nursing homes to evict Medicaid-eligible seniors with unpaid bills. 

“One of the biggest drivers of involuntary discharge in nursing homes is unpaid bills,” Brooks said. “And oftentimes those bills are unpaid because of some Medicaid snafu – not getting the documents in, not applying on time.”

Nursing home facilities will suffer, too. Keeping residents housed while not getting reimbursed by Medicaid could force already-struggling homes to shutter. In Mississippi, there are 11 nursing homes at risk of closure, according to the United States Senate Committee on Finance in June. 

Leadership at the 11 nursing homes could not be reached by the time of publication.

The Mississippi Health Care Association, the state’s largest association of nursing homes, did not respond to a request for comment. 

“The destabilizing effect (the law) will have on nursing homes and their residents will leave these seniors in peril,” said Cecchi, of the Mississippi Health Advocacy Program. 

Mississippi nursing homes at risk of closure: 

• Glenburney Health Care and Rehabilitation Center in Adams County
• West Point Community Living Center in Clay County
• Leakesville Rehabilitation and Nursing Center, Inc. in Greene County
• Pleasant Hills Community Living Center in Hinds County
• Columbia Rehabilitation and Healthcare Center in Marion County
• Diversicare in Batesville in Panola County
• Pearl River County Nursing Home in Pearl River County
• Longwood Community Living Center in Prentiss County
• Azalea Gardens Nursing Center in Stone County
• River Heights Healthcare Center in Washington County
• Mississippi Care Center of Greenville in Washington County