Federal Medicaid spending reductions in the GOP budget reconciliation bill could have significant effects for seniors across the country, particularly those in long-term care facilities.

President Donald Trump has repeatedly promised not to touch Medicare, the federal health insurance system for seniors over age 65, but federal spending reductions for Medicaid baked into the One Big Beautiful Bill Act will also have a sizable impact on low-income seniors.

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The spending bill is supposed to reduce Medicaid spending by roughly $1 trillion over the next 10 years compared to the current spending trajectory. Republicans argue that this is not a cut in spending but rather a reduction in spending over time, while Democrats warn that millions of people will lose access to healthcare.

This is particularly true for seniors, even without substantial changes to the Medicare program.

According to the healthcare think tank KFF, 22 million adults over 50 in the United States comprise 23% of all Medicaid enrollees and 42% of the program’s spending. Roughly 11 million are known as dual-eligible individuals, or those who have Medicare as their primary source of health coverage because they are either over age 65 or have a long-term disability.

For dual-eligibles, Medicaid pays for costs that Medicare does not cover, including premiums, cost-sharing, and supplemental benefits such as long-term or nursing home care.

American Nurses Association President Jennifer Mensik Kennedy told the Washington Examiner that 65% of nursing home residents are covered by Medicaid.

“There’s a lot of people who rely on dual coverage, a lot of our elderly have dual coverage,” Mensik Kennedy said. “Where they’re low-income seniors, they have Medicare, but they also have Medicaid to pay and kind of bridge the gap to provide them better services.”

The Congressional Budget Office estimated in June that roughly 10.9 million people would lose health insurance coverage if provisions in the House version of the One Big Beautiful Bill Act changing Medicaid and Affordable Care Act marketplace enrollment take effect.

Mensik Kennedy said that will also have a “detrimental impact on our elderly,” but the CBO did not calculate how many dual eligibles will be affected in the sweeping coverage losses to come.

“There’s a lot of people, particularly seniors, who will also lose their dual coverage, which is helping to provide and pay for things such as long-term care, paying for their medications,” Mensik Kennedy said.

Also baked into the “big, beautiful bill” is a provision delaying for 10 years the implementation of a Biden-era rule requiring nursing homes to increase the amount of skilled nursing care per day.

When the rule was announced in October 2023, implementing it would have required 75% of nursing home facilities to increase their staff to meet new federal guidelines.

Since its announcement, the rule has received significant pushback from Republicans, but Mensik Kennedy said the devastating consequences of the COVID-19 pandemic on seniors in long-term care facilities inspired its creation. She said she fears for the welfare of seniors during the next public health emergency.

“I am so afraid, you know, because it’s not if COVID or if a pandemic happens, it’s when it will happen,” Mensik Kennedy said. “We are going to see the same thinking repeat itself. It’s not that we didn’t learn from our mistakes in history. We just chose not to act and be preventative.”

Delaying the implementation of the Biden-era nursing home staffing provision is estimated to reduce federal Medicaid spending by $23 billion over 10 years, according to KFF. 

AARP chief advocacy officer Nancy LeaMond wrote to Senate leadership before the passage of the reconciliation bill on Monday, expressing concerns that delaying the implementation of the nursing home staffing rule would “perpetuate unsafe conditions in many facilities across the country.”

LeaMond told Sens. Chuck Schumer (D-NY) and John Thune (R-SD) that the minimum nursing home staffing standards were estimated to save nearly 13,000 lives annually.

“Every American–especially our most vulnerable older adults–deserves to live in dignity and safety, and we must ensure that facilities receiving taxpayer dollars provide the quality of care they are being paid to provide,” LeaMond said.

For seniors below the retirement age, LeaMond also highlighted that new work requirements for both Medicaid and Supplemental Nutrition Assistance Program benefits apply to those under 64.

Exemptions for work requirements are clear for pregnant women, people with disabilities, and caregivers of young children, but they are not as explicit for caregivers of older adults.

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“There are no clear automatic exemptions for people caring for individuals with chronic or other health conditions or functional limitations, including family caregivers of older adults,” LeaMond wrote.

According to AARP, 10 million households that receive SNAP benefits have at least one adult age 50 or over.