Health care budgetary resources are provided by the federal government in three ways: mandatory expenditures for health care programs, federal tax subsidies, and annual discretionary appropriation funding for health care programs. Medicare and Medicaid spending has risen dramatically in recent decades, largely due to rising enrollment in those programs. Additionally, rising health care spending per beneficiary has also contributed to the growth in spending in those programs. Overall, the growth of health care spending per beneficiary has been faster than economic growth during the past few decades. Most of the projected spending in the major federal health care programs is for people age 65 or older (Congressional Budget Office, 2016).

This article will examine how health option two, impose caps on federal spending for Medicaid, will affect a long-term care facility. Medicaid funding caps present several advantages for the federal government. By setting spending limits, for example, federal Medicaid costs could be better predicted, and the caps might produce varying amounts of budgetary savings. Additionally, spending caps would limit states' ability to increase Medicaid funding from the federal government and reduce the relatively high proportion of program costs currently covered by the federal government. Medicaid covers more than 60 percent of all nursing home residents and roughly 50 percent of the costs for long-term care services and supports (Center on Budget and Policy Priorities, 2020).

Under current law, the federal government matches state spending for eligible beneficiaries and qualifying services without a limit (Rudowitz et al., 2021). By imposing mandatory spending caps on the Medicaid program, states would ultimately be forced to cut payments to long-term care facilities and healthcare providers. For instance, spending per enrollee for children, nonelderly, and non-disabled adults is lower than that for elderly patients and those with disabilities (Congressional Budget Office, 2016). Therefore, a state that enrolls every child, nonelderly adult and non-disabled adult, will remain within its total spending limit. It would be more difficult to achieve this goal if more elderly or disabled individuals were enrolled.

As a recommendation, the facility should expand its services by offering home-based care. A move of care to the home is one of the most promising ways to improve care and reduce costs. New and established organizations are launching and implementing models that make primary, acute, and palliative care accessible in the home (Chandrashekar, 2019). Home-based care can reduce the need for expensive care in hospitals and other institutional settings for frail and vulnerable patients. For example, early results from Independent at Home, a five-year Medicare demonstration to test the effectiveness of home-based primary care, showed that all participating programs reduced emergency department visits, hospitalizations, and 30-day readmissions for homebound patients, saving an average of $2,700 per beneficiary per year and increasing patient and caregiver satisfaction (U.S. Centers for Medicare & Medicaid Services, 2021). Not only will this reduce the high costs associated with institutionalized care, but it will also attract more patients that prefer to age in place by remaining in their home and increase patient satisfaction.

Center on Budget and Policy Priorities. (2020, April 14). Policy Basics: Introduction to Medicaid. Retrieved from

Chandrashekar, P. (2019, October 17). 5 Obstacles to Home-Based Health Care, and How to Overcome Them. Retrieved from

Congressional Budget Office. (2016, December 08). Options for Reducing the Deficit: 2017 to 2026. Retrieved from

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This is an old thread from July.   The class would likely be over by now.

Geaton777, I do like your response though!   And I think you make a good comment about term limits, although in the past there have been good legislators who were much better than the caliber of people we're seeing today (Veterans and some qualified people excepted).  

I've often thought that some of these people who are "hangers-on" couldn't find or hold a real job if they had to.  

The reason why they NEVER do cut Medicaid (and never will) is because it is political suicide to do so. Politicians' MO is to keep getting reelected so that they keep accruing power and money while doing very little actual work. But they are excellent at fundraising, which is basically all they do while in office. The answer to controlling any spending is TERM LIMITS. This way their decisions and voting won't be based on whether or not they get reelected because they CAN'T.

Everything sounds good in theory and I realize you need to write all that nice rhetoric to get an overpriced degree, but the reality once you get into the real world is that political decisions are influenced by all kinds of other complex and difficult variables (like the current very severe labor shortage which nullifies a more towards more in-home care since this would require way more people and there literally aren't enough qualified workers to do it for the amount of current need).

The OP is a student. This is for a MHA class. Reported

If you're looking for comments, I have a few.

1.  I take issue with the statements in your second paragraph, not in terms of effect, but of intent.   I find it not only insulting but inconsiderate, irresponsible, and lacking in compassion to address and infer that cutting Medicaid might be a viable alternative to control of costs.

2. WHY do you feel Medicaid should be cut?  

3.  How old are you?    How many times have you cared for aging, illness compromised, immobile or other compromised family members, whether adults, children, or the elderly?  

4.   Do you have any idea how much people struggle as they age and face limitations, especially if they're financially compromised?   Have you read some of the heartbreaking threads here of people who may be caught between qualifying for Medicaid or not?  

5.   What substitutions would you propose for people who might not qualify for Medicaid if changes you address are implemented?  Do you have any concept how much their quality of life would be lowered?

6.   How many times, and for how many people, have you contracted for at home care?  How many agencies did you interview before deciding on one?   Do you have any idea how difficult it is to find a good agency and reliable staff, especially when someone has medical issues that are hard to address?

7.    And how can you consider depriving people in need while fools, idiots and morons challenge the more practical and intelligent members of Congress with undercutting, infantile outbursts, and/or ridiculous suggestions, ones which affect us, i.e., we, the taxpayers, many of whom are striving and adapting to sometimes challenging positions while the idiot corps of the parties are wasting taxpayer money with their juvenile behavior and personal vendettas?

8.   If you think costs should be cut (and I don't disagree with that), why not start with legislators' salaries?   Folks at the local Arby's and other restaurants work harder than some of the playboys in Congress.

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