Vice President Vance attends President Trump’s cabinet meeting following passage and signing of the One Big Beautiful Bill. Public domain photo

Aging services advocates say the FY 2026 budget bill, which includes massive cuts to Medicaid and nutrition services, will mean the upheaval of vital programs keeping older adults healthy and aging in their communities. 

Journalists can use any of the following tips as a starting point to ask local, state, and federal policymakers how these cuts will affect their older constituents, how the state budget will address the shortfalls and what might happen to the millions of older adults in their communities.

Medicaid is a joint federal-state program. It pays for many services for about 9 million older adults — like home care assistants, adult day care and transportation to medical appointments — that are not covered by Medicare. It also provides much-needed financial assistance for health care costs, prescription drugs, dental, vision and hearing care. But with significant Medicaid cuts on the horizon, states will have to make up the shortfall somewhere. Advocacy groups say many programs will be significantly scaled back or eliminated, leaving older adults and their families to figure out how to pay for care. The Congressional Budget Office estimates that about 1.3 million people over 65 will lose their Medicaid coverage under the budget plan by 2034.

Among the programs and services affected

  • Medicare Shared Savings Program: This program helps dual-eligibles — low-income older adults who receive both Medicare and Medicaid — pay for their Medicare premiums. The Congressional Budget Office estimates that 1.4 million Medicare enrollees could lose this financial assistance. The Medicare Rights Center says that a restructuring of Medicaid financing could eliminate many home and community-based services that aren’t mandated under existing regulations.
  • Home and community-based services: These help older people with activities of daily living, like bathing, dressing and toileting. They’re important services that help keep people out of nursing homes. But because these programs are not mandatory, they will likely be a key target for cuts, The Scan Foundation’s Sarita Mohanty, M.D., and Narda Ipakchi wrote. “States with fewer federal dollars for Medicaid might restrict access for HCBS by modifying eligibility standards or reducing benefits. Ironically, this could ultimately end up costing states more, as HCBS has been shown to be cost-effective by delaying or preventing the need for more expensive institutional care,” they said.
  • Direct Care Workforce: Medicaid recipients who need home-based services are required to use Medicaid-certified agencies. However, funding cuts will reduce payments to these agencies, where workforce recruitment and retention are already a major problem, according to the direct care workforce research and advocacy organization PHI. It will become harder to find workers or agencies to provide vital home care.

Medicaid is not the only target of the budget. Food assistance — SNAP, the Supplemental Nutrition Assistance Program run by the USDA, will see about $300 billion in cuts, or about 30% of its funding over the next decade, according to Health Affairs. 

While Republican lawmakers have consistently said that qualified elderly, children and those with disabilities would not lose benefits, elder advocates noted,  “SNAP is a household-based program, when able-bodied adults in the household lose benefits due to work requirements, SNAP allotments would be cut for the remaining members, who disproportionately include seniors, disabled people and children, increasing their risk of hunger.” They also say that SNAP cuts would increase the likelihood of Medicaid cuts, particularly the optional programs relied upon by disabled and older people, due to cost-shifting to the states.

Higher costs 

The Center for Budget and Policy Priorities says Medicaid cuts will also mean higher out-of-pocket costs and more red tape for older adults. This will contribute to poorer health outcomes and loss of benefits, particularly for those ages 50-64, who will face mandatory work requirements. CBPP pointed out that loss of coverage includes low-income people who are working or who should be exempt due to a disability. Over half of such adults, 50 and older, report health as a barrier to employment. CBO estimates that 5.2 million adults will lose Medicaid under this work requirement, but CBPP said this is likely an underestimate.

Elimination of the Administration for Community Living and restructuring of its program will also result in significant cuts to older adult services. Here are some of the major changes, according to the National Council on Aging:

  • Health Promotion and Disease Prevention (Preventive Health): Moved to CMS and funding eliminated.
  • Falls Prevention, Chronic Disease Self-Management Education (CDSME), and Alzheimer’s Disease Initiative: Moved to CMS, but the Prevention and Public Health Fund (PPHF) would be eliminated, along with additional appropriations for falls prevention. The $16.7 million appropriation for Alzheimer’s Disease would be retained. This would erase a significant source of investment in other public health initiatives as well. The fund not only supports ACL healthy aging grants but also key programs at the CDC and the Substance Abuse and Mental Health Services Administration.
  • Elder rights: Moved to CMS and slashed to $5 million, eliminating the Long-Term Care Ombudsman Program, Adult Protective Services support, and other elder abuse, neglect and exploitation efforts.
  • Aging Network Support: Moved to CMS and reduced by over 40% — potentially eliminating the Direct Care Workforce Strategies Center.
  • Aging and Disability Resource Centers (ADRCs): Moved to CMS and eliminated.
  • Other non-OAA ACL Aging Services:

The proposed FY26 budget would also eliminate the Low-Income Home Energy Assistance Program and the Community Services Block Grant program. The HHS restructuring would eliminate the CDC Injury Center. No funding would be provided for the CDC’s efforts on falls prevention, which has included crucial research and data evaluation, and efforts like the Stopping Elderly Accidents, Deaths & Injuries (STEADI) Initiative.

Advocacy groups are pushing back against the dismantling of the ACL, and Democrats have launched an inquiry into the move, according to Mother Jones. Meanwhile, the ACL website is still up and recently put out a call for grant applications for a new round of funding to help support family caregivers. 

Additional resources