AUDIE CORNISH, HOST:
As we just heard, the GOP health plan will bring changes to Medicaid. Under the proposal, the federal government would limit the amount of money it gives states for Medicaid. And that has elder advocates worried. Stephanie O'Neill reports.
STEPHANIE O'NEILL, BYLINE: Charlotte Altieri of Long Beach, Calif., says her mother, Carmencita Misa, was a veritable dancing queen despite her long hours at work.
CHARLOTTE ALTIERI: She would work, like, regularly 60 hours or so a week. But no matter what, she would make one night a week where she could go dancing. That was her thing.
O'NEILL: But three years ago, her now 71-year-old mom suffered a debilitating stroke that stole her short-term memory, her eyesight and her mobility. Today, 39-year-old Charlotte spends her time juggling between visits to her mother's nursing home and caring for her two small children.
UNIDENTIFIED CHILD: Look, Mommy.
O'NEILL: On this particular evening, she and her husband tag team bath time duties.
UNIDENTIFIED MAN: Want me to take your sunglasses for you so you don't have them in the bathtub?
UNIDENTIFIED CHILD: Mine.
ALTIERI: Mine (laughter).
O'NEILL: Charlotte says it's these family moments that offer her a reprieve from worrying about her mom, who needs 24-hour care that she wishes she could provide but can't.
ALTIERI: It's not just physically having to, like, the logistics of, like, two kids and their energies and if they're hungry or if they're sleepy. It is me trying to get my brain of my heart together to go visit my mom, who's not my mom. She's just lying there.
O'NEILL: Initially, it was Medicare, the federal insurance for those 65 and older that paid for her mom's care. But Medicare only provides up to 100 days of skilled nursing coverage. For Misa and more than 2 million low-income seniors nationwide, it's Medicaid that foots the bill for long-term care. Matt Salo heads the National Association of Medicaid Directors.
MATT SALO: Most people, when they think about Medicaid, they think of it as sort of a low-income working population welfare health care program.
O'NEILL: That's probably because 3 out of 4 people covered by Medicaid are low-income children, pregnant women and since Obamacare, low-income working adults.
SALO: But what really comes as a big surprise to almost everybody is that that's not where Medicaid spends most of its dollars.
ALTIERI: Instead, he says about two-thirds of Medicaid's annual budget is spent on elderly enrollees and on people with disabilities. Currently, state and federal governments share the cost of Medicaid. But the bill in front of Congress puts a limit on what the federal government would contribute. Eric Carlson is an attorney for the nonprofit group Justice in Aging.
ERIC CARLSON: It's really a form of rationing, where you have the care based on the money that's been budgeted rather than on the needs of the people. And that's entirely backwards.
O'NEILL: But the current system leads to state overspending that comes at the expense of other things like education, says Oren Cass. He's with the conservative Manhattan Institute.
OREN CASS: It just forces states to work within the budget constraints of a fixed amount of federal money, which by the way is how every other part of our government already works.
O'NEILL: What's more, Cass says, under GOP plans the states will get more flexibility to run Medicaid with fewer federal regulations. Pat McGinnis, who heads the California Advocates for Nursing Home Reform, says that worries her.
PAT MCGINNIS: There are so many federal protections under the current Medicaid system. And I think most of those would be gone.
O'NEILL: Meanwhile, Charlotte Altieri of Long Beach, Calif., says thinking about what could happen if federal dollars and protections are cut from Medicaid stresses her out.
ALTIERI: 'Cause this stuff makes me depressed because I think what if it really does happen? What are we supposed to do?
O'NEILL: For NPR News, I'm Stephanie O'Neill in Los Angeles.
CORNISH: This story's part of a reporting partnership with Kaiser Health News.
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