Over 72 million low-income people in the U.S. rely on Medicaid for their health coverage. Medicaid provides health care services to multiple populations, including low-income seniors, people with disabilities, children and some adults. It also provides assistance to low-income Medicare beneficiaries, long-term services and supports (LTSS) to seniors and people with disabilities, and support to safety-net hospitals and health centers. Medicaid is the primary payer for LTSS (not Medicare), and covers 52 percent of LTSS spending.
THE IMPORTANCE OF MEDICAID TO OLDER WOMEN
Nearly 60 percent of low-income seniors who receive Medicaid benefits are women. Older women depend on Medicaid more than older men because they have a longer life expectancy, less income, higher poverty rates and multiple chronic conditions that require long-term services.
Longer Lifespans
Older women tend to live longer than older men, therefore are more likely to outlive their resources. A woman who reaches age 65 can expect to live, on average, another 21.5 years, while men the same age can expect to live an additional 18.9 years.
Less Retirement Income
Many older women have less income in retirement than men because they had lower-paying jobs or took time off from the workforce for caregiving. According to the Family Caregiver Alliance, women spend as much as 50 percent more time on caregiving duties compared to male caregivers. Taking extended breaks from the workforce can result in lower Social Security retirement benefits for women. In 2019, the annual Social Security income for women age 65 and older was $13,505 while it was $17,374 for men.
Higher Poverty Rates
A history of low wages and extended caregiving can make it difficult for many women to save for retirement. Therefore, it is not surprising that the poverty rate for older women is much higher than it is for older men. In 2019, 10 percent of older women lived in poverty compared to 7 percent of older men. The poverty rate for women of color is higher than it is for White, Non-Hispanic women. In 2019, the poverty rate for White Non-Hispanic women age 65 and over was 8 percent but climbed to 20 percent for Black women; 19 percent for Latino women; 11 percent for Asian women and 21 for Native American women.
More Chronic Conditions
More older women than older men suffer from chronic conditions. These include arthritis, hypertension, osteoporosis, physical limitations and cognitive impairments, making them more likely to need LTSS as they age. Women account for 66 percent of nursing home residents and 62 percent of the people receiving care at home.
The cost of LTSS is high, and out of reach for many older women. On average, nursing home care costs over $93,000 a year, assisted living costs over $51,000 a year and home health aide services cost about $54,000 a year. As a result, many older women, including those who are middle-class, are forced to impoverish themselves to become eligible for Medicaid benefits to help pay for the LTSS they require. To be eligible for Medicaid, some states require individuals to have income below the federal poverty level (poverty level is $12,880 in 2021) and assets no greater than $2,000 for an individual and $3,000 for a couple.
MEDICAID AND THE AFFORDABLE CARE ACT
Older women benefit from improvements made to Medicaid under the Affordable Care Act. These include expanding Medicaid, which enables more low-income women to have access to health care coverage, and state demonstrations that may improve care coordination and delivery to beneficiaries.
Medicaid Expansion
Beginning in 2014, states can voluntarily expand Medicaid coverage to adults under age 65 with incomes up to 138 percent of the federal poverty level (about $17,775 for an individual in 2021). The federal government covered 100 percent of the costs for these “newly-eligible” Medicaid beneficiaries from 2014-2016, and then phased down to 90 percent in 2020 and afterward. Expanding Medicaid gives more low-income women, age 50-64, greater access to health coverage. This can lead to lower incidence of chronic health conditions as they age and transition to Medicare coverage, reducing costs for the individual as well as the Medicaid and Medicare programs.
Thirty-five states (plus the District of Columbia) have implemented the Affordable Care Act’s (ACA) Medicaid expansion. Consequently, they are better positioned to respond to public health emergencies such as the COVID-19 pandemic. Expansion states entered the pandemic crisis with much lower uninsured rates than non-expansion states, due in large part to the expansion. Expansion has given Medicaid coverage to over 12 million people. At least 4 million uninsured adults would become eligible for Medicaid coverage if the remaining 15 states expanded.
Expansion has also helped narrow racial and ethnic disparities in both health coverage and access to care. If the remaining 15 states that have not yet implemented Medicaid expansion were to do so, African Americans would comprise 23 percent of those gaining eligibility and Latinos would comprise 29 percent, according to Kaiser Family Foundation estimates.
State Demonstrations
Under the ACA, states can develop demonstration programs aimed at saving money and improving the health care provided to the most expensive Medicaid beneficiaries, those who are eligible for Medicaid and Medicare benefits. There are over 12 million “dual eligible” individuals, who are generally older, sicker and poorer than other beneficiaries. Dually eligible individuals represent about 40 percent of all Medicaid costs.
These demonstrations are important to older women because 60 percent of dual-eligible individuals were women in 2018. However, because many states plan to deliver care through private managed care organizations, which have little experience serving the LTSS population, the demonstrations must be monitored to ensure that participants’ health is not at risk. Other ACA improvements include requiring states to establish a coordinated enrollment system for Medicaid, the Children’s Health Insurance Program (CHIP) and health insurance through the new Marketplaces; providing new funding opportunities for delivery system and provider payment reform initiatives; and offering incentives to states for rebalancing their LTSS funds from institutional care to more home and community-based services and supports.
RECOMMENDATIONS
The National Committee to Preserve Social Security and Medicare believes that the Medicaid program must be preserved for low-income individuals, including millions of older women, who depend on it for health care services and LTSS. We support protecting and strengthening Medicaid for beneficiaries by:
- Encouraging states to expand their Medicaid programs under the ACA to serve additional low-income adults.
- Monitoring the state dual eligible demonstrations to ensure that participants are receiving quality services from private managed care entities.
- Developing a new national long-term care social insurance program to ease some of the financial burden on Medicaid.
- End the bias toward institutional care and improve funding for home- and community-based services so that individuals who wish to receive care at home can.
- Enacting legislation to provide Social Security credits for the time family members are away from employment to care for young children, seniors or disabled family members.
Resources
https://files.kff.org/attachment/Fact-Sheet-Medicaids-Role-for-Women
https://www.ssa.gov/news/press/factsheets/women-alt.pdf
https://nwlc.org/wp-content/uploads/2020/12/PovertySnapshot2020.pdf