LISTEN: Medicaid helps pay for the services seniors can no longer do for themselves. Proposed cuts target federal spending for the program, worrying providers of caregiving services. GPB's Sofi Gratas reports.
Every morning, nurses at the Homeplace Adult Day Center in Wrens, Ga., engage their visitors in an exercise routine — they do right and left leg kicks and ankle rolls, and weights and jumping jacks, for those who are able.
“We just do different activities that they can do to still keep them moving, to keep that range of motion going,” nurse Pam Williford said during a recent visit.
Also on the center’s calendar that day — painting. They also do field trips to a local grocery store, pet therapy and gardening.
“They’re working on going fishing,” said Claire Russell, owner of the Homeplace center under Family Care Inc.
At the Wrens location about an hour outside Augusta, Russell said they have 30 clients on a full day. She oversees four other centers. Homeplace, which really is laid out like a home, is just one example of what aging can look like with the help of federally funded Medicaid services.
Most of the clients here are on the Elderly and Disabled Waiver Program (EDWP). It’s a program offered under Medicaid for people with low incomes who want to get care at home, or in their communities, rather than at a nursing home or hospital.
Last year, according to state records, Georgia spent $1.1 billion dollars on EDWP services — that's about 7% of the state’s total Medicaid spending.
As more people choose to age at home, the budget set for these services has slowly been ticking up. Now providers of caregiving services worry these programs could be at risk because proposed cuts target federal spending for the program.
For Patricia Cheeley, the EDWP waiver pays for an aide who helps clean her apartment. She also receives Medicare, and Social Security benefits every month for a disability.
“Sometimes I can't even hardly walk so far without pain starting to slow me down and stuff,” Cheeley said.
Cheeley lives alone -— Medicaid ensures she has a little emergency button in case she falls and needs an ambulance. She doesn’t have family in town, and comes to Homeplace in Wrens every day and has been for about five years, besides when the center closed during spikes in COVID-19 infections.
“It feels good, you know, getting away from the house,” she said. “Because it's more comfortable being up here around people than just sitting around the house by myself.”
She calls the day center like a “second home.” Cheely has heard about potential cuts to Medicaid, but trusts that her faith community would support her if she did lose access to services.
Others may not be so lucky, says nurse manager at the center, Lisa Thigpen.
“I feel like if you take this out, or cut back, then you're gonna see more people decline, not only in their physical wellbeing, but their mental wellbeing,” Thigpen said.
Not just that of elderly people but families too, she said, who might rely on the care offered at day centers to recharge from the job of being caregivers.
In Wrens, there is no pharmacy, and no hospital. The same goes for other towns from where the day center goes and picks up clients — that transportation is paid for by the Medicaid waiver, too.
When clients get to the day center, there is a flock of attentive nurses and two hot meals a day. That’s stability that not every client has, even for those who can only come twice a week because of the limitations of what Medicaid pays for.
“It may be that maybe they only get one meal at home,” said Thigpen.
Thigpen, other nurses and Medicaid caseworkers can look out for them.
Georgia has 22% of its state budget set aside for Medicaid, around $14 billion. The federal government covers about $9 billion of that.
That share is expected to be much smaller if Congress passes President Donald Trump’s big spending bill.
Claire Russell of Family Care Inc. said her centers can only stay open if they have enough people covered by Medicaid waivers.
“It's a matter of numbers so that you can pay for the nurse and the overhead,” she said.
People eligible for so-called Home and Community Based Services under the Medicaid waiver live at home and in residential facilities called personal care homes.
The EDWP includes the Community Care Services Program, and The Services Options Using Resources in Community Environments (SOURCE) Program.
As of January 2024, about 41,000 people in Georgia were getting services at home through these programs. Total, the federal government paid about 65% of the cost to operate the EDWP last fiscal year — down slightly from its 73% contribution in 2021.
Health policy analysts warn any cuts to Medicaid spending from the federal government would have a trickle-down effect, as would administrative hurdles from adding work requirements which in some cases, have already proven too much for Georgia’s system to handle.
“Which person would you want to sit down and say, I'm sorry, but you can't ever come back, because our numbers have been cut and you're on a waiting list?” Russell said.
After narrowly passing the House of Representatives, the big spending bill is now in the hands of the Senate, which is proposing deeper cuts.
Becky Kurtz leads aging and independence services for the Atlanta Regional Commission. She said Georgia recently hit a milestone. The state has seen Medicaid fund services at home for almost as many people who use Medicaid to pay for nursing homes.
“It's exciting because the vast majority of older adults say, 'I would rather be in my home' or 'I would rather live with my family,'” she said. “'That's my choice.'”
Medicaid spending nationally has a similar track, with far more spent on Home and Community Based Services than on institutional placement.
Kurtz is part of the system of Area Agencies on Aging — every county in Georgia has access to one. The system exists to help cut through the time it would normally take aging and disabled people to find care.
Many families who call don’t know that health insurance such as Medicare doesn’t often cover the help that people might need with daily tasks, like getting dressed, fed or getting around town.
“If you can pay privately, you've got a lot of options,” Kurtz said.
Those who can’t may rely on Medicaid for long-term living support.
But the choice that people have now to age at home could be threatened by the White House's big spending bill, which proposes a historic cut to federal Medicaid spending.
“If it's small, I'm thinking Georgia can handle it,” she said. “If it's huge, if it hundreds of millions of dollars, I don't see how Georgia is going to replace the funding needs.”
Already this year, a federal grant to the Atlanta Regional Commission supporting senior Americorps volunteers was canceled.
The state’s aging population is also increasing. Already, Kurtz said demand for aging in place services is outstripping state money for programs like the Atlanta Regional Commission's that provides home delivered meals and respite care.
A study commission of Georgia senators set to meet this summer will address gaps in family caregiving services.
Chairman Sen. Harold Jones said he hopes to identify more ways in which the state can step in to support caregivers at home, and said Medicaid reimbursement “barely scratches the surface” for some families who have already had to pay for private care before they’re deemed eligible.
