LGBTQ+ Older Adults Can’t Afford Cuts to Medicaid

Medicaid is a lifeline for LGBTQ+ older adults. Over 7 million low-income older adults age 65+ are enrolled in Medicaid, together with not less than 1.2 million LGBT^[1] older adults.^[2] Medicaid is the one possibility for paid home-based care, and fills in gaps in Medicare protection. It additionally helps LBGTQ+ older adults who’re beneath age 65 or in any other case not eligible for Medicare entry primary well being care. Any cuts to Medicaid harm LGBTQ+ older adults by stopping them from accessing vital healthcare at a time after they want it probably the most.

Why is Medicaid Essential to LGBTQ+ Older Adults?

LGBTQ+ older adults expertise inequities because of discrimination on the idea of sexual orientation or gender identification (SOGI), which lead to well being and financial disparities. For instance, LGBTQ+ people could also be much less more likely to safe employment because of discrimination, which creates boundaries to accessing well being care insurance coverage, even in older age.^[3] Inequities on the idea of SOGI improve with age, and together with excessive charges of poverty, imply that many LGBTQ+ older adults depend on Medicaid for well being and long-term care.^[4]

Medicaid is a medical health insurance program out there to sure folks with restricted incomes and property, enabling them to entry important well being and long-term care to age with dignity.^[5] Whereas most older adults who’re 65 and older in addition to folks beneath age 65 who’ve sure disabilities are eligible for Medicare, Medicare alone is insufficient to satisfy the well being wants of LGBTQ+ older adults.

Medicaid Offers Financial Assist and Providers for LGBTQ+ Older Adults with Medicare

Medicaid pays Medicare premiums and cost-sharing for a lot of seniors residing on mounted incomes, together with LGBTQ+ older adults, which in flip helps them pay for lease, meals, and different requirements. For these with out enough work histories totally free Half A, Medicare’s hospital profit, these premiums could be unaffordable with out Medicaid.^[6] LGBTQ+ older adults additionally depend on Medicaid for companies that Medicare doesn’t cowl, akin to long-term care at house and in services, in addition to dental, imaginative and prescient, and listening to.

Medicaid Allows LGBTQ+ Older Adults to Reside with their Communities

Most LGBTQ+ older adults want to dwell at house as they age and sometimes expertise higher psychological well being and social outcomes with home-based care.^[7] The choice of institutional long-term care might current a menace of discrimination, isolation, or denial of important look after LGBTQ+ older adults.

Nevertheless, LGBTQ+ older adults usually face boundaries to remaining at house, together with that they might not have conventional sources of unpaid care from household. For instance, LGBTQ+ older adults are twice as more likely to be single and 4 occasions much less more likely to have kids.^[8] These residing in rural areas are much less more likely to have assist from household and associates.^[9]

Medicaid fills this want by empowering LGBTQ+ older adults to obtain assist in their very own houses with day by day actions and different care. Medicaid is the first funder of house and community-based companies (HCBS) in the USA—serving 4.2 million folks.^[10] HCBS contains an array of companies, starting from private care aides who assist older adults with their day by day actions (like consuming and bathing) to house modifications that assist older adults to maneuver round their houses independently.

Medicaid is Crucial for LGBTQ+ Older Adults Who Don’t Have Medicare

LGBTQ+ older adults with restricted earnings ages 50-64 and others who aren’t eligible for Medicare might rely solely on Medicaid for all of their well being care.^[11] Given the various boundaries that LGBTQ+ folks face in accessing different types of medical health insurance in older age, Medicaid will also be a crucial useful resource to assist LGBTQ+ older adults entry HIV care^[12] and gender-affirming care. ^[13] Gender-affirming care contains well being care companies and inclusive approaches that assist a person’s gender identification, together with hormone therapies, psychiatric companies, and first care—all of which enhance high quality of life, significantly for transgender and gender expansive folks, together with older adults.^[14]

How Would Medicaid Cuts Hurt LGBTQ+ Older Adults?

Chopping federal funding to Medicaid would shrink Medicaid for everybody, however the results could be vital for LGBTQ+ older adults. Any funding caps or cuts would restrict states’ skills to maintain up with elevated healthcare prices for the rising variety of older adults, resulting in decreased state budgets and in the end cuts to crucial packages like HCBS.^[15] As a result of Medicaid is usually the one supply of home-based care—paid or unpaid—out there to LGBTQ+ older adults, cuts to Medicaid funding in any kind threaten the way forward for long-term care choices and would pressure many LGBTQ+ older adults into institutionalization or to forgo vital care.

Federal funding cuts would additionally seemingly lead states to scale back supplier reimbursement, which is already low, and will trigger the already restricted variety of suppliers serving adults to cease accepting Medicaid. This might significantly hurt LGBTQ+ older adults by limiting their entry to suppliers whom they might belief, culturally competent suppliers of gender affirming care, and to specialists. States may additionally attempt to restrict protection for gender affirming care or pricey therapies for continual circumstances akin to HIV and hepatitis C.

Different proposed purple tape on Medicaid, akin to work necessities, additionally threaten LGBTQ+ communities.^[16] LGBTQ+ older adults beneath age 65 could be vulnerable to having their solely supply of well being protection taken away as a result of they can not discover or keep work, because of discrimination and/or continual well being circumstances and incapacity. In comparison with non-LGBTQ+ friends, LGBTQ+ persons are over 3 times as more likely to be caregivers to associates and make up 9% of all caregivers in the USA.^[17] Caregiving duties restrict caregivers’ availability for paid employment or might result in office discrimination.^[18] The specter of Medicaid work necessities additionally jeopardizes the wellbeing of the older adults who depend on unpaid caregiver assist from the LGBTQ+ group.

Assets

To study extra about healthcare for LGBTQ+ older adults, state Medicaid packages, and federal advocacy to guard Medicaid, please see the assets under:

Endnotes

1. All through this challenge transient, we use the time period LGBTQ+ to discuss with the lesbian, homosexual, bisexual, transgender, queer, and gender expansive group. Nevertheless, we sometimes different acronyms—akin to LGBT—to mirror the cited assets. ↑

2. Medicaid.gov, Seniors & Medicare and Medicaid Enrollees; MACPAC, Entry in Transient: Experiences of Lesbian, Homosexual, Bisexual, and Transgender Medicaid Beneficiaries with Accessing Medical and Behavioral Well being Care (2022). ↑

3. LGBT Getting older Middle, Shining a Gentle on Medicare: Demystifying Medicare for the Elder LGBT Group 1 (2024); Nik M. Lampe et al, Well being Disparities Amongst Lesbian, Homosexual, Bisexual, Transgender, and Queer Older Adults Structural Competency Method, 98 Int. J. Getting older and Human Improvement (2023); Brad Sears et al., Williams Institute, LGBTQ Individuals’s Experiences of Office Discrimination and Harassment (2024). ↑

4. Denny Chan, Justice in Getting older, Fulfilling the Promise of Fairness for Older Adults: Alternatives in Regulation and Coverage (2023). ↑

5. U.S. Dep’t of Well being & Human Providers, What’s the distinction between Medicare and Medicaid? (2022). ↑

6. SAGE, Marriage, Medicare & Medicaid (2023). ↑

7. SAGE, Understanding Points Going through LGBT Older Adults 16 (2017). ↑

8. SAGE, Info on LBGT Getting older 1 (2021). ↑

9. LGBTQ+ Social Community, Getting older, and Coverage Examine (McKay et al., 2024) ↑

10. KFF, How Many Individuals Use Medicaid Lengthy-Time period Providers and Helps and How A lot Does Medicaid Spend on These Individuals? (2023). ↑

11. See typically Arielle Bosworth et al., Asst. Sec. of Planning & Analysis, Well being Insurance coverage Protection and Entry to Look after LGBTQ+ People: Present Traits and Key Challenges 5 (2021) (noting that 17.2 % of the LGB+ inhabitants accesses Medicaid, in comparison with solely 10% of non-LGB+ inhabitants). ↑

12. KFF, Medicare and Individuals with HIV (2023). ↑

13. KFF, Replace on Medicaid Protection of Gender-Affirming Well being Providers (2022). For state-by-state details about Medicaid protection of gender affirming care, see LGBT Map, Medicaid Protection of Transgender-Associated Well being Care. ↑

14. See, e.g., Xiang Cai et al., Good thing about Gender Affirming Medical Remedy for Transgender Elders: Later-Life Alignment of Thoughts and Physique (2019). ↑

15. See Justice in Getting older, Chopping to Medicaid Harms Older Adults No Matter How It’s Sliced (2025). ↑

16. For extra details about Medicaid work necessities, see Justice in Getting older, Medicaid Work Necessities: Crimson Tape That Would Minimize Well being Protection For Older Adults (2025). ↑

17. Id. ↑

18. AARP, 2020 Report Caregiving within the U.S. 70 (2020). ↑