Gray Davis

SAN FRANCISCO–As states slash health services to make up for record budget shortfalls, one group will shoulder a disproportionate part of the burden: elderly women.

Two-thirds of states plan to cut benefits for Medicaid–the national health care program for low-income people, the disabled and seniors–increase co-payments, and restrict eligibility to the program, a new survey by the Henry J. Kaiser Family Foundation has found. Some 21 states will freeze or decrease medical paymentsto doctors, hospitals and nursing homes.

These cuts will disproportionately affect elderly women, experts say. The typical patient in a nursing home is an 85-year-old woman. This is because the average woman age 65 and over lives six years longer than the average man and is far poorer. Senior women in the United States are typically widowed and receive an annual income of only $15,600, compared to about $29,000 for senior men, according to the Older Women’s League, a national grassroots organization. As a result, more elderly women rely on programs such as Medicaid.

"I really believe that we’re seeing the safety net for the most frail seniors collapse because of these cuts," said Jim Gomez, executive director of the California Association of Health Facilities. "We are abandoning our seniors."

Medicaid provides a wide range of health services for more than 40 million low-income, elderly and disabled people nationwide. By contrast, Medicare, the nation’s health care program for seniors over 65 and the disabled, doesn’t typically cover costs of long-term care, such as nursing homes. Many low-income seniors supplement Medicare benefits with Medicaid.

State Budget Shortfalls Make the Situation Worse

Governors argue that they have no choice but to slash Medicaid programs. States today face the worst fiscal outlook since World War II, with deficits for 2004 projected to be even bleaker, according to a survey released in February by the National Conference of State Legislatures. A weak national economy, stock market declines, slow manufacturing and technology sectors and soaring health care costs are blamed.

The situation in California is the most dire. California faces a budget shortfall estimated at $35 billion. To partially make up the loss, Democratic Governor Gray Davis proposes significant cuts to MediCal, the state’s version of Medicaid that is used by more than 6 million people. The proposal would reduce health care provider reimbursements by 5 percent and require those on MediCal to prove their eligibility every three months, as opposed to once a year, lowering MediCal rolls by an estimated 209,000 people.

Under the governor’s plan, MediCal reimbursements to nursing homes would drop by 15 percent, stripping an estimated $350 million from nursing homes across the state, which care for about 250,000 seniors, most of whom are women.

"Like any CEO in a recession, I have to make difficult choices," Davis said in January when he unveiled his proposed budget.

Davis’ plan has evoked an outcry among advocates for the poor and elderly. Jim Gomez estimates that some 200 to 300 nursing homes will go bankrupt because the facilities have nowhere left to cut. The total cost to provide an elderly person with round-the-clock care in a nursing home is $115 a day.

"Seniors will be forced to turn to emergency rooms for much of their care," Gomez said at a panel discussion hosted by the California HealthCare Foundation.

California is not alone in cutting basic health services to the elderly.

"What is happening in California is happening across the nation," says Lark Galloway-Gilliam, executive director of Community Health Councils, Inc., in Los Angeles. "These benefits being cut are not to be viewed as optional–we are talking about no longer providing inhalers, wheelchairs, sugar tests for those with diabetes, syringes for insulin."

The situation for elderly women will likely worsen, experts say. Although older generations are staying healthier longer, state and federal health programs are not equipped to meet the demands of the growing number of seniors. A new report by AARP (formerly known as the American Association of Retired Persons) suggests that the elderly will have fewer options for long-term care over the coming decades, when millions of baby boomers retire.

"[I]f the issues of the growing and aging population’s future long-term care needs are not addressed today, the choices will be limited to the wealthy and highly educated," John Rother, AARP policy and strategy director, said in the report. "Access to choices for the population at large will be restricted to those who can afford alternatives to nursing homes such as assisted living or home and community-based services."

In the coming weeks, the California state legislature will hammer out the details of the budget. In late January, the state Senate passed a budget that did not include MediCal cuts. But if the proposed MediCal cuts are included in the final budget, Gomez says that his organization may sue.

"Clearly we would consider legal action," he says. "We need to protect the most vulnerable in our society."

Rebecca Vesely is a freelance writer based in Oakland, CA.



For more information:

Older Women’s League:

California HealthCare Foundation–
"Troubled Budget Times Hit Nursing Homes Hard":

California Association of Health Facilities–
"Budget Cut Spells Disaster for California’s Most Fragile Seniors and Disabled":