What Medicaid cuts could mean for rural nursing homes and hospitals

For the past 17 years, April Chirdon has cared for people who often feel more like family than patients at the Haida Healthcare and Rehabilitation Center in Hastings.

There, in the small town in western Pennsylvania’s Cambria County, Chirdon spends her days with people for whom the nursing home is a lifeline. For many of her patients, the facility is where they’ll spend the final moments of their lives.

“A lot of them have become family over the years,” said Chirdon, a certified nursing assistant. “We’ve had a lot of them that have been there for the past 10 years. You become close with their family; you become close with them, and then it’s awful when they pass. You almost feel like it was your own family member that passed.”

Now, Chirdon is worried about the future for her patients as congressional Republicans set their sights on cutting Medicaid, a public health insurance program that provides coverage for about three million Pennsylvanians, including individuals in long-term care facilities, children, pregnant people, and people with disabilities. 

Republican lawmakers are advocating for the cuts to Medicaid in order to pay for President Donald Trump’s tax cuts for the wealthy and for the mass deportation of immigrants. In February, the GOP-led House passed a budget resolution that calls for $4.5 trillion in tax cuts and a $2 trillion reduction in federal spending over the next 10 years. The plan instructs the Committee on Energy and Commerce, which oversees the Medicaid and Medicare programs, to cut at least $880 billion from its budget.

What, Chirdon asked, would these cuts mean for her patients — people who are unable to look after themselves and whose families often don’t have the time, resources or skills needed to care for them? 

“I just don’t know where these people are going to go,” Chirdon said. “You can’t just open up the door and kick them out onto the streets. They’re there because they cannot take care of themselves. Where are they going?”

Hospital closures and job loss

Health care workers and advocates told the Pennsylvania Independent that the cuts being considered would wreak havoc on the commonwealth’s health care system, including in rural nursing homes and hospitals that are heavily funded by Medicaid and whose patients often rely on public insurance. 

Hundreds of thousands of Pennsylvanians could lose their Medicaid coverage with the federal cuts, and about 42,000 jobs may be lost as well, according to the Hospital and Healthsystem Association of Pennsylvania.

The Center on Budget and Policy Priorities, a progressive think tank that analyzes government policies, estimates the number of Pennsylvanians who would lose Medicaid coverage would be even higher, at 1.2 million. The Commonwealth Fund, which studies health care in the United States, points out in a March report that Pennsylvania could be the fourth-highest state in terms of the number of job losses associated with Medicaid cuts. The organization reported that the state could lose 41,800 jobs because of cuts to Medicaid.

In rural areas, job losses could be especially pronounced because the local health care systems are often the biggest employers in those communities, said Patrick Keenan, the policy director of the Pennsylvania Health Access Network.

“A cut to Medicaid is going to cause job loss,” Keenan said. “It’s going to cause loss of access to care. It’s going to force patients in rural communities, if they don’t lose their coverage outright, to travel further and have to wait more to get just basic, essential health care. And, ultimately, if they do lose coverage, it’s going to cause rural communities to struggle, not just with poor health outcomes but more uncompensated care that puts additional strain on our safety net hospitals in rural communities.”

Rural hospitals, many of which are already operating in the red, could close because they wouldn’t be able to financially withstand the increase in the number of uninsured patients coming to them for emergency services after being unable to access primary care, Keenan said. With no local hospital, other health care workers, like primary care doctors, may leave those communities, Keenan said. In turn, those rural communities, which are already losing residents, will further struggle to draw people to areas with little to no health care, Keenan said. 

Should people lose coverage and hospitals close, that would have a ripple effect that would be felt throughout the state’s health care system, said Lisa Davis, the director of the Pennsylvania Office of Rural Health. Not only would remaining hospitals see an increase in uninsured patients, but federally qualified health centers, often referred to as community health centers, and free health clinics could also see a spike in the number of people seeking care, Davis said. Federally qualified health centers provide primary care to anyone, regardless of their ability to pay, and free clinics provide medical and dental services at no cost to low-income, uninsured or underinsured patients.

The fallout when nursing homes close

Pennsylvania nursing homes, where 64% of residents rely on Medicaid, could also shutter if these cuts go into effect, Keenan said. Rural nursing homes are especially susceptible because it’s common for 100% of residents at a rural nursing home to be covered by Medicaid, Davis said.

Chirdon said she expects already understaffed nursing homes that remain open would find it increasingly difficult to find workers for jobs that have long been low-wage positions with limited benefits.

Chirdon said the understaffing at nursing homes is the worst she has seen in her 17-year career. That, she explained, is in part because of low wages and few benefits and in part because of workers leaving their jobs during the early days of the COVID pandemic, when nursing home staff were deemed to be essential employees and mandated to do in-person work. Medicaid cuts would further strain a struggling workforce, Chirdon said. Any cuts to salary or benefits could then push more people from the field or make it so people don’t apply for nursing home jobs to begin with.

“You take this Medicaid away, then the companies don’t have the money to pay for staffing,” Chirdon said. “They don’t have the money to pay for raises. Who’s going to go and work in a nursing home? It’s back-breaking work.”

If her nursing home closed altogether, it would be devastating for the Hastings community, Chirdon said. 

“It’s not like the big towns or big cities, where you can just go 10 miles down the road and there’s another one; we’re pretty much it,” Chirdon said. “So if we close, you’re out all the workers there, all the residents. The other businesses in town — you can’t tell me that the food places aren’t getting a lot of business from all the workers and family members coming.”

As Congress debates sweeping cuts to Medicaid, nursing home employees and residents are left to wonder what will become of them, Chirdon said. 

“You have the workers that are all stressed out because, are we going to have a job? Are they going to close this down? Where are residents going to go?” Chirdon asked. “You have the family members that are all stressed out — what am I going to do if this closes down? Are we going to find somewhere close, if we can even get them in somewhere else? If we can’t, how am I going to take care of them at home? And then the residents: I don’t want to be a burden on my family.”