How Medicaid Supports Older Adults

Medicaid Improves Access to Care and Outcomes for Low-Income Seniors

Medicaid’s value to older adults is demonstrable. Only 7% of people ages 65 and older who are dually enrolled in Medicaid and Medicare report having unmet needs, about half the rate of seniors with Medicare alone.³ Only 4% of older people with both Medicare and Medicaid are unable to pay health care bills, compared to 8% of seniors with Medicare alone.⁴ Medicaid also improves health outcomes for people on Medicare. Research shows that older adults who were enrolled in Medicaid prior to becoming eligible for Medicare and were able to keep their Medicaid coverage have fewer chronic conditions and limitations on activities of daily living, and lower rates of depression in older age compared to people who lose Medicaid at age 65.⁵ Most importantly, continued Medicaid coverage significantly reduces mortality at age 75 for low-income adults.⁶

Medicaid Makes Medicare More Affordable

The Medicare Savings Programs (MSP) are Medicaid funded programs that pay Medicare Part A and/or B premiums, and out-of-pocket costs. Some MSP beneficiaries are also protected against improper balance billing where providers try to charge the individual for some Medicare expenses. Because the MSP income and asset limits are higher than most states’ full-benefit Medicaid eligibility limits, some Medicare enrollees are only eligible for an MSP and not eligible for full wrap around Medicaid coverage such as dental and vision care.⁸

Medicaid Covers Essential Services Not Covered by Medicare, Including Long-Term Care

Although Medicare provides coverage for acute care like hospitalizations and medical appointments, there are still many gaps in the program. For low-income older adults enrolled in full-benefit Medicaid, their Medicaid coverage can fill in these gaps left by Medicare for services like dental, vision, hearing, non-emergency medical transportation and long-term care.⁹

For example, long-term care is limited under Medicare, which provides a maximum of 100 days of skilled nursing facility coverage. Medicare’s home-based coverage for assistance with Activities of Daily Living (ADL) like eating, mobility, and bathing can also be difficult to access and does not provide the full array of services many older adults need to remain at home. Medicaid, on the other hand, offers long-term coverage for nursing home residents and older adults living in the community who need help with ADLs beyond what is available in Medicare. As a result, Medicaid is the primary payor for all long-term services and supports in the United States, including over 60% of nursing home residents and 70% of home-based care.¹⁰

Medicaid Enables Older Adults to Age in Place

Millions of older adults rely on Medicaid to access home- and community-based services (HCBS) like skilled therapy, personal care, and respite. Every state and Washington D.C. offer HCBS despite it being an optional program, as an alternative to institutional care. Some states also use HCBS waivers to pay family caregivers for their services, which provides crucial financial support for families.¹¹

Medicaid Helps Older Adults Who Are Not Yet Eligible for Medicare

Medicaid is also crucial for older adults under age 65 who are not yet eligible for Medicare and often lack access to other affordable insurance. Among adults aged 50 to 64, half of those who rely on Medicaid have a disability and eight in 10 who are unable to work have two or more chronic conditions.¹² Many adults over 50 rely on the Affordable Care Act’s (ACA) Medicaid expansion in particular, including individuals with disabilities who do not meet the restrictive Social Security disability criteria or who are waiting for their SSI eligibility to be approved.¹³ Research shows that adults ages 50 to 64 who have coverage through Medicaid expansion, have fewer out-of-pocket healthcare expenses, use the hospital less and have improved health outcomes.¹⁴ It’s no surprise that Medicaid expansion under the ACA saved the lives of at least 19,200 adults ages 55 to 64 over the four-year period from 2014 to 2017.¹⁵

Medicaid, including the coverage provided under the ACA’s Medicaid expansion, is a crucial lifeline for older adults, including their families and caregivers.¹⁶ Low-income older adults need both Medicaid and Medicare to access health and long-term care. Without Medicaid, health care would be unaffordable for millions of low-income older adults, and long-term care would be inaccessible for millions of individuals, including seniors. As the population continues to age, it is imperative that Medicaid funding and support is strengthened to meet the needs of older Americans and their families.

Endnotes

1. UnidosUS, “Medicaid Cuts Would Rip Away Health Coverage from Millions of Americans, Disproportionately Harming People of Color,” (Washington: UnidosUS, March 13, 2025), available here. ↩︎
2. AARP, “Midlife Medicaid Recipients Age 50-64: A Summary of their Health and Financial Security,” (Washington: AARP, November 2024), available here. ↩︎
3. H.S. Kaye, “Preserving Medicaid & the Affordable Care Act for Adults with Disabilities,” (Berkeley, CA: Disability Rights Education & Defense Fund, February 7, 2025), available here. ↩︎
4. Ibid ↩︎
5. Analyses conducted by Jane Tavares, PhD, and Marc Cohen, PhD, LeadingAge LTSS Center, University of Massachusetts Boston. ↩︎
6. Ibid ↩︎
7. KFF, “U.S. Medicare Savings Program Enrollment,” (Washington: KFF), available here. ↩︎
8. Centers for Medicare & Medicaid Services, “Seniors & Medicare and Medicaid Enrollees,” (Woodlawn, MD: Centers for Medicare & Medicaid Services), available here. ↩︎
9. M.T. Peña, M. Mohamed, & A. Burns, “How Does Use of Medicaid Wraparound Services by Dual-Eligible Individuals Vary by Service, State, and Enrollees’ Demographics?” (Washington: KFF, January 31, 2024), available here. ↩︎
10. P. Chidambaram and A. Burns, “10 Things About Long-Term Services and Supports (LTSS),” (Washington: KFF, July 8, 2025), available here. ↩︎
11. S. Teshale, W. Fox-Grage, & K. Purington, “Paying Family Caregivers through Medicaid Consumer-Directed Payments: State Opportunities and Innovations,” (Washington: National Academy for State Health Policy, April 12, 2021), available here. ↩︎
12. M. Musumeci, J. Foutz, & R. Garfield, “How Might Older Nonelderly Medicaid Adults with Disabilities Be Affected by Work Requirements in Section 1115 Waivers?” (Washington: KFF, March 30, 2018), available here. ↩︎
13. Justice in Aging, “Work Requirements Would Cut Medicaid for Older Adults,” (Washington: Justice in Aging, February 4, 2025), available here. ↩︎
14. J. Tavares and M. Cohen, “Impacts of Medicaid Expansion on Older Adults Age 50-64 from 2012 to 2020, (Boston, MA: LeadingAge LTSS Center, University of Massachusetts Boston, April 2025), available here. ↩︎
15. M. Broaddus and A. Aron-Dine, “Medicaid Expansion Has Saved at Least 19,000 Lices, New Research Finds,” (Washington: Center of Budget and Policy Priorities, November 6, 2025), available here. ↩︎
16. Center for Children and Families, “How Medicaid Support Seniors and People with Disabilities and Their Caregivers,” (Washington: Center for Children and Families, March 11, 2025), available here. ↩︎