Gail Smith: The Cost of Cuts to Medicaid in Our Nursing Homes

Gail Smith lives in a nursing home in Somerset County, New Jersey, where Medicaid has sustained her here and in another facility for the past four years. “It’s been a lifeline for me,” she shared. After a near-fatal health crisis in 2021, she lost a kidney and now depends on two teams of specialists to monitor her condition closely. “They prescribe different medications and supplements, so I don’t create more kidney stones, and they also watch every other medication and supplement that I take.” Her doctors also run regular labs and scans to manage her care and Medicaid keeps her covered. “I can’t live well or safely without all of that being covered by Medicaid.”

Medicaid, the largest payer for long-term care facilities, covers around 2 in 3 nursing home residents. Cuts to the program as well as Medicare would devastate people like Gail. “Our nursing homes are supported tremendously by Medicaid and they’re already, some of them are… substandard, like poverty level with food and supplies, and staffing and care issues.”

Gail is not of the mindset that the system is perfect, in fact, she pointed to successful fraud investigations in New Jersey just last year where they found “a pattern of waste and abuse of public funds, financial mismanagement, disregard of federal and state oversight requirements, and substandard care.” “That’s the way to root out fraud and waste and abuse, not to just blanketly cut funding when you don’t know how that’s going to turn out.” She supports rooting out fraud and holding bad actors accountable but believes cutting funding across the board would only punish vulnerable residents.

Before entering long-term care, Gail lived independently. In February 2021, after her surgery, she entered a rehab facility. “Medicare paid for a few weeks of rehab.” But her mobility worsened. “I laid around for two and a half months, hardly doing anything.” Without a call bell, she had to wait for someone to help her use the bathroom. “I lost my own confidence thinking I couldn’t do it either.”

She eventually moved to assisted living, spending most of her savings. “I ended up going to the first nursing home for three and a half years and used up all my money.” Applying for Medicaid was overwhelming. “It can be a grueling process for some people, and it was for me.” She described digging through years of financial records, taking many months to get the paperwork in order.

During that time, the bills kept coming. “They only go back a certain amount of days to cover.” She warned that the new reconciliation bill could shorten that window from 90 days to 30. “That’s a really short time to decide a major life decision like that.”

With her background as a legal secretary, Gail became a strong advocate for fellow residents. “I became vice president of our residents’ council pretty soon after I arrived at the first nursing home.” She supported council leaders behind the scenes, ended up running the meetings and regularly connected with the 280-bed facility’s department heads.

She partnered with the New Jersey Long-Term Care Ombudsman’s Community Engagement Program to strengthen her skills. “I learned from them a lot about advocacy.” Unlike traditional methods, the program empowers residents directly. “Their program is unique in New Jersey, where they come alongside the leadership in the residents’ council, or even just strong residents, teaching them how to advocate.”

She now speaks nationally about the advocacy work she and others do. “We spoke at the Consumer Voice Conference, their annual conference last September.” Alongside state leaders, she shared how the program helped residents succeed.

Gail continues to fight for those in long-term care. Regarding the bill’s drastic financial cuts and eliminating nursing homes’ minimum staffing requirements, she said, “You can’t… just disrupt the whole foundation of something in hopes that it’ll turn out for the best when you’re dealing with people’s lives, well-being, and health and safety.”