Immigration, Medicaid & Long-Term Care Crisis
Immigration policies and potential Medicaid cuts are poised to destabilize the long-term care system, putting the care of older adults and those with disabilities at risk. Immigrant workers, who comprise a large portion of the long-term care workforce, face uncertainty due to immigration enforcement, exacerbating existing worker shortages. Together, proposed Medicaid cuts threaten to reduce services and lower wages for caregivers, putting vulnerable individuals at risk. News Directory 3 reports that experts are suggesting several solutions—including workforce enhancement and social insurance programs—to address these issues and restructure the long-term care system. Discover what’s next as lawmakers debate these critical reforms.
Long-term care system faces dual threats
Updated May 31, 2025
The U.S. long-term care system is facing a potential crisis due to immigration enforcement and proposed Medicaid cuts, experts say. These issues could destabilize care for older adults and people with disabilities.
Immigrants make up 28% of the long-term care workforce,providing essential frontline support. Though, increased immigration enforcement is affecting even legal residents, exacerbating existing worker shortages, according to research. the potential loss of these workers poses an existential threat to the nation’s long-term care system.
Adding to the strain, Republicans in Congress are considering $880 billion in Medicaid cuts to fund other priorities. Medicaid is the largest source of funding for long-term care, supporting nearly 6 million people. These cuts could force states to reduce services, especially optional home-based support, and lower payment rates for providers.
Currently, over 700,000 people are on waiting lists for Medicaid services. Reduced funding could worsen this situation, leading to fewer services and lower wages for already underpaid home care workers.Many of these workers rely on public assistance, highlighting the unsustainable nature of these jobs.
The combined effect of immigration policies and Medicaid cuts could trigger a significant workforce exodus,leaving vulnerable individuals without necessary care.
Experts suggest several solutions, including higher wages, career advancement opportunities, and improved worker training. A more comprehensive approach involves restructuring the long-term care system to better meet the needs of an aging population.
Currently, more than half of Americans will require long-term care as they age. While Medicaid offers support, it is indeed primarily available to low-income individuals. The average cost of long-term care is nearly $300,000, with a significant portion paid out-of-pocket.
Family caregivers often bear a substantial burden, sacrificing their own well-being to support loved ones. With shrinking family sizes,this informal support system is becoming increasingly strained.
To address these challenges, experts recommend strengthening Medicaid and standardizing care across states. Another approach involves expanding Medicare to include long-term care benefits, similar to the Medicare Part D program for prescription drugs.
U.S.Reps. John Moolenaar, R-Mich., and Tom Suozzi, D-N.Y., have proposed the WISH Act, a bipartisan bill that would create a social insurance program for long-term care through Social Security, offering affordable coverage to all Americans.
Without significant changes, current policies threaten to undermine the long-term care system, rather than improve it.
What’s next
Lawmakers are expected to debate the proposed Medicaid cuts in the coming weeks, while advocates continue to push for comprehensive long-term care reform.