Dr. Marvin Singleton, a Republican who spent 13 years as a Missouri state senator, worries about many of the policies he sees coming out of Washington D.C. these days.
Of course, the retired ear, nose and throat doctor is concerned about federal cuts to Medicaid spending, which could leave millions of Americans without insurance and strain hospitals, nursing homes and home-based care programs that senior citizens rely on.
But Singleton, 85, who now lives in a retirement community in Overland Park and was recently elected to the Kansas Silver-Haired Legislature, is also concerned about cuts to food assistance programs and economic policies like tariffs and tax cuts that he fears will push up prices.
“Everything has ramifications on aging individuals,” he said, “and those individuals who are on fixed incomes get hurt the worst.”
Singleton is not alone. Many advocates working to help senior citizens in the Kansas City area worry, too. A growing population of older low-income adults, they said, already struggles to find health care, pay rent and afford food.
In Missouri, almost 10% of the state’s 1.1 million residents 65 years old or older live below the poverty level and 22% receive food assistance. In Kansas, 8.5% of the state’s 510,000 seniors live below the poverty level.
“We do not have the infrastructure to meet the needs of the region’s aging population at this moment,” said Jeron Ravin, president and CEO of Swope Health, a safety-net health clinic in Kansas City that has made improving that infrastructure one of its priorities.
And that’s the situation before provisions in new federal legislation, President Donald Trump’s “Big Beautiful Bill,” go into effect.
That legislation will cut $911 billion in spending on Medicaid over the next decade and trim $300 billion from the Supplemental Nutrition Assistance Program (SNAP), causing an estimated 22 million households to lose all or part of their food assistance.
All of that will hurt low-income seniors and the long-term care facilities, health care providers and community organizations that they rely on, senior advocates said.
“We’re in crisis now,” said Janet Baker, executive director of KC Shepherd’s Center, which provides meals and other support to older, mainly low-income adults. “We can’t meet the need that we already have, and that need is just going to grow.”
Growing older populations
In both Missouri and Kansas, older adults make up a growing portion of the populations.
A recent survey of older Missourians found that almost one-third of respondents couldn’t access the health care they needed, often because it cost too much or they couldn’t find a provider in their area. And at least three in 10 said they didn’t have enough money to afford healthy meals.
“We’ve seen this coming for a long time based on demographics and population shift,” said Rachel Ohlhausen, director of program partnerships with Jewish Family Services, “and we haven’t seen federal dollar investments that match.”
In fact, since Trump returned to office in January, the opposite has happened.
Funding has been slashed for safety-net programs like Meals on Wheels and transportation services to help older adults get to the doctor or the grocery store. Area agencies like KC Shepherd’s Center and Jewish Family Services have been forced to turn down requests for help from seniors and their families.
Food pantries and meal sites, meanwhile, also are struggling to help food-insecure seniors as federal food aid from the U.S. Department of Agriculture also experiences steep cuts. And affordable housing for seniors is a growing need.
“We’re in crisis now. We can’t meet the need that we already have, and that need is just going to grow.”Janet Baker, executive director of KC Shepherd’s Center
According to the National Alliance to End Homelessness, people 50 years or older represent the fastest-growing group experiencing homelessness. The organization predicts that that group will triple in size by 2030.
In Kansas City, Swope Health will break ground Aug. 7 on a development at 5900 Swope Parkway designed to include 200 units of senior affordable housing, along with senior health and dental clinics.
But Ravin said plans for the project, called Swope Health Village, may be curtailed by federal funding cuts, which will likely take money away from community health clinics like Swope by reducing the number of patients covered by Medicaid and potentially increasing the number who need free care.
In addition, he said, the donations required to complete future phases of the project will be harder to come by.
“The question is, due to these cuts, will the project, instead of being completed within five years, take 10 years or 15 years?” Ravin said. “All safety-net providers are likely to be less financially secure. Philanthropy is going to have more of us asking them for support than ever. And, you know, the well is only so big.”
Impact on care for seniors
Across the spectrum, health providers are expecting to feel the effect of cuts to Medicaid funding.
The new federal law will reduce the number of people who can receive Medicaid, the government-funded health insurance program, by adding work requirements and more frequent eligibility checks. Some of those requirements could be especially burdensome for seniors, advocates said.
The law also shifts more of the program’s costs, which have always been jointly funded by state and federal taxes, to states. Finding those dollars in Missouri and Kansas will probably be difficult.
In addition to federally qualified health clinics like Swope that rely heavily on revenue from patients covered by Medicaid, safety-net hospitals like University Health in Kansas City expect to lose revenue. And so will long-term care facilities like nursing homes, which already have faced headwinds in recent years.
Medicaid covers 65% of residents in Missouri nursing homes and 58% in Kansas nursing homes.
During the COVID pandemic, long-term care facilities became ground zero for deaths because the virus so easily spread in close quarters and residents’ health and age made them more vulnerable.
Many patients moved out of the facilities as well, resulting in empty beds and, in some cases, closed doors.
Kansas once had at least one skilled nursing home option in all 105 counties in the state. Now nine counties have none, said Linda MowBray, president and CEO of the Kansas Health Care Association and Kansas Center for Assisted Living, which represents long-term care facilities in the state.
MowBray praised the Kansas legislature for adding funding to the Medicaid program to increase reimbursement rates for long-term care facilities. But reimbursements still don’t meet the actual cost, she said, and many facilities continue to struggle financially. The new federal law won’t help, she said.
Most concerning to her members, MowBray said, is a reduction in the amount of time people have to qualify for Medicaid coverage once they’ve moved into a long-term care facility.
Currently, if a person enters with a Medicaid application pending, they get 90 days to complete the cumbersome process. The facility will be reimbursed for the time the patient’s application was pending as long as approval comes within that 90-day window.
But the new law shortens that window to 60 days, which may not be long enough for many older patients to complete the process, MowBray said. That means nursing homes won’t be reimbursed for all of the days that the application process requires.
“This will force providers to take a serious look at how much risk they can take,” MowBray said.
Some small facilities may not be able to afford the risk, she said.
“The concern is … where are these people going to go?” MowBray said. “Are they just parked in the hospital while the application is going through? And if it doesn’t go through, and they’re beyond 60 days and the hospital doesn’t get paid, that’s an even bigger bill that’s going to have to get written off.”
Marie Dunham, an owner of Blue Hills Rest Home in Independence, is not ready to panic. After four decades in this business, she said, she’s seen this play out before when people have worried about government benefits being reduced but then everything turned out to be fine.
“Every time we get a new president, a new governor, everybody always gets this fear factor,” Dunham said. “Everybody needs to take a big breath.”
Blue Hills, an assisted living facility, serves senior citizens and people with disabilities. The vast majority of them receive Medicaid. Dunham doesn’t believe the state of Missouri will abandon this population.
“There’s got to be homes to take care of our people — our elderly and disabled,” Dunham said. “They’re not going to put our people out on the streets.”
Ripple effects
Baker, who, in addition to her role with KC Shepherd’s Center, serves in Missouri’s Silver-Haired Legislature, is less optimistic. She expects to see more nursing homes close and more seniors left at greater risk.
“More hunger, more hardship and more homeless seniors,” she said. “I don’t believe the state is prepared from the standpoint that senior services are inadequately funded in the first place.”
“There’s got to be homes to take care of our people — our elderly and disabled. They’re not going to put our people out on the streets.”Marie Dunham, an owner of Blue Hills Rest Home
Low-income older adults will almost certainly feel the ripple effects that follow cuts to federal funding, health leaders said. Even before those cuts passed Congress, states were expecting increased needs among the growing senior population. And both Missouri and Kansas have been planning.
In 2023, then-Missouri Gov. Mike Parson launched a study to develop a master plan on aging for the state. Officials are holding town hall meetings across the state before the report is finalized later this year. A Kansas City event is scheduled at 9 a.m. Aug. 1 at the Kauffman Foundation at 4801 Rockhill Road.
And the Kansas Department for Aging and Disability Services has drafted a state plan on aging that makes several recommendations for improving care for older Kansans.
Now the question becomes whether the current political landscape will allow priorities laid out in the state plans to be implemented. Observers fear that fiscal and political realities make that unlikely.
Missouri has shifted its own tax policy, including eliminating the state’s capital gains tax earlier this year, which will mean less tax revenue coming in. And federal changes to Medicaid and SNAP will force both states to carry a greater portion of the costs of those programs, meaning less money for other priorities.
Stacy Morse, executive director of the Missouri Council on Aging, said she hopes state legislators will understand that priorities included in the master plan on aging, which her organization supports, are recommendations from people around the state.
After tax cuts, “it’s going to be really hard … to fund these services and support that people across Missouri are saying they need,” Morse said. “There’s a complete disconnect between what we want and what Missouri is willing to pay for.”
Even if big financial investments are not possible in the current environment, small changes could still help, said Mindy Ulstad, who has led the master plan process from her post with the Missouri Department of Health and Senior Services.
For example, the master plan will recommend that the state work on a “no wrong door” policy for seniors in the state, so one call to a single agency will let them get all their questions answered. And the state can work on outreach, so seniors have a better idea of what services are available to help them.
“There may be things that are harder to enact over the next few years,” she said. But the state can work on “getting information out about what’s available and helping people navigate those systems.”
Ulstad also said that the information gathered during the process of writing the master plan will be available to local governments and community organizations so they can learn from it and perhaps implement some of its recommendations.
“We are letting people know that the plan will be out there and they can use it for their own strategic planning,” she said.
Increasingly, support for older adult services is falling to county taxpayers. In November, for example, Jackson County voters passed a tax levy that will raise $8 million annually to support senior services beginning sometime next year. Across the state, 55 other counties have similar taxes.
But as state legislators look at limiting property taxes, Morse fears that this source of revenue could be at risk, too. In testimony before a Missouri House committee on the issue, she urged legislators to remember that those taxes are helping seniors.
“We recognize that there is this need to reduce the property tax burden,” she said. “Also that the assessments may have increased too quickly, and it took a lot of people by surprise. But what we want to remind you is that the property taxes are providing really necessary services. For the older adults, it’s helping them age in place.”
More patients are likely to need support to stay at home. Many people can’t afford long-term care or would prefer to be in a familiar place.
Swope Health started a program a year ago called PACE KC, which relies on Medicaid and Medicare payments to provide health care and social support like transportation to Jackson County residents who are 55 or older.
But the reality is that more people will need more help, especially after federal and state cuts are absorbed.
“It will get worse before it gets better,” Ohlhausen said, “and my hope is that we learn and we really try to hold on to what we want to build back on the other side.”
She is also still holding out hope that lawmakers will reconsider and reverse some of the funding cuts before they take effect.
“I don’t know if that’s possible, but whatever is possible should be pursued.”
This story was originally published by The Beacon, a fellow member of the KC Media Collective.
