In the wake of the proposed $700 billion Medicaid cuts in the House Republicans’ “One Big Beautiful Bill,” advocates and experts are assessing the situation at the state level, and a bleak picture is emerging.

In Illinois, nursing home and long-term care facilities could have severe consequences, according to a story in the local affiliate of NPR News. These cuts threaten the quality and availability of care for low-income seniors and people with disabilities who rely on Medicaid to cover extended stays in such facilities.

Medicare only pays for up to 100 days of nursing home care, leaving Medicaid as the primary payer for long-term stays and in the state. Meanwhile, Medicaid covers about 70% of nursing home days, amounting to $3.8 billion in federal funding in fiscal year 2024. 

“Medicaid is the payer for disability services, nursing home services – it is usually the only payer for a lot of these services,” Susan Agrawal, director of the family-to-family health information center at the Arc of Illinois, an organization that advocates for people with developmental and physical disabilities, told NPR. “Without Medicaid, we do not have a disability system here in the United States. Medicaid is our disability system.”

Experts warn that reduced federal funding would force state and local governments into budget crises they can’t compensate for, putting essential services at risk.

Advocates fear that diminished funding will lead to facility closures, worsened staffing shortages, and a decline in the quality of care. Illinois has already seen 50 nursing home closures over the past five years. If more shut down, it would displace vulnerable residents and burden their families.

“When those facilities close, it’s not just a business, it’s not just employees losing their jobs, it’s residents having to relocate the home that they may have been in for five years, three years,” Ron Nunziato, the senior director of policy for the Health Care Council of Illinois, told NPR. “It’s putting a strain on families.”

The proposed legislation would also halt efforts to increase staffing levels at nursing homes, which many say are already dangerously low. Without mandated staffing increases, care quality may decline, increasing risks for residents. Staff already report being overburdened, sometimes caring for up to 15 residents per shift without breaks.

Other changes include stricter eligibility checks every six months and a reduction in retroactive Medicaid coverage from three months to one, complicating enrollment for patients needing urgent care after hospitalizations.

Cuts could also impact people with disabilities outside of institutions. Reduced funding for personal care aides, assistive equipment, and home modifications could force individuals into institutional settings, despite advocacy efforts to promote independent living. Without Medicaid, many would have no access to these critical services.

“That’s a great fear that we have of this too, it will lead to more institutionalization and that is something we try to prevent, and our entire community tries to prevent that as much as possible,” said Samantha Alloway, executive director of the Arc of Illinois. “Lack of services, less services and often that can lead to more crisis situations … And that is a great fear, too, for many families: Where will we go?”