Jennifer Foushee is worried she and her friends could lose their home if Congress makes cuts to Medicaid. Foushee, 40, is among the thousands of people who use the public health insurance program to pay for long-term, residential care in their communities. For the last 13 years, she has lived at Clinton Manor Living Center in New Baden, a nursing home that also cares for adults like Foushee who have developmental disabilities.
She is watching discussions around new budget proposals in Washington, D.C., to find out whether her fears will become reality. With only Republican support, the House of Representatives recently passed a resolution that provides a framework for President Donald Trump’s budget priorities, including tax and spending cuts. It specifically calls for the House Energy and Commerce Committee to cut $880 billion in health care spending over 10 years, $88 billion annually.
People believe Medicaid will be affected by those cuts despite statements to the contrary from Republicans because the program accounts for 93% of the spending under that committee’s jurisdiction excluding Medicare, according to an analysis by the nonpartisan Congressional Budget Office that House Democrats requested. (Medicare is under the jurisdiction of more than one committee.) Medicaid covers a significant portion of the cost of long-term care and other types of community housing.
Most nursing homes rely on Medicaid for around 75% of their budget, according to Ron Nunziato, an official from the trade association Health Care Council of Illinois. At Clinton Manor, 90% of its costs are covered by Medicaid because of the additional residents with disabilities.
“What are we gonna do?” Foushee said of Medicaid recipients in long-term care. “I can’t move back into my parents’ house; they’re getting older. This place gives me a chance to live a semi-normal life.”
Republicans, who control the House and Senate, still need to write a bill that details exactly where cuts will be made and convince enough members inthe House, where they have a slim majority, to vote for it.
Foushee wants elected officials to know about her fears as they prepare to put their spending framework into action in a budget reconciliation package, a process that could reportedly start as early as May 5. She sent letters to Trump and several members of Congress, including U.S. Sen. Tammy Duckworth, D-Illinois; U.S. Rep. Mike Bost, R-Murphysboro, whose district includes New Baden; and U.S. Rep. Jasmine Crockett, D-Dallas, a vocal critic of the Trump administration from Foushee’s home state of Texas.
Foushee has also been speaking out about the Trump administration and disability rights in videos posted on the social media platform TikTok, where she shares her opinions, her experiences with cerebral palsy and footage of her life — from doing physical therapy exercises to listening to music and cheering on the St. Louis Blues at a hockey game.
“I never thought I would see so many programs in different aspects of the government being up for debate,” Foushee wrote in the letter, which she also shared on TikTok. “… I implore you to think before you react and start doing irreversible damage.”
White House alleges fraud in public insurance programs Trump has repeatedly said Medicaid won’t be cut, except to eliminate alleged fraud.
In interviews since February, Trump has suggested fraud in Medicaid and the other public insurance programs, Medicare and Social Security, might include payments for ineligible enrollees, specifically those living in the country illegally and dead people.
The White House issued a “fact check” in March about waste, fraud and abuse and spending on Medicaid, Medicare and Social Security. The statement cited a number of government reports that estimated total fraud and payments to ineligible people across multiple programs.
Health care fraud was mentioned specifically in a U.S. Government Accountability Office report in the context of work the Department of Justice and the Department of Health and Human Services was already doing to take back fraudulently obtained money through civil settlements and judgments.
Another report mentioning Medicaid, specifically, was a fiscal year 2024 assessment by the Centers for Medicare and Medicaid Services that found $31 billion in “improper payments” through the program. But that assessment noted “not all improper payments represent fraud or abuse.” Most of the improper Medicaid payments were the result of “insufficient documentation,” typically when a state or provider missed an administrative step, according to the Centers for Medicare and Medicaid Services. The same was true of improper Medicaid payments in 2023 and 2022, past assessments show.
U.S. Rep. Nikki Budzinski, D-Springfield, characterized “waste, fraud and abuse” as a “completely empty” political slogan in an interview with the Belleville News-Democrat during a visit to the metro-east last week.
“It is infuriating to me that there is no specificity to what they’re talking about,” Budzinski said.
Republicans suggest ways to cut Medicaid
Despite Trump’s assurances about Medicaid, House Budget Committee Republicans have floated proposals for how to cut spending on the program, including:
- Cap federal Medicaid spending per person based on a new formula, which would increase based on medical inflation and not the actual costs of services.
- Estimated savings: Up to $900 billion
- Stop the federal government from paying 90% of the costs for recipients who enrolled in Medicaid under the Affordable Care Act’s expansion of the program to include single, childless and nondisabled adults under age 65 who have low incomes. The government would instead use the same reimbursement formula for them as it does other Medicaid recipients, bringing the federal share down to between 50% and 83%.
- Estimated savings: $561 billion
- Establish work requirements to qualify for Medicaid. The requirement would apply to adults with no dependents. It would not apply to people with disabilities or health-related barriers to employment, pregnant women or full-time students.
- Estimated savings: $100 billion
Medicaid is jointly funded by federal and state governments. Gov. J.B. Pritzker has said in multiple public statements that Illinois doesn’t have the money to fill the gap created by billions of dollars in proposed federal cuts. That means federal cuts will lead to reduced services and enrollment, according to the Illinois Department of Healthcare and Family Services.
“A per capita cap will force Illinois to limit benefits for people with disabilities, seniors, pregnant women, and children,” the agency stated in a presentation to state lawmakers. Department of Healthcare and Family Services Director Lizzy Whitehorn testified about Medicaid’s impact in Illinois to a state House budget committee in March.
Illinois stands to lose a projected $24 billion to $39 billion through 2034 from a federal spending cap, according to the agency. The state also has a “trigger” law that will take effect if Congress adjusts its reimbursement formula for the Medicaid expansion group. About 770,000 low-income people across Illinois who are part of that group would automatically lose coverage if the federal match falls below 90%.
The Department of Healthcare and Family Services also raised concerns that thousands of eligible people could lose coverage in Illinois due to administrative errors if work requirements are imposed, based on what has happened in other states. Of the people kicked off of Medicaid when Arkansas imposed work rules in 2018, 97% were compliant or had exemptions but still lost coverage, the Illinois agency noted in the presentation to lawmakers.
How cuts would affect the metro-east:
In New Baden, Clinton Manor Living Center CEO Michael Brave said the facility would struggle to pay employees and offer the same services they do now if there are federal cuts to Medicaid. Most of the facility’s Medicaid dollars pay for personnel, Brave said. With 231 staff members, Clinton Manor is the largest employer in New Baden and likely the western portion of Clinton County, Administrator Cheryl Smith said.
Clinton Manor detailed some of its daily workload in information shared with Congressman Bost’s office: Staff provide 1,421 medications and 448 treatments per day, for instance. The facility cares for a total of 88 residents.
The prospect of funding cuts is also hampering expansion plans at Clinton Manor, which includes building a ninth group home for its residents with disabilities who want to live more independently. Foushee said she’d like that option, but there’s a waitlist and she needs a home with the space and equipment for an electric wheelchair user.
BRIA of Belleville Administrator Amy Merritt said most facilities, including hers, will have to scale back if there are federal cuts. Medicaid accounts for more than 80% of BRIA of Belleville’s budget. It has 110 residents.
“It’s gonna be scrutinizing down to the last dollar on things,” Merritt said. Reduced federal funding could put some struggling facilities at risk of closure, limiting access to care particularly in rural communities where there are fewer long-term care options, according to Nunziato, the trade association official. He is the senior director of policy and regulatory engagement for the Health Care Council of Illinois.
Depending on how steeps the cuts are, Brave said closure could be a possibility for lots of nursing homes, even Clinton Manor. He said it may also push facilities into bankruptcy, meaning locally-owned buildings like Clinton Manor might be taken over by conglomerates that don’t have the same goals and high standards for care.
Like Foushee, other people from the metro-east have been voicing concerns to their representatives in Congress, including officials from Chestnut Health Systems. They had a roundtable discussion with Budzinski last week to talk about Medicaid cuts. Chestnut is a safety net for the community, said Amy Gibbar, the nonprofit’s vice president of integrated care. It helps keep people with mental health conditions and substance use issues from experiencing homelessness or filling up hospital emergency rooms and jails by providing treatment, primary medical care and housing options.
Belinda Gunning, the director of mental health for Chestnut, compared the possible cuts to natural disasters that leave devastation in their wake.
“That’s what this is gonna do to the services that we provide,” Gunning told Budzinski. “In any disaster, it takes years to come back from that. “When I started providing services in Illinois, there were over 277 agencies providing services. Now we’re down to 150-160. … That number’s gonna go down even more.” Chestnut gets more than 22,000 calls a month from people in St. Clair and Madison counties reaching out for help, according to Gibbar. She said nearly all of the people Chestnut serves — 85-90% — use Medicaid to pay for their care.
After the roundtable, Orville Mercer, a Chestnut board member and former regional director, said in an interview the proposed cuts will increase homelessness because providers like Chestnut will have to cut services. “There’s no question,” he said. “… There will be probably this retrenchment where we’ll begin to have to start all over and reinvent those in 10 years or 15 years, because the need is there.”
Where do Republicans stand on Medicaid cuts?
The metro-east’s Republican representatives in Congress, Mike Bost and Mary Miller, both voted in favor of the House resolution that sets up possible cuts to Medicaid. But a dozen other House Republicans who also supported the resolution have since come out against Medicaid cuts.
They sent a letter to House Speaker Mike Johnson and other Republican leaders saying they “cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.” “Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic security,” the representatives wrote.
Some Senate Republicans have also discussed tax hikes for the wealthy as another possible way to pay for GOP priorities in the budget reconciliation package, though Trump has been critical of the idea.
Bost, R-Murphysboro, declined the BND’s request to discuss whether he would oppose or support cuts to Medicaid in the budget and how he came to his position. His office responded to the interview request with a written statement: “We’re working to preserve Medicaid for people who truly need help and ensure it remains solvent for generations to come,” he wrote. “While I don’t serve on the committees that will identify these reforms in the budget, I share in the belief that we must streamline access to benefits for vulnerable families and make government more efficient,” Bost added. “We should provide healthy, working age individuals the tools they need to thrive without a long-term dependence on government assistance.”
Miller, R-Hindsboro, didn’t respond to multiple requests for comment sent to congressional staffers in March and April. In that time, Miller has released official statements on other issues, including anti-transgender, abortion and immigration policies.
Foushee, meanwhile, thinks the public health care system could use more money, not less. There are aspects of her life she tolerates but wishes were different, like the small bedroom she shares with a roommate with only a curtain to separate their spaces. They both use electric wheelchairs and need other equipment to help them get into bed. It can get cramped. She would prefer a single room, but it isn’t an option at the moment and won’t be for a while under the threat of cuts, said Brave, the facility’s CEO.
Foushee also noted that she receives a small stipend from Medicaid— a monthly $60 “personal needs allowance” — for things like clothes, haircuts and entertainment. For many years, it was $30. She said she has had to sell her belongings to afford more expensive things she wants, like tickets to go see musical performances. “I wish we could take Donald Trump and transplant him and put him in my position and see how he likes it for a year,” Foushee said. “I bet you he would not be happy. He wouldn’t be able to fit in the shoes I’m sitting in right now or some of my friends are sitting in right now.”
