TL;DR
A Milken Institute publication released Oct. 20 warns that care-worker shortages and Medicaid cuts threaten access to in-home support, leaving families to fill gaps. The report’s contributors call for stronger funding, care coordination and policies that support both older adults and caregivers; the scale and timing of any Medicaid effects remain unclear.
A Milken Institute publication released Oct. 20 warns that shortages of paid care workers and Medicaid cuts could make it harder for older adults to receive care at home, pushing more responsibility onto relatives. Contributors say the resulting pressure can affect family caregivers’ jobs and finances, and call for stronger payment systems and coordination across health and community services.
The publication, A Decade of Progress, A Decade to Act, brings together essays and practitioner perspectives from the institute’s Future of Aging and Longevity team. Diane Ty, the team’s managing director, said paid caregivers are difficult to find in some areas, so families are already taking on care that might otherwise be provided by workers. She said federal immigration enforcement has worsened existing labor shortages; that is her assessment, and the source material provides no workforce figures to quantify the effect.
When paid care is unavailable, relatives may have to cut work hours or leave jobs. Ty said that can reduce current household income as well as retirement contributions and future Social Security benefits. She warned that Medicaid cuts could add to these pressures, but the report material does not specify particular cuts, their implementation dates or how many households could be affected.
The publication also points to the effects on young people. An essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean Feylyn Lewis says about 4 million U.S. children under 18 are family caregivers, while another 5 million young people combine caregiving with postsecondary education. Those figures are presented in the essay; the supplied report does not give a measurement period or further methodology.
Family Care Can Carry Economic Costs
The issue reaches beyond the availability of home-care visits. If relatives compensate for gaps in paid support, the burden can show up in lost wages, reduced retirement savings and less time for education. Ty also said lower employment could mean less tax revenue for governments, though no estimate of that potential effect was provided.
For older adults, the availability of dependable care at home can shape whether they can continue living in their communities. The report’s authors argue that care should be treated as essential public infrastructure, with services designed around people’s needs rather than fragmented programs. These are policy arguments in the publication, not evidence that a specific new policy has been adopted.
The Report’s Proposed Care Model
In an essay in the publication, Sarita Mohanty, president and CEO of The SCAN Foundation, and Kapil Dhingra, a physician leader at Kaiser Permanente, call for affordable long-term care at home and better coordination for people enrolled in both Medicare and Medicaid. They identify the federal Program of All-Inclusive Care for the Elderly (PACE) as an example of connecting medical care with community support. PACE offers eligible older adults nursing-home-level care while they live at home or in the community.
Mohanty and Dhingra argue that expanding integrated home- and community-based care requires payment frameworks that reward whole-person outcomes, improved data sharing between health systems and community organizations, and meaningful involvement of families in designing services. Ty described the needed response as coordinated systems and policy change, rather than a series of isolated reforms.
““They’re going to have real impacts on families who are already stressed with affordability, and then they’re going to have to make tough decisions about work.””
— Diane Ty
Scale of Medicaid Effects Is Unclear
The supplied report material does not identify the specific Medicaid cuts at issue, their timing, or the number of people whose home-care services may change. It also provides no figures measuring the size of local caregiver shortages or how much immigration enforcement has contributed to them. The publication presents warnings and policy proposals; it does not establish that all families will lose services or that every caregiver will reduce paid work.
The cited totals for young caregivers are not accompanied in the source material by a survey period or detailed methodology. The actual effects will depend on policy decisions, local labor supply, eligibility rules and the availability of other services.
Policy and Funding Decisions Ahead
The publication’s contributors call for governments and health care providers to strengthen payment frameworks, improve coordination and expand integrated home- and community-based care. Ty said the aim should be to scale effective approaches over the coming decade. The source material does not announce a new federal policy, funding commitment or implementation schedule, so the next developments will depend on decisions by policymakers, health systems and community organizations.
Key Questions
What did the Milken Institute publication warn about?
It warned that care-worker shortages and Medicaid cuts could make home-based support harder to access and shift more caregiving onto families.
How could family caregivers be affected at work?
Diane Ty said some relatives may need to reduce work hours or leave jobs. She said that could affect both current income and future retirement benefits; the report does not quantify how many people may face those choices.
What does the report say about young caregivers?
An essay in the publication cites about 4 million U.S. children under 18 as family caregivers and another 5 million young people balancing caregiving with postsecondary education. The supplied material does not state the figures’ measurement period.
Does the publication announce a new Medicaid policy?
No. It offers warnings and recommendations, including stronger funding and care coordination. The source material does not specify particular Medicaid cuts or announce a new policy or implementation date.
Source: homehealthcarenews.com
