As reported in the New York Times on July 21, the federal government may withhold $1 billion in Medicaid funds from California and Minnesota. The federal action appears to target areas that the Centers for Medicare & Medicaid Services considers vulnerable to fraud, including certain in-home personal care services and other long-term support claims. According to the administration, a significant portion of the California review involves in-home care services, which could include programs closely related to the supports that keep seniors and people with disabilities living independently.

For organizations serving older adults — such as Bet Tzedek’s Holocaust Survivor Justice Network and our Elder Justice programs — the areas most likely to be affected by prolonged federal-state disputes include:

In Home Supportive Services and personal attendant services

Home- and community-based services

Long-term services and supports

Programs that help seniors avoid nursing home placement

It’s true the federal government has stated that these are payment deferrals, not benefit cuts, and that beneficiaries’ eligibility and services are not currently being terminated as a result of the action. Others have pointed out that the withholding (about $867.5 million to California) is small given California’s Medicaid program cost $150 billion in 2024. Many have alleged that the targeting of California and Minnesota, two democratic states, is purely political.

Ultimately, the fact remains that a sustained federal withholding of Medi-Cal funds could negatively affect services relied upon by Holocaust survivors and other low-income seniors. That risk would likely be greatest in the long-term care, IHSS, and home-care sectors that many of our clients depend on. Here are just some of the services that could be cut back, with community members ultimately bearing the brunt of these changes:

IHSS is one of California’s most significant Medi-Cal-funded programs. It provides:

Personal care assistance

Bathing, dressing, eating, and mobility support

Homemaker services

Assistance that allows older adults and people with disabilities to remain at home rather than enter institutional care

Medi-Cal pays for a broad range of long-term care services, including:

Nursing facility care

Skilled nursing facility services

Intermediate care facilities

Home- and community-based services (HCBS)

Long-term care supports for people with chronic illnesses and disabilities

For people enrolled in both Medicare and Medi-Cal (“dual eligibles”), Medi-Cal helps pay for:

Long-term services and supports

Medicare cost-sharing

Services not covered by Medicare

In short, this means low-income, elderly people will go without necessary care and medicine. While some may, as a result, face worsening health, others will face institutionalization. Sadly, even securing treatment from an institution may not be realistic given the Department of Justice’s recent interpretation of the Supreme Court’s landmark decision in Olmstead v. L.C. arguing that federal disability laws in fact does not impose a meaningful obligation on states to provide services in the most integrated setting, and that institutionalization is permissible so long as it can be “justified.”

We must come to terms with the fact that our social safety programs are not a net that catch a few “unlucky” individuals. They are a necessary part of our infrastructure that protect community members that are our grandparents, parents, friends, family, and other loved ones. This infrastructure must be protected, not dismantled, particularly during this time of economic instability.