Many health-care advocates tout the benefits of home-based care rather than sending loved ones to nursing homes or other facilities. For Medicaid recipients in Florida, however, home-based care can be difficult to find because of long waiting lists and high turnover among underpaid home-care workers. There's some hope that lawmakers in Congress could agree - and pass a new, "slimmed down" version of President Joe Biden's Build Back Better plan, with $150 billion for Home and Community-based Services.

Miriam Haramatz, founder and advocacy director for the Florida Health Justice Project, said the funding needs are critical because too many people are fending for themselves.

"One of our clients had to go days without services," she said. "She is in bed after a stroke; she needs aides to come and operate a Hoyer lift. She was going virtually every weekend without any aid."

Harmatz said caregivers often are paid less than $11 an hour to provide intense, round-the-clock care while juggling other duties. She said she sees an infusion of federal funding as a way to help states take people off wait lists, increase worker pay and provide other critical services.

Amber Christ, director of Health Policy and Advocacy for the group Justice in Aging, said chronic underfunding is making it difficult for Floridians to get the proper care they need where they want to receive it - at home with loved ones.

"From an older adult perspective," she said, "this lack of investment in home- and community-based services in effect pushes older adults into nursing facilities, unnecessarily."

Democrats in Tallahassee have put forward a bill to establish a Medicaid "buy-in" program for people between ages 16 and 64 who earn too much to qualify for Medicaid. They've also proposed a bill requiring the state's Social Services Estimating Conference to develop 'iBudget' enrollment and cost projections, so state economists can better track the number of folks on wait lists, which averages around 22,000.

New York could see major effects from President-elect Donald Trump's proposed budget cuts.

Elon Musk and Vivek Ramaswamy's Department of Government Efficiency is set to slice $2 trillion in federal spending. While their focus is cutting agency budgets and the government's workforce, safety nets will be in their crosshairs.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said states will have flexibilities if cuts occur, but they will make using services harder.

"In practice, these flexibilities will mean things like cutting back eligibility, adding red tape so that it's harder for families and people to get through the process, which cuts down on enrollment," Alker explained. "We know that from the unwinding that we've just been through."

She added benefits could be limited and providers who see a lot of low-wage working families might face reimbursement cuts. There has been consideration to cut Medicaid's expansion match rate to a regular rate, which would move most costs to states. Estimates show New York's cost for expansion group under a reduced federal match rate could be more than $5 billion, if it occurs.

The Supplemental Nutrition Assistance Program could face cuts as well.

Mayra Alvarez, president of the Children's Partnership, said the proposed changes outlined in Project 2025 could make the program harder to access while increasing inefficiencies.

"Everything from increasing time limits for the program for adults without dependents," Alvarez outlined. "Also, eliminating categorical eligibility, which would remove the state options of increasing the gross income limits from 130 % of the poverty line to up to 200%."

In 2022, 53% of SNAP participants in New York were families with children, and close to 3 million people statewide relying on the program. Nationwide, SNAP has helped lift more than 3.4 million people out of poverty in 2023.

In the Wyoming governor's new supplemental state budget, the biggest line item by far is wildfire recovery.

Gov. Mark Gordon on Monday gave a virtual speech to kick off several days of agency budget meetings, in which legislators request supplements to the 2025-2026 biennial budget adopted in March.

Gordon noted the historic nature of the 2024 wildfire season, which he said burned 850,000 acres across the state and cost more than $55 million in suppression efforts. The price tag emptied several state coffers, he said, and he requested $130 million be added to the new budget for similar purposes.

"Without further appropriation, Wyoming will not have sufficient unobligated funds to effectively respond to future fires or other potential emergencies such as flooding or rapid runoff or massive winter and spring snowstorms," Gordon contended. "Which as we know are not uncommon to Wyoming."

The funds would also help with recovery efforts after wildfire, such as preventing invasive plant species from taking over burned landscapes and providing assistance to restore lost infrastructure and stabilize watersheds.

Gordon also requested funds to both mitigate past federal actions and prepare for future ones. One example is the federal COVID-era American Rescue Plan Act, designed to fund local governments' infrastructure projects. The deadline for the plans was this year. Many proposed project in Wyoming were delayed, Gordon said, because of "federal deadlines and supply-chain issues." He asked for more than $20 million in mineral royalty grants to fill the gaps.

"The unprecedented influx of federal programs, beginning with the CARES Act, skewed Wyoming's homegrown approach to addressing community emergencies and needs," Gordon argued. "This is the time we can return to the more conservative and direct approach our state is accustomed to."

Gordon also asked for two additional senior attorneys to be funded for the Attorney General's Office to continue challenging federal regulations, which, he said, "hinder our ability to manage agriculture, energy, water and wildlife."


get more stories like this via email

As President-elect Donald Trump prepares to take office, federal health programs affecting 85 million low-income Americans, including more than 12 million in California, may face cuts to reduce inflation and debt.

As of 2024, California has the largest state Medicaid program in the U.S. Programs such as Medicaid, CHIP, and SNAP could be affected by fiscal tightening in the upcoming year.

Mayra Alvarez, president of the Children's Partnership, told an Ethnic Media panel Medicaid cuts would deeply affect families.

"It's these public programs that are core to helping families meet the day-to-day needs of raising healthy kids," Alvarez contended. "These have been bipartisan programs that have helped our families thrive."

Political experts said Congress is expected to act swiftly on its agenda next year, with key actions likely starting in January, before the presidential inauguration.

Medicaid is funded by the federal government and individual states but each state runs its own program.

Joan Alker, executive director of the Georgetown University Center for Children and Families, who also participated on the panel, said cuts to the program will have widespread effects.

"Medicaid accounts for about 56% of all federal money that is flowing to states, is coming in through Medicaid," Alker pointed out. "If we do see big cuts to Medicaid, that will affect all areas of states' budget."

Key proposals include setting federal funding caps, reducing federal match rates, and eliminating mandatory benefits such as nursing home care. Medicaid advocates are also concerned plans to replace benefits with private insurance vouchers could offer less coverage.