U.S. Long-Term Care Threatened by Immigration Crackdown and Medicaid Cuts

Key Takeaways

• 28% of LTC workforce are immigrants; 15% undocumented, facing deportation risks.
• Medicaid funds over 60% of nursing home residents; $880 billion cuts proposed.
• 700,000+ awaiting Medicaid LTC services; workforce shortages and low pay threaten care quality.

The U.S. long-term care (LTC) system is facing a period of deep uncertainty and risk. Two major policy shifts—an aggressive immigration crackdown and sweeping Medicaid cuts—are converging to threaten the stability of care for millions of older adults and people with disabilities. This analysis examines the scope and impact of these changes, drawing on recent data, official statements, and industry trends. The goal is to provide a clear, evidence-based overview for stakeholders, including providers, families, policymakers, and the general public.

Purpose and Scope

This report aims to:

• Explain how recent immigration enforcement and Medicaid cuts are affecting long-term care in the United States 🇺🇸
• Present key data and trends about the LTC workforce, funding, and service delivery
• Analyze the practical effects on providers, workers, and care recipients
• Summarize expert opinions and policy responses
• Offer practical guidance and identify resources for those affected

The analysis covers developments up to May 30, 2025, focusing on federal actions and their nationwide implications.

Methodology

This content is based on:

• Official government data (Centers for Medicare & Medicaid Services, U.S. Congress)
• Industry statements (American Health Care Association, American Hospital Association)
• Recent news reports and policy analysis
• Direct quotes and statistics from the provided source material
• Review of regulatory updates and legislative proposals

All information is presented objectively, with clear explanations of technical terms and processes.

Key Findings

• Immigrants make up a critical share of the LTC workforce: 28% of all workers and 33% of home care workers are immigrants. About 15% of immigrant LTC workers are undocumented.
• Medicaid is the main funder of long-term care: Over 60% of nursing home residents rely on Medicaid for payment.
• Recent policy changes threaten both workforce and funding: Immigration crackdowns are leading to deportations and work authorization problems, while the House-passed budget bill would cut $880 billion from Medicaid over 10 years.
• Service access is already strained: More than 700,000 people are on waiting lists for Medicaid-funded LTC services.
• Low pay and poverty are widespread among LTC workers: The average home care worker earns just under $22,000 per year; 40% live at or below the poverty line, and over half rely on public assistance.
• Quality of care is at risk: Studies link higher immigrant staffing to better care outcomes; losing these workers could lower quality and safety.

Data Presentation and Visual Descriptions

To help readers picture the current state of long-term care, consider the following visual breakdowns:

Workforce Composition

• Pie Chart: Imagine a pie chart showing the LTC workforce. Nearly one-third of the chart is shaded to represent immigrant workers (28%). A separate slice, about one in seven of those, is marked as undocumented (15% of immigrant workers).
• Bar Graph: A bar graph could show the difference in workforce makeup between nursing homes and home care agencies, with home care relying even more heavily on immigrants.

Medicaid’s Role

• Stacked Bar Chart: Visualize a bar where over 60% of its height is labeled “Medicaid-funded residents,” showing how most nursing home care depends on this program.
• Line Graph: A line graph could show the steady growth of Medicaid spending on LTC over the past decade, with a sharp projected drop if the proposed cuts take effect.

Waiting Lists

• Map Visualization: Picture a map of the United States 🇺🇸 with states shaded darker where waiting lists for Medicaid LTC services are longest. Over 700,000 people are waiting nationwide, with some states facing especially long delays.

Worker Pay and Poverty

• Infographic: An infographic could show a home care worker’s paycheck—just under $22,000 a year—next to icons representing the 40% living in poverty and the 50%+ who need public assistance.

Comparisons, Trends, and Patterns

Historical Reliance on Immigrant Labor

The LTC sector has depended on immigrant workers for decades. This reliance has grown as wages have stayed low and working conditions remain demanding. U.S.-born workers are less likely to take these jobs, especially in home care, where the work is physically and emotionally taxing.

Medicaid as the Backbone of LTC

Since its creation, Medicaid has been the main way Americans pay for long-term care. Private insurance covers only a small share, and out-of-pocket costs are often unaffordable. Medicaid’s role has grown as the population ages and more people need help with daily activities.

Recent Policy Shifts

• Immigration Crackdown: Enforcement has increased, targeting both undocumented and some lawful permanent resident workers. Temporary Protected Status (TPS) has been rolled back, affecting thousands of LTC workers.
• Medicaid Cuts: The House-passed budget bill would slash $880 billion from Medicaid over 10 years, the largest proposed reduction ever. This is intended to fund border security and make the 2017 tax cuts permanent.

Impact on Access and Quality

• Workforce Shortages: Immigration enforcement is making it even harder to fill essential jobs. Facilities report growing vacancies, especially in direct care roles.
• Service Reductions: States facing Medicaid cuts may reduce services, cut payments to providers, and eliminate optional benefits like home-based care. Waiting lists are likely to grow.
• Provider Viability: Lower Medicaid payments could force wage cuts, layoffs, or even facility closures, shrinking the workforce and limiting care options.
• Quality of Care: Research shows that facilities with more immigrant workers tend to deliver better care. Losing these workers could harm both quality and safety.

Evidence-Based Conclusions

Based on the data and trends:

• The LTC system is at risk of destabilization. The combined effect of losing immigrant workers and cutting Medicaid funding could lead to widespread service reductions, facility closures, and loss of care for vulnerable populations.
• Workforce shortages will worsen. With nearly one-third of the workforce at risk due to immigration enforcement, and low pay making recruitment difficult, providers may struggle to maintain safe staffing levels.
• Access to care will decline. Medicaid cuts will force states to limit services, especially home-based care, which is not required by federal law. Waiting lists will grow, and some people may lose access altogether.
• Quality and safety are threatened. As experienced workers leave and facilities cut costs, the risk of poor care and safety incidents will rise.
• Insurance markets are unstable. Rising costs and regulatory uncertainty are making it harder for families to find affordable long-term care insurance.

Step-by-Step Processes and Procedures

For Providers

• Review and update compliance with new CMS surveyor guidance and staffing requirements. The latest guidance, effective April 28, 2025, focuses on resident rights, staffing, and quality of care. Providers should ensure all staff are trained and policies are up to date.
• Prepare for potential Medicaid reimbursement reductions. Providers should review budgets, identify areas for cost savings, and plan for possible service adjustments.
• Monitor workforce authorization status. Employers should support affected employees by connecting them with legal and advocacy resources, and keep up with changes in immigration policy.
• Advocate for policy changes. Providers can join industry groups in urging Congress and the administration to protect funding and workforce stability.

For Individuals and Families

• Check Medicaid eligibility and stay informed about state-level changes to LTC benefits. Each state administers its own Medicaid program, so rules and services may vary.
• Explore private LTC insurance options, but be aware that premiums are rising and coverage rules are changing.
• Contact local Area Agencies on Aging or state Medicaid offices for help with waiting lists and service access. These agencies can provide information about available services and how to apply.
• Monitor news and policy updates to stay aware of changes that may affect care options.

For more information on Medicaid and long-term care, visit the official Centers for Medicare & Medicaid Services (CMS) website.

Key Stakeholders and Perspectives

Industry Leaders

• American Health Care Association (AHCA): President and CEO Clif Porter has called for proactive solutions to workforce shortages and sustainable funding. He urges Congress and the Trump Administration to work with providers to protect access to care.
• American Hospital Association (AHA): Senior VP Ashley Thompson warns that proposed payment updates and outlier threshold increases would strain LTC hospitals, making it harder to care for the sickest patients.

Advocacy Groups

• Long-term care leaders are urging the Department of Homeland Security to halt deportations and reinstate TPS protections for workers.
• Advocacy groups are calling on Congress to reject Medicaid funding caps and preserve ACA Medicaid expansion.

Editorial and Policy Analysis

• John O’Connor of McKnight’s Long-Term Care News warns that the combined impact of immigration crackdowns and Medicaid cuts could destabilize the entire LTC system, risking facility closures and loss of care for vulnerable populations.
• Policy analysts emphasize the need for higher pay, career advancement, and training to attract and retain LTC workers.

State Officials

• State Medicaid directors face tough choices as they try to balance reduced federal funding with growing demand for services. Some states are considering public LTC insurance programs or regulatory reforms to stabilize the sector.

Limitations

• Legislative uncertainty: The Senate has not yet acted on the House-passed budget bill. The final outcome is unknown, and changes may occur during negotiations.
• Rapidly changing policy environment: Immigration enforcement and Medicaid rules are evolving quickly, making it difficult to predict long-term effects.
• State-level variation: Medicaid programs and LTC services differ by state, so impacts will not be uniform across the country.
• Data gaps: Some statistics, especially on undocumented workers, are estimates due to the lack of comprehensive data.

Future Outlook

• If the Senate passes the House bill, Medicaid cuts and immigration enforcement will likely intensify, with immediate and long-term impacts on LTC access and quality.
• Advocacy efforts are ongoing. Industry and advocacy groups are lobbying for policy reversals and increased funding, but the outcome remains uncertain.
• States may pursue reforms. Some are exploring public LTC insurance or regulatory changes to stabilize the sector.

Practical Guidance and Resources

• Providers should stay updated on CMS regulations, review workforce policies, and engage in advocacy.
• Individuals and families should check eligibility, monitor state changes, and seek help from local agencies.
• All stakeholders can find authoritative information and updates on the CMS website.

For further support, contact:

• American Health Care Association (AHCA): [email protected]
• Medicare Rights Center: www.medicarerights.org
• National Association of Area Agencies on Aging: www.n4a.org

Evidence-Based Summary

The U.S. long-term care system stands at a crossroads. The combined threats of an immigration crackdown and Medicaid cuts could disrupt care for millions, worsen workforce shortages, and lower quality. Immigrants are essential to the LTC workforce, and Medicaid is the backbone of funding. Policy changes in either area have immediate and far-reaching effects.

As reported by VisaVerge.com, industry leaders, advocacy groups, and policy analysts agree that urgent action is needed to protect both the workforce and funding for long-term care. The coming months will be critical as Congress debates the future of Medicaid and immigration policy. Stakeholders should stay informed, advocate for stability, and prepare for possible changes.

The situation is evolving rapidly. For the latest updates and official guidance, visit the Centers for Medicare & Medicaid Services (CMS) website.

Learn Today

Long-Term Care (LTC) → Services that help people with chronic illness or disability with daily living activities over an extended period.
Medicaid → A government health insurance program funding most long-term care services for low-income Americans.
Immigration Crackdown → Government enforcement actions targeting undocumented immigrants, impacting workforce availability in LTC.
Temporary Protected Status (TPS) → A temporary immigration status given to eligible individuals from designated countries to prevent deportation.
Workforce Shortage → A lack of sufficient qualified workers to meet the demand in the long-term care sector.

This Article in a Nutshell

The US long-term care system faces severe risks from immigration crackdowns and Medicaid cuts. Immigrants comprise 28% of LTC workers, with Medicaid funding over 60% of residents. Policy changes threaten workforce stability, worsen waiting lists, and endanger care quality, demanding urgent action from providers, families, and policymakers nationwide.
— By VisaVerge.com