Industry Experts React to Trump’s “Big Beautiful Bill”

Trump’s One Big Beautiful Bill was signed into law on July 4, and it will have widespread effects on the country, but it’s poised to have a tremendous impact on the senior care industry. According to the KFF, the Congressional Budget Office estimates that the bill’s implementation of Medicaid work requirements will reduce federal Medicaid spending by $326 billion over 10 years. An earlier Congressional Budget Office analysis of the House version of the bill estimated that by 2034, Medicaid coverage will decrease by 5.2 million adults. Among other implications of the bill, the cuts to Medicaid pose a significant threat to the senior care industry.

Initial Reactions to the Bill

Dr. Ahzam Afzal, CEO and Co-Founder of Puzzle Healthcare

Initial reactions to the bill highlight widespread concern over the potential implications of Medicaid funding cuts. Dr. Ahzam Afzal, CEO and Co-Founder of Puzzle Healthcare, says the bill is a turning point in healthcare policy, but compares it to the eye of a storm for the senior care industry. “While it may reduce federal spending in the long run, its blunt reductions to Medicaid funding and provider tax mechanisms introduce major destabilization risks for both skilled nursing facilities and home and community-based service programs,” he says. “Facilities that were already operating on razor-thin margins now face tough choices: reduce staff, limit admissions, or shutter entirely.”

Most notably, the bill doesn’t just cut spending for senior care communities, but shifts pressure to nursing homes which already operate on stretched budgets.

Jeremy Gurewitz, Co-Founder and CEO at Solace Health, shares that he is alarmed by the bill’s passage, since it jeopardizes care for Medicaid-dependent seniors that his organization supports. “My initial reaction is that these cuts undermine our mission to ensure dignified care for seniors, increasing financial and emotional burdens on families,” he says.

John Enwere, Co-Founder and Media Lead at Caringene, echoes those sentiments, and notes that the bill feels disconnected from the reality he sees in his on-the-ground work. “A lot of families are already struggling to find affordable care,” he says. “Removing Medicaid now is like pulling the last bit of support out from under them, and it’ll have a wide range across our country.”

How the Bill Will Affect the Industry

Kelly Arduino, Healthcare Industry Leader at Wipfli

Kelly Arduino, Healthcare Industry Leader at Wipfli, predicts that the Medicaid cuts will significantly impact healthcare providers. These cuts will particularly affect hospitals in urban areas serving low-income populations, as well as hospitals in rural areas, which see a disproportionate number of Medicaid patients. “Both of these categories of hospitals already operate on razor thin margins and the additional matching funding from the Federal government in addition to State payments can be the difference between being solvent and not,” explains Arduino.

While the Medicaid cuts will ripple throughout the industry, Dr. Afzal believes that skilled nursing facilities will likely bear the brunt of the cuts. He notes that Medicaid funds more than 60 percent of skilled nursing facility stays in many markets. “As provider taxes are slashed and optional benefits like home and community-based service waivers come under threat, we’re expecting an influx of patients into skilled nursing facilities who would otherwise be supported at home,” he explains. “Yet most facilities don’t have the workforce or infrastructure to handle that influx.”

He predicts that facilities could face a double jeopardy scenario in which demand increases but reimbursement does not. “That’s a dangerous combination, and it could trigger closures, particularly in Medicaid-dependent or rural markets,” says Dr. Afzal.

John Enwere, Co-Founder and Media Lead at Caringene

He adds that the bill doesn’t just impact skilled nursing facilities, but that it affects the entire long-term care system. “Cutting home and community-based service waivers could push tens of thousands of patients into nursing homes unnecessarily, especially in states like Idaho that lack sufficient skilled nursing facility capacity or staffing,” explains Dr. Afzal. “That bottleneck will create a cascade effect: hospital discharges get delayed, emergency departments get overcrowded, and patients end up stuck in higher-cost settings due to lack of alternatives.”

Enwere predicts that the bill’s cuts won’t just reduce funding for home care, but will erase access. “Seniors who might need just a few hours of help per day won’t get anything, which leads to bigger problems down the line,” he explains.

Preparing for Potential Impacts of the Bill

Arduino encourages senior care communities to start preparing now for the bill’s potential impact. “If you don’t have a foundation set up and running, do so. It will be essential to supplement operational revenue with private funds,” she says. She also recommends communities explore expanding their services into wellness areas that have historically been private pay, such as med spa, nutrition and cooking classes, and gym memberships, but which are also consistent with the community’s mission. “Ramp up the speed and plan for greater automation to fill the labor gap, meet demand, and point internal and external staff for highest and best use,” she advises.

Preparations to address the bill’s effects are already underway at Puzzle Healthcare. The company is enhancing patient care by using predictive analytics to identify at-risk patients before discharge, implementing remote monitoring to extend support into homes, deploying 24/7 escalation teams to manage clinical events in real time, and embedding care managers in facilities to improve quality and engagement.

“In many ways, our playbook has been written for this exact moment,” says Dr. Afzal. “But we’re also working with our partner facilities to assess their Medicaid exposure, strengthen outcome metrics, and ensure they’re aligned with value-based benchmarks that will be prioritized in future reimbursement models.”

Jeremy Gurewitz, Co-Founder and CEO at Solace Health

Caringene is also actively preparing for the anticipated cuts. The company is currently reviewing pricing, reducing its reliance on Medicaid referrals, and focusing more on private-pay families.

According to Gurewitz, Solace Health is pushing for increased state funding to help offset Medicaid cuts, while also partnering with local agencies to expand senior telehealth services and encouraging families to consider private pay options. “Our goal is to help facilities optimize their staffing through cross-training,” he explains. “After all, efficiency is key. We are also working with community groups to find partners who can help provide low-cost HCBS services, which we hope will lower reliance on nursing homes.”

Actions for the Senior Care Industry

Dr. Afzal urges senior care industry operations to perform a financial self-assessment, asking:

• What percentage of our revenue is Medicaid-dependent?
• What is our home and community-based service footprint and exposure?
• Where are our staffing gaps, and what is our plan if volume increases without funding?

Providers should also prioritize clinical outcomes, as payers will favor skilled nursing facilities that lower readmissions and control overall care costs. “We need to advocate collectively,” he says. “Industry leaders must push for legislative reforms that reinstate provider tax flexibility, preserve home and community-based service programs, and protect access in rural markets. Without policy changes, the financial and operational burden will fall squarely on the backs of skilled nursing facilities.”

Gurewitz emphasizes that the senior care industry must push for increased state and federal funding, particularly as rural facilities face the risk of closure. He also recommends greater investment in staff retention to reduce turnover costs, along with cost-saving initiatives such as energy-efficient upgrades to lower operating expenses.

“We are entering a new era of post-acute care—one where survival hinges on strategic agility,” says Dr. Afzal. “The facilities that will thrive are those that don’t wait for the crisis to hit before they act. Whether through technology, staffing innovation, or cross-continuum partnerships, the senior care industry must evolve quickly to protect patient access and organizational viability.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.