Community Health & Wellness

Care facilities monitoring Medicaid, immigration changes

Posted on August 4th, 2025 By: Conor Wilson

Long-term care providers in Washington are not experiencing staffing losses from recent immigration crackdowns, officials say, despite reports of that happening elsewhere in the country.

Yet they remain concerned about how the Trump administration’s hard-line immigration policies could worsen existing staffing shortages at a time when demand for care is rising as the population ages.

Providers have long relied on foreign-born workers to fill critical and often low-wage jobs, said Carma Matti-Jackson, president and CEO of the Washington Health Care Association. The association represents 560 skilled nursing and assisted living facilities.

Foreign-born work force

About a quarter of those working in long-term care are born outside the country.

“To be honest, we just don’t have a lot of folks lining up for these jobs because they’re hard,” she said. “We need these folks that are working for us.”

The federal government has designated decade health care facilities as sensitive locations for about a decade. Places of worship and schools have the same designation, which prevented Immigration and Customs Enforcement agents from taking enforcement actions there.

President Donald Trump suspended those rules after taking office. The administration claims to only target criminals and the “worst of the worst,” but multiple news agencies have reported the majority of those being apprehended now do not have criminal records.

Although reliable data is not available, few long term care workers are believed to be undocumented due to the requirements imposed on facilities that accept government insurance.

But as arrests have ramped up and become less targeted, some speculate that more foreign-born residents will avoid settings where they risk interacting with immigration agents. That could be troublesome for long-term care providers.

“Most nursing homes have had a staffing crisis for many years,” said Rachel Prusynski, an assistant professor and researcher for the University of Washington Center for Health Workforce Studies. “The immigration crackdowns will make it worse.”

Aging population

The Center for Health Workforce Studies and state Workforce Board have spent the last three years studying the long-term care workforce and developing policies to address the glaring gap for workers as the Baby Boomer generation reaches retirement age.

Adults over 65 in Washington are expected to grow by 14% by 2030, according to a legislative report produced last year, more than double the state’s overall growth rate. More than half are expected to need some form of long-term care, putting an even greater demand on the industry.

“Health policy and immigration policy are undoubtedly linked. There’s no way to separate the two,” Prusynski said. “People I don’t think realize how much our health system is buoyed by immigrants.”

Long-term care providers have already been struggling to rebuild after the pandemic and find workers, said Patricia Hunter, Washington’s long-term care ombudsman and president of the National Association of State LTC Ombudsman Programs.

Losing more staff could be consequential. Extensive vacancies can result in service delays, worse patient outcomes and decreased profitability for providers.

“It’s not pretty out there at the end of the day,” Hunter said. “If you don’t have the right staffing levels, the person who suffers is the vulnerable adult.”

Residents have concerns about Medicaid

Hunter, who is responsible for representing residents of long-term care facilities, said she has been hearing frequent concerns about Medicaid benefits after Congress last month passed the so-called One Big Beautiful Bill.

Medicaid, the state-federal insurance program for Americans with disabilities or low incomes, is expected to see nearly a $1 trillion reduction over the next decade.

Cuts would come specifically from the Medicaid expansion population, those who received benefits under the Affordable Care Act, said Matti-Jackson, the association CEO. The traditional Medicaid population, which includes the majority of those served by long-term care providers, would not see direct impacts.

However, they could experience adverse consequences from reductions to the system at-large. The state, for example, could reduce payments to long term-care to balance the fallout from the federal bill, she said.

Another issue is older adults who need hospital care before coming to an assisted living or skilled nursing facility will likely see worse access. The decline in Medicaid is expected to drive more uninsured patients to the emergency room for minor issues.

“We’re just causing a bigger surge in impact on an already backlogged hospital system,” Matti-Jackson said. “That impacts our seniors ability to get in there and get the care that they need before they come to assisted living or skilled nursing facilities.”