Amy Bernard and her brother kept their mother out of a nursing home as long as they could, until Parkinson's and dementia took their toll and she was seriously injured in a fall.
Bernard is happy with her mother's nursing home care, but it comes at a steep price: $7,000 per month, an amount that would be way beyond the older woman's means if not for Medicaid, which picks up $3,000 of the tab.
Which is why Bernard and many other Americans like her are watching the health care debate on Capitol Hill with trepidation.
The Senate Republicans' plan to repeal and replace President Barack Obama's Affordable Care Act would cut projected Medicaid spending over the next decade by 25 percent.
Supporters of the bill say nursing home subsidies would not suffer significant cuts, but opponents say they are inevitable. The uncertainty is frustrating to those who rely on them.
In the case of Bernard's 83-year-old mother, retired teacher Franceen Golditch, the $4,000 that she receives each month from her pension and Social Security goes almost entirely to the nursing home.
"Without Medicaid supplementing, I don't know what would happen," said Bernard, a self-employed graphic artist in Boynton Beach, Florida. She added: "I have a house and kids to support myself. I honestly have no answer."
While the federal-state Medicaid program is most often associated with poor children and single mothers, almost two-thirds of its spending goes to the elderly and the disabled, even though they make up just 1 in 4 recipients.
The reason: Well over half the nation's 1.3 million senior citizens in nursing homes receive Medicaid. The burden is expected to balloon as the 74 million surviving baby boomers — those born between 1946 and 1964 — get older. They are 52 to 71 now.
In part because of the Medicaid cuts, the GOP bill lacks the votes to pass in the Senate, which is expected to take up the measure again after Congress' weeklong July Fourth recess.
The bill would cut Medicaid's projected budget over the next 10 years by a combined $772 billion, according to the Congressional Budget Office. That would decrease the amount projected to be spent federally on Medicaid during that time to about $4.2 trillion.
Even with those cuts, nursing home patients would continue to receive significant assistance because federal Medicaid spending would grow by 20 percent over the next decade from its current level, said Zach Hunter, a spokesman for the GOP-led House Committee on Energy and Commerce, which helped write the House version of the bill.
Meanwhile, he said, federal regulations would be eased, giving states more flexibility to tailor their programs.
The proposed changes are "an important step towards strengthening the Medicaid program and ensuring vital funds go to the most vulnerable," Hunter said. He said the bill makes provisions, for example, for possible medical advances such as drugs for Alzheimer's or other diseases of the aged.
Joe Baker, president of the Medicare Rights Center, an advocacy group that opposes the bill, said substantial cuts eventually would hurt those who rely on nursing home assistance.
"You can't say you are going to save a lot of money on kids and pregnant women because there isn't a lot of money there to save," Baker said. "Look at the population that is costing you a lot and, frankly, that is older adults and older adults who are 85-plus."
Medicare, the federal health insurance program that primarily covers people 65 and older, does not cover long-term nursing home care.
To qualify for Medicaid nursing-home coverage, unmarried senior citizens in most states must have incomes of less than $2,205 per month, including Social Security and pensions. Some states have a lower limit. The threshold is higher for married couples. Single people also must have drained their assets below $2,000, though there is an exemption for home equity.
People with higher incomes can become eligible if their medical and nursing home expenses are too heavy. That is why Golditch is covered.
In 45 states and the District of Columbia, Medicaid also covers some senior citizens who are in assisted living centers or need home health aides.
Chuck Schwarz, who suffered a stroke in 2014, said Illinois' Medicaid program allows him and his wife of 60 years, Cathy, to stay at an assisted living complex in South Elgin, about 40 miles from Chicago. She has Alzheimer's, and Schwarz said being able to visit her daily has kept them both alive. Medicaid pays about 85 percent of their $9,785 monthly bill.
"I don't know if I will be affected by the cuts or not. I may not be. If they do, I don't know what I would do," said Schwarz, an 82-year-old retired salesman and former Navy commander. "We have pretty much exhausted our savings. We didn't expect to live this long."
Daniel Reingold, CEO of the nonprofit that runs New York City's 1,000-bed Hebrew Home at Riverdale, a nursing home, said Medicaid cuts will reduce the quality and amount of care for the aged and sick. He said nursing homes will reduce staff and might send their residents to the hospital for some medical procedures, at a higher cost to the government.
"It is a short-sighted view," he said.