The Senate version of the budget reconciliation bill would cut even more from the Medicaid program than the House version, bringing cuts to the federal healthcare program to $1 trillion over a decade, according to multiple news outlets.

On Monday, Senate Finance Committee Chair Mike Crapo (R-ID) unveiled the Senate’s draft version of the bill, adding $200 billion in cuts to Medicaid over the House version. 

Specifically, the proposed Senate bill would cap most states’ provider taxes at 3.5% by 2031, down from the current 6% limit, according to CNN. The provision would only apply to 40 states and Washington, DC, which expanded Medicaid under the Affordable Care Act. States use provider taxes to boost provider rates and fund health-related initiatives.

“The House bill placed a moratorium on taxes on providers that help states fund their Medicaid programs and increase payments to providers for services they provide. The Senate bill goes further, limiting the provider taxes that many states already have in place, but only in states that have expanded Medicaid under the ACA,” Larry Levitt, KFF executive vice president for health policy, told NBC News. “There were expectations that the Senate might moderate the Medicaid cuts passed by the House, but if anything they’re doubling down.”

On a positive note, Argentum told McKnight’s Senior Living, the package does not make direct cuts to Medicaid assisted living programs — something the association said it is watching and continuing to engage with lawmakers about as the legislative process continues.

Approximately 17% of assisted living community residents were Medicaid beneficiaries as of 2022, according to a 2024 report from the Centers for Disease Control and Prevention’s National Center for Health Statistics. Almost half of assisted living communities surveyed in 2018 by the CDC were authorized or certified to participate in a state-federal Medicaid program, according to a 2023 report. The National Center for Assisted Living notes that “a small minority of state Medicaid programs do not cover services in assisted living.”

“Additionally, the Senate version of the bill permanently enhances the low-income housing tax credit by 12% and lowers the bond financing threshold to 25% starting in 2026, which would encourage higher utilization of these important programs across the senior living industry,” Argentum Vice President of Government Relations Paul Williams said. “Notably, the package also includes Argentum priorities of a tax deduction for seniors and investments in the caregiving workforce.”

The American Seniors Housing Association told McKnight’s Senior Living that it remains concerned that reductions in Medicaid dollars to states will result in fewer dollars going to home- and community-based services programs that fund some assisted living.

“These programs are optional and, therefore, will be at risk,” ASHA Vice President of Government Affairs Jeanne McGlynn Delgado said. States can choose whether to provide most HCBS, but the Medicaid program is required to cover nursing facility care for Medicaid beneficiaries.

Delgado added, however, that ASHA was pleased to see that the federal nursing home staffing mandate was addressed in both the House and Senate bills. Both versions would prohibit the Health and Human Services Secretary Robert F. Kennedy Jr. from implementing or enforcing the mandate.

“Imposing additional staffing requirements at the same time the industry is experiencing a significant workforce shortage never made sense,” Delgado said. “Policymakers need to recognize this shortage and understand that as the population ages, it will only get worse, and we must take steps now to create a long-term care worker visa or other work visa to address our staffing needs.”

Meanwhile, 86 national and state organizations sent a letter to Senate leaders Monday urging them not to advance the budget reconciliation bill, saying it would “devastate our nation’s healthcare system.”

The letter — signed by LeadingAge, the Alliance for Retired Americans, Caring Across Generations, the Gerontological Society of America, Justice in Aging, Lutheran Services in America, National Consumer Voice for Quality Long-Term Care and the National Council on Aging, among other groups — asked the senators to prioritize transparency and the rigor of analysis over expediency in enacting federal policies that affect the health and financial well-being of their constituents.

“More than anything, we urge you to commit that you will not ever trade your constituents’ access to healthcare in order to enact tax cuts,” the letter concluded. 

Caring Across Generations said in a statement that the Senate version of the bill would severely restrict how states can pay their share of Medicaid costs, leaving “massive holes” in state budgets and forcing states to cut vital services relied on by older adults, people with disabilities and care workers, including home- and community-based services. 

Justice in Aging stated that the Senate’s bill would “starve Medicaid, undermine Medicare, strip essential coverage from millions of older adults and people with disabilities, and attack immigrants — all to line the pockets of the wealthiest.”

“Senate leadership had the chance to stop cuts to Medicaid, Medicare and other programs older adults and people across America rely on from moving forward, but instead chose to slash these programs even further under the guise of protecting older adults,” Justice in Aging Executive Director Kevin Prindiville said in a statement. “These cuts harm us all — eroding the safety net that benefits everyone in society.”

KFF expanded its 2025 reconciliation bill tracker with a side-by-side summary of the key health provisions in the legislation to include the Senate’s draft language. Lawmakers’ goal is to deliver a package to the president by July 4.