Health care providers have taken a wait-and-see posture in the wake of the so-called "Big Beautiful Bill" passing last week in Congress.
Cuts to food assistance and Medicaid have left Democrats reeling about skimming from the social safety net to afford extending tax cuts that disproportionately benefit America’s wealthiest taxpayers.
Republicans say they’re reserving public assistance for those who really need it, adding work requirements for working age, non-disabled adults seeking Medicaid assistance.
Illinois Democrats warn the changes to Medicaid — a loss of about $48 billion over the course of 10 years for the state — could result in 330,000 Illinoisans losing their health care. And Gov. JB Pritzker has signaled the state is not prepared to fill the financial gap.
In a joint statement, U.S. Sens. Dick Durbin and Tammy Duckworth said the cuts also put 93 nursing homes across the state in danger of closing.
That's confusing to Tim Wiley, administrator of the McLean County Nursing Home in Normal, who said he's not seen anything in the reconciliation bill that directly targets nursing homes.
According to the Illinois Department of Healthcare and Family Services, the state spent $33.7 billion on Medicaid benefits in 2024, with $335 million going to nursing home residents.
“Which is 1% of their total spend,” Wiley said. “That kind of helps me be a little more at ease because I know, when I’m having to make cuts, I’m not going to cut something that’s 1% of my budget.”
Balancing the budget
Since Wiley arrived at the county-run nursing home in 2021, the facility has started to rebound financially after years in the red. Wiley said his strategy has included diversifying income streams and keeping beds filled.
Typically, the nursing home on North Main Street cares for about 100 residents. This year, that number hovers closer to 80 as mechanical, electrical and air handling improvements are made to a section of the building. Of the 78 residents currently staying at the nursing home, Wiley said 33 receive Medicaid benefits.
At one time, the proportion of residents on Medicaid was closer to 80%.
“You have to manage your payers,” Wiley said.
Most residents have some combination of coverage that can include a blend of Medicare and Medicaid, Medicare with supplemental private insurance, VA benefits or private pay. Easing off reliance on Medicaid has been one key to balancing the budget.
“It’s always critical to manage that mixture, like you would a 401(k),” said Wiley. “You don’t want to put all your money into one type of investment. You want to spread it out. That provides for a more stable revenue stream and more stable census.”
The plan appears to be working. Prior to Wiley’s arrival, McLean County Nursing Home was bleeding money. The facility was in the black in 2024, registering an $82,000 surplus, according to county filings.
If the state did reduce its Medicaid reimbursement rate to providers writ large, that could impact nursing homes. Wiley said at this point that possibility is “pure speculation.”
Could the cuts have unintended consequences?
Some health care providers express concern that adding more paperwork to maintaining Medicaid coverage could inadvertently exclude eligible people, including seniors, from receiving benefits.
“Every year, Medicaid recipients have to do a revaluation,” Wiley said, “but that’s been going on forever. I don’t anticipate that changing.”
Wiley also doesn't perceive a threat to seniors receiving access to care. A trip to the hospital, for example, would most often be billed to Medicare.
“Medicare is not ongoing assistance,” he said, likening it to an “as needed” insurance policy.
“You have an acute clinical need, you get it taken care of, your insurance policy pays for it, then the insurance policy stops paying,” he said. “Medicaid is a subsidy for living.”
McLean County Nursing Home residents on Medicaid thus have a higher per-day rate compared to “private pay” residents, with the nursing home paying for all added expenses like pharmaceutical and medical device costs.
“Sometimes, we providers are able to absorb that — other times we’re not,” Wiley said. “I don’t anticipate for our elder population an inability to access care. I don’t see that writing on the wall yet.”
For now, Wiley is committed to staying the course with the current strategy.
“We want to help as many people as we can. We wish we could help them all, but we closely monitor the medical necessity of the people who are referred to us who are on Medicaid," he said. "Those who need to be here the most are the ones that we want to help the most first.”
