LAWRENCE, Kansas — Shelley Miles lives on a quaint, tree lined street in Lawrence. She used to share her split-level home with her husband, Kirk. But then he was diagnosed with dementia. Miles said in 2021, Kirk’s memory issues progressed quickly.
“He was much more agitated, kind of confrontational. He was hallucinating,” she said. Kirk started wandering away from the house late at night. She felt like she had to watch him day and night to keep him safe.
“We have six exits out of this house, so it was really difficult to keep an eye on him 24/7,” Miles said. “My kids were coming over from Kansas City and sleeping on the couch to help me because I was exhausted.”
Miles said Kirk’s doctors told her he needed to move to assisted living. It took time — Miles said it was difficult to find a facility that had space for her husband and could handle his memory issues. But eventually, she moved him to a facility about 25 minutes away from Lawrence in Baldwin City, Kansas.
It took about a year to enroll her husband in Medicaid. She said she spent more than $70,000 before they were able to qualify — completely draining their savings and money they’d earned off the sale of Kirk’s family’s farm. Currently, with the help of Medicaid, Miles pays the facility about $1,595 per month.
But now, proposed federal cuts to Medicaid have Miles concerned. She’s afraid Kirk will lose coverage, raise her monthly costs or the cuts will cause the facility he lives in to close.
“I’m stressed every day that they’re going to make cuts to Medicaid and that extra help won’t be there,” she said. “I definitely will not be able to afford it and keep this home.”
Federal lawmakers are considering billions of dollars in cuts to Medicaid as part of President Donald Trump’s “big, beautiful bill” aimed at lowering spending and taxes. The proposed changes have divided Republicans.
What politicians say
Congressional lawmakers currently want to cut an estimated $715 billion over the next decade from Medicaid. The program covers more than 440,000 Kansans who are older adults, have disabilities, are pregnant or are children.
Proponents of the cuts, like Republican Speaker of the U.S. House Mike Johnson, say they’re going after waste and fraud in the Medicaid system.
“The Democrats, as I noted this morning, have said that we are going to gut Medicaid. It is not true. We’re going to protect the benefits that everyone is legally entitled to,” Johnson told reporters last month.
But Republicans aren’t all on the same page. Area politicians, like Kansas Republican Sen. Jerry Moran and Missouri Republican Sen. Josh Hawley have spoken against steep cuts to Medicaid.
Moran said the reduction in funds would harm health care systems in Kansas.
“It’s broader than just hospitals. It’s the hospital. It’s the nursing home. It’s the community pharmacist. It’s the physician. It's the nurse practitioner. It’s the chiropractor. It’s the optometrist,” Moran said during a speech on the Senate floor.
In an op-ed published by the New York Times, Sen. Hawley said cutting Medicaid is “morally wrong and politically suicidal.”
“We should cap prescription drug costs, as I have recently proposed. We should give every family in America with children a hefty tax cut,” Hawley said. “What we should not do is eliminate their health care.”
Kansas Democratic Gov. Laura Kelly also released a statement speaking against Medicaid cuts.
“Significant cuts to the Medicaid program will directly affect Kansans across the state, regardless of their political views. These cuts would be particularly detrimental to our rural hospitals and providers,” Kelly said in a letter to Kansas congressional members.
“We must stand up against these changes to ensure the hundreds of thousands of Kansans covered under Medicaid can continue to receive quality, affordable care,” Kelly said.
Kansas Speaker of the House, Republican Dan Hawkins, responded to Kelly’s letter. Hawkins accused Kelly of fear mongering.
“For years, we have said that expanding Medicaid beyond those who truly need it will jeopardize the program and now here we are. Our country cannot continue spending money like drunken sailors,” said Hawkins.
“While Governor Kelly would like to turn Medicaid into taxpayer-funded coverage for anyone who wants it, that’s simply not sustainable,” Hawkins said.
Hawkins recently announced he’s running for state insurance commissioner.
How might Kansans be impacted by Medicaid cuts?
Lawmakers are still debating how to come up with billions of dollars in cuts to Medicaid. But estimates by the nonpartisan Congressional Budget Office found as many as 7.6 million people could lose access to health insurance over the next 10 years.
A study funded by the REACH Healthcare Foundation and the United Methodist Health Ministry Fund analyzed what several proposed scenarios would look like for Kansas.
The study was conducted by Manatt Health, a company that offers consulting and legal services focused on health care. It found Kansas could lose millions of dollars over the first year.
Cindy Mann, a partner at Manatt, said that’s subject to change as lawmakers continue to markup the bill. Currently, lawmakers are considering things like restrictions to provider taxes, which states use to help pay their share of Medicaid, implementing work requirements and increased eligibility checks.
But Mann said regardless of how the cuts are made, it will be up to individual states to balance the budget and navigate how to make up for less federal funds.
Mann said historically, states target provider rates before cutting eligibility or benefits. But they also target the most costly Medicaid recipients, like people in nursing homes and long-term care.
“I don't think states are jumping to do those kinds of things, but faced with a budget hole and a requirement for a balanced budget … they're going to have to make changes that will produce some quick savings,” Mann said.
Mann said the restrictions lawmakers have proposed on provider taxes, if passed, would block states from being able to adjust provider tax rates, making it harder for states to keep up with inflation and rising costs. The Kansas legislature voted to raise provider tax rates from 3% to 6% last year, but that change hasn’t gone into effect yet.
Benjamin Anderson is president and CEO of Hutchinson Regional Medical Center, a safety net hospital that serves a lot of rural patients.
“The potential cuts to the Medicaid system threaten not only the care to people who are covered by Medicaid but it threatens the entire health care delivery system,” he said.
Anderson said at Hutchinson Regional, they’re operating at a 1% profit margin and more than half of their patients are covered by Medicaid or Medicare.
His hospital isn’t alone — a lot of rural hospitals are facing similar situations.
According to the Center for Health Care Quality and Payment Reform, Kansas has 26 rural hospitals immediately at risk of closure — more than in any other state.
Anderson, who identifies himself as a conservative Republican, said he’s worried about the nation’s debt. But in his view, cutting Medicaid isn’t the way to solve it.
“These cuts are best done with a scalpel and not a machete. And that requires precision and skill, thoughtfulness, preparation,” Anderson said.
Caitlin Linscheid is a practicing OBGYN in Kansas City with experience in Medicaid policy. According to the March of Dimes, KanCare, the state’s Medicaid program, covered 31.8% of births in 2023.
In 2022, the state expanded Medicaid to cover moms up to 12 months after giving birth. Linscheid said one of her biggest concerns is that Medicaid cuts will cause the state to roll back on progress like that.
She said in Kansas, most maternal deaths happen in the 12-month period after a woman gives birth. Linscheid said a lot of women are seeing doctors regularly for the first time in pregnancy and doctors diagnose things like type two diabetes or even cancer during those visits.
“I worry that if we lose Medicaid coverage during the postpartum period that many of those patients will lose the ability to get the ongoing care that they need to stay healthy,” she said.
Kansas also recently started covering doula care for pregnant Medicaid recipients. Linscheid said she’s concerned benefits like that could end, too.
She said reduced funding would only add to Kansas’ shortage of birth workers and facilities.
“I worry that with any sort of Medicaid cuts, whether that's to maternity care or to women's health care, or to obstetrics, or just globally, that these smaller rural hospitals won't have the resources they need to maintain labor and delivery units,” Linscheid said.
Double impact
Back in Lawrence, Miles is anxiously keeping an eye on the news and considering ways to prepare for if her husband loses coverage or access to assisted living.
She said her husband’s decades-long career with the U.S. Department of Agriculture provided a decent retirement fund, but the fees for his care quickly ate that up. And her job in medical billing did not have retirement benefits. Miles said if the Medicaid cuts impact Kirk, she’ll have to move him home.
Miles could be doubly impacted by Medicaid cuts. She's the legal guardian of her sister, and uses Medicaid to help pay for her living in a mental health facility.
“So I may be bringing my sister here as well. I won't be able to afford it. She certainly can't afford it,” Miles said. “The cost of the facilities are so expensive, so I may have both of them here with me.”
Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at r.shackelford@kcur.org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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