Possible federal cuts to Medicaid have raised concerns at the Good Samaritan Health Center, a senior living facility on 16th Avenue in Yakima that provides skilled nursing and long-term care.

Half of the center’s residents rely on Medicaid, said Joany Schimmelfennig, Good Samaritan’s administrator.

Many at the center, from residents and patients to nurses and office staff to Schimmelfennig, say the cuts could seriously affect health care access. Medicaid helps fund health care for low-income patients and kids, and is known as Apple Health in Washington state.

“If it’s cut, I have no place to live,” said Shirley Ellis, one of the senior-age residents. “It sucks. I wish it was a lot better, but it doesn’t look like it’s going to be.”

Renee Navarez, a registered nurse at the center, agreed. Staff just want the resources to take care of the residents, she said.

“They should be secure in these years of their life,” Navarez said. “For us to allow this to happen, where some of them could be put out in the street, it’s unethical.”

In Washington, D.C., lawmakers are considering possible cuts to Medicaid as part of President Donald Trump's budget plan. Medicaid is funded jointly by the state and federal government.

Good Samaritan Health Center isn’t the only facility that serves patients using Medicaid. Nearly 50% of Yakima County residents received health insurance through Medicaid and Apple Health in 2023, according to the state’s most recent data.

That same year, Medicaid dollars paid for more than 30% of admissions at MultiCare Yakima Memorial Hospital and Astria’s Sunnyside and Toppenish facilities.

“It’s a very crucial need in the state of Washington,” Schimmelfennig said. “We cannot afford to have any Medicaid cuts.”

What are Medicare and Medicaid?

Medicaid is a government health insurance program for people making 138% or less of the federal poverty level or less, just over $20,000 in 2024. It was expanded to its current form by the Affordable Care Act in 2010. 

Medicare is a federal health insurance program for people with a disability or who are 65 and older.

Support for both programs is broad among Americans, according to KFF, an independent health policy organization. Trump has made public promises to protect both programs from spending cuts.

Gov. Bob Ferguson, who outlined a state budget plan on Thursday to save $4 billion, said his goal is to maintain Medicaid eligibility at the state level.

"Put another way, if you are a Washingtonian on Medicaid, you will not lose your state coverage," he said in a news release.

In 2023, over 130,000 Yakima County residents, 50% of the county’s population, were enrolled in Apple Health. The percentage for kids is even higher, with nearly 87% of people under the age of 19 in Yakima County using Apple Health.

Apple Health helps pay for hospitalization, appointments with health care providers, prescription drugs, dental services and other health needs with no co-pays or deductibles.

National politics

Republican lawmakers in Congress are trying to meet President Trump’s budget goals for the next decade.

Those include billions in spending increases in military, judiciary and homeland security programs, according to a New York Times article, and a $4.5 trillion tax cut that critics say will have the most benefits for those who are wealthy.

The budget, which will outline spending – or the lack thereof – for the next decade, also included $2 trillion in spending cuts. Around $880 billion will come out of House of Representatives’ Energy and Commerce Committee, which oversees Medicaid and Medicare funding.

Another $230 billion in cuts has been assigned to the House Agriculture Committee and could come out of the Supplemental Nutritional Assistance Program, or SNAP, according to the Associated Press.

On Tuesday, Republicans in the House of Representatives passed that budget plan, directing those committees to start planning what to cut and asking the Senate for approval.

Dan Newhouse, who represents Central Washington in the House, voted for the budget resolution. In Newhouse’s 4th Congressional District, 38% of the total population are Medicaid patients, according to the Washington State Health Care Authority. It’s the highest of any congressional district in the state.

In a statement after his vote, Newhouse focused on the other spending cuts and defense funding in the resolution.

“The passage of this resolution unlocks the process to rein in out-of-control spending, secure our border, and achieve energy dominance,” Newhouse said. “I look forward to working with my colleagues in both chambers to identify savings, and efficiencies, in our federal spending as we move forward.”

There have been strong statements from Republicans, including from Trump, that Medicaid and Medicare will not be affected. The budget is still in its early stage so what, how and where the cuts will take place within certain programs is not yet clear.

One Republican proposal for cutting Medicaid costs has included a work requirement for able-bodied recipients. That wouldn’t save enough, though, according to a report from The New York Times.

If the House’s Energy and Commerce Committee cut all of its spending besides Medicaid and Medicare, it would still be around $600 billion short of its goal.

Criticism has been loud from Democrats. Both of Washington state's senators have denounced the budget resolution. Sen. Maria Cantwell published a report outlining Medicaid usage in Washington.

Sen. Patty Murray held a news conference Thursday morning where Yakima Valley health care providers spoke.

“Emergency response times will skyrocket — from closures which cost precious time as the nearest ER gets further away, and crowding, as patients put off preventive care they can no longer afford,” Murray said. “Republicans need to stop listening to Donald Trump and Elon Musk who want tax breaks for their billionaire buddies — and start listening to their constituents.”

Where does Medicaid funding go in Yakima County?

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All three hospitals in Yakima County have patients reliant on Medicaid and Medicare. Funding from the programs affects the organizations' bottom line. 

Medicaid payments make up 27.1% of gross revenues for MultiCare Yakima Memorial, Astria Toppenish and Astria Sunnyside hospitals combined. In Toppenish, Medicaid patients made up 36.9% of gross and 43.7% of all hospital admissions in 2023.

The program pays for more than just hospital costs.

Ellis, Mike Beehler and Dallas Johnson are all residents at the Good Samaritan Health Center. The services they receive there are critical, they said.

Ellis has nowhere else to go – her children have their own health issues and cannot take care of her, she said.

Beehler’s mobility issues mean he requires nursing assistance to get out of bed in the morning. If he wasn’t at a senior living facility, he wouldn’t be able to get up, he said.

Johnson has lived at Good Samaritan for five years. He moved there after he began to fall frequently at home and had trouble managing his medications. It was too much of a burden on his wife, he said.

Erica Wick, who works in Good Samaritan’s admissions department, said nursing staff help with everything from getting dressed to managing specialized diets and preventing bed sores.

“We provide all of that every day activity that we take for granted when we’re young,” Wick said. “It’s all individually tailored to each resident.”

Johnson said the staff are friendly and often share jokes and laughs with residents. Living in the facility and engaging in activity keeps people happy and involved in the community, he said.

But if Medicaid funding dries up, some residents might be forced out. Ellis said she could end up homeless. Johnson and Beehler said other insurance would help cover their stay, but they would have little spending money beyond that. 

Melanie Pitt, the facility’s nursing director, said staff will work hard to provide care and make it work, but stresses and challenges will mount.

“It feels like this is the one area you should be giving more to,” she said. “This is it. Why would you want them to be stressed?”

Rhonda Hauff, CEO of Yakima Neighborhood Health Services, said cuts would have a disproportionate impact on rural, low-income communities like Yakima.

"Because of the low incomes to residents of Yakima, we have a disproportionately high rate of people (of all ages) covered by Medicaid – many of them working individuals, others disabled and unable to work, and tens of thousands of children," Hauff said in an email.

Losing health coverage will likely cause people to avoid visiting medical providers until far later, Hauff added.

"We know this doesn’t end well. Uninsured patients end up in the specialists’ offices and emergency rooms," she said in an email. "This uncompensated care costs the taxpayers a lot more in the end."

Health care providers at the limit

Local health care providers are calling for an increase to Medicaid funding and reimbursements, not cuts.

In a statement, MultiCare officials said the health system is significantly impacted by the financial pressures from inadequate Medicare and Medicaid reimbursement rates. MultiCare operates the only hospital in Yakima.

MultiCare is monitoring and evaluating the potential federal cuts and acknowledged that many local patients rely on Medicaid. According to financial reports submitted to the state, over 30% of the hospital’s admissions in 2023 were paid with Medicaid.

“A large percentage of our patients rely on government programs like Medicare and Medicaid and cuts to this funding could impact both access and the ability to provide care to those who need it most,” the statement from the hospital said.

Critics of the cuts are concerned they could result in hospitals closing their doors.

“The only thing left to cut is the hospital itself,” said Astria Toppenish Administrator Cathy Bambrick in a report published by Democratic Sen. Maria Cantwell. “Areas within the Toppenish service area are at risk of becoming a medical desert within which many residents would live at least 60 minutes from a hospital with trauma care services.”

Astria Toppenish closed its maternity center in late 2021. At the time, it cited reduced Medicaid funding as one of the reasons.

Schimmelfennig agreed that facilities might close. At a minimum, cuts will make it harder to accept new residents at Good Samaritan Health Center.

Staff do everything they can for patients, she said, but cuts would reduce services they can offer and impact the quality of health care.

Worker shortages are already affecting the industry, with 10.5% vacancy rate among registered nurses in Washington, she said.

“Not only will a Medicaid cut impact our residents, it will also affect our workforce,” she said.

Despite the employment challenges that may loom, Wilson said her biggest concern is for the patients who rely on Medicaid. She can find a new job, she said, but how will patients find the money for health care if it’s taken away?

Nelly Prieto, a home care worker in Sunnyside, echoed that sentiment at Sen. Murray’s news conference Thursday morning.

“I may be able to get a job somewhere else, but what about clients who depend on Medicaid funding to receive care, what’s going to happen to them?” Prieto said. “Where are they going to get the money for lifesaving care and treatments?”

Johnson understands that the cuts will change the services that can be provided at places like Good Samaritan Health Center. It’s a business, he said, and the money has to come out of somewhere.

Johnson hopes it doesn’t come to that, he said. He hopes the government listens.

“I just hope they listen to us in Congress,” Johnson said. “Let them live here for a day or two and see what it’s like.”