As a provider of high-quality aging services at Valley Cares Inc. in Townshend, I am concerned about proposed changes to the Medicaid program.

I recently sent a letter to Representative Peter Welch and to Senators Bernie Sanders and Patrick Leahy urging them to preserve its present structure and financing and to leave its expansion in place as Congress considers the future of the Affordable Care Act.

Medicaid is the most important financial resource available for families who need help in covering the cost of long-term services and supports, whether in their homes and communities or in assisted living or nursing homes.

Medicaid has become the default payer for long-term services and supports because there are no significant alternative sources of payment, other than private pay. As of 2013, over one-third of all Medicaid expenditures went towards paying for long-term services and supports.

The expansion of Medicaid has given low- and moderate-income people access to cost-effective primary care. States that have expanded their programs have experienced budgetary savings and economic growth.

Proposals to convert Medicaid into block grants or a system of per-capita capped allocations to the states would reduce the funding every state now receives under the program. I am concerned about the loss of certainty that nursing home and assisted-living care would be covered and about the potential elimination of optional coverage for long-term services and supports in the community.

The proposed changes in Medicaid come at a time when the senior population is growing and more people are reaching the advanced ages at which the need for long-term services and supports can become more urgent.

With what would inevitably be a more limited Medicaid program through block grants or per-capita allocations, seniors and their families will have little or no means of paying for these services.

We have to remember that, in terms of percentage of population over age 65, Vermont ranks second in the country. Windham County is at the top of the list of counties in Vermont.

As legislation on health and budget issues is developed, I urge our representatives, senators, and others to support the present structure and financing of Medicaid as well as its expansion.

As an administrator and registered nurse of over 25 years, I urge members of Congress to think long-term in their political decisions. It might be any one of us who someday will need the services.

Susanne Shapiro

Townshend