LGBTQ+ Aging: For Pride, Dignity, and Community

As Pride Month draws to a close, we reflect on the pioneering generation of LGBTQ+ Americans who made it possible. Pride Month began as a commemoration of the June 1969 Stonewall Uprising and has evolved over the decades into a national celebration of the diverse and intersectional LGBTQ+ community. Now in their sixties and beyond, the so-called “Stonewall Generation,” who came of age during the activist era of the Stonewall Uprising and the first Pride demonstrations, constitutes a growing segment of the Medicare population.

Challenges and Needs of LGBTQ+ Older Adults

The population of older adults in the United States is projected to steadily increase in the coming decades, and studies forecast that by 2030, there will be 7 million LGBTQ+ Americans over the age of 50. These growing numbers underscore the unique aging needs of LGBTQ+ older adults, who are more likely to live alone or in communities outside of the traditional family structures that our medical and legal systems most commonly support.

LGBTQ+ older adults are two times more likely than the general older population to be single and living alone, and four times less likely to be parents. They are more likely to rely on friends and chosen families, which can be socially and emotionally fulfilling but can lack equitable legal protections and risk increased precarity. Because friends and chosen family members are often of similar ages, they may experience illness or disability at the same time, making it harder to care for one another adequately. LGBTQ+ people are also over three times as likely to be caregivers compared to non-LGBTQ+ people. A 2024 AARP survey found that nearly six in ten LGBTQ+ adults over 45 were, or had been, caregivers to older relatives or other members of their community. Even among comparatively younger caregivers in the aging LGBTQ+ community, caregiver burnout can take a toll due to stress, lack of rest, and difficulty attending to their own health needs and medical appointments.

The historic lack of legal recognition of marriages and partnerships continues to affect the financial and social stability of many in the older LGBTQ+ population. Data shows that regardless of marital status, LGBTQ+ older adults with a partner or social support network experience better health outcomes and quality of life. Still, friends and non-married partners often face far more restrictions in their ability to provide support for each other, such as sharing health insurance plans, taking leave from work, and making medical decisions for a partner.

Medicare and Medicaid Support

Ensuring LGBTQ+ older Americans can age safely in place with pride and dignity requires strengthening community-based care, where LGBTQ+ people can care and be cared for among their chosen families while receiving robust federal support. Medicare and Medicaid help support aging in community through provisions for home and community-based services (HCBS), which allow beneficiaries to receive health coverage for services provided at home or in a community setting, such as a covered assisted living facility of the beneficiary’s choice. These services are most often offered through state-level Medicaid waivers, which are more expansive than Medicare’s home health benefit with fewer statutory limitations.

Within the scope of HCBS, the Program of All-Inclusive Care for the Elderly (PACE) offers a state-sponsored Medicaid waiver program that provides a home care infrastructure that can accommodate chosen families for aging LGBTQ+ adults. Studies show that LGBTQ+ people fear discrimination in long-term care facilities, and they report that this discrimination is more frequent and severe for those of color, with disabilities or lower incomes, and other stigmatized identifications. This may cause them to forgo seeking necessary health care as they age. PACE provides a model for LGBTQ+ older adults to seek assistance and care without having to sacrifice the comfort they find in their community.

Community Services in the Older Americans Act

The Older Americans Act (OAA) was passed in 1965, the same year that Medicare and Medicaid became law. Under the OAA, the federal government supports a wide range of community-based services and social support, including nutrition services, transportation, caregiver support, and preventive care. The act aims to support non-institutional living for adults age 60+ with the “greatest economic or social need,” and provides not only medical support but also employment training and legal assistance.

The OAA was last reauthorized in 2020 with LGBTQ+ inclusive provisions, including those that hold state departments of aging accountable to meeting the specific needs of LGBTQ+ older adults and other minority aging populations. Among the states’ duties under the reauthorization is conducting outreach to local LGBTQ+ communities to report on their particular needs and track the efficacy of government services within these populations.

Federal Cuts are Anathema to Aging in Chosen Communities

The current administration’s targeting of health care services and federal agencies is disproportionately damaging to the aging LGBTQ+ population. As KFF reported earlier this month, dramatic reorganization and reductions at the Department of Health and Human Services threaten services provided under the OAA. Cutting Medicaid funding at the federal level would cause downstream damage to community-based services by increasing stress on state health care budgets and stretching them too thin to support robust HCBS services, forcing many LGBTQ+ older adults into a one-size-fits-all institution or no options for care at all.

Imposing work requirements on Medicaid coverage also unduly targets LGBTQ+ beneficiaries, as caregiving responsibilities limit people’s availability and ability to find and maintain employment. This cuts both ways in a caregiving relationship: those giving care would risk their Medicaid eligibility or have to find additional employment to meet the work requirements, and those who receive their care would be reliant on caregivers who are less available and may have untreated health needs.

Everyone Deserves to Age with Dignity and Respect

The Stonewall Generation is also the generation that was devastated by the AIDS crisis. These LGBTQ+ Americans know too well the trauma and dire consequences of medical discrimination and government apathy to LGBTQ+ health, and they deserve to age with dignity in the country they dreamed of as activists and in the communities with which they feel most at home.

At the Medicare Rights Center, we believe that everyone deserves to age with dignity, respect, and access to the care they need—no matter who they are or whom they love. As we honor the Stonewall Generation and the broader LGBTQ+ community this Pride Month and beyond, we remain committed to advancing policies and programs that promote health equity, expand access to home and community-based services, and protect critical lifelines like Medicare and Medicaid. Together, we can ensure that LGBTQ+ older adults are supported to age safely, joyfully, and authentically.