President Donald Trump

President Trump is proposing drastic cuts to nursing homes’ biggest payer source that could amount to more than $1 trillion over the next decade.

Administration officials are reportedly mulling moving the Medicaid program to a system of block grants, giving states more control of how they dole out dollars, the Washington Post reported Monday. Such a change has been a longstanding dream of conservatives, and nightmare for nursing homes.

Cuts are also being eyed for the Medicare program, though not as severe as what’s being proposed in Medicaid, with an $845 billion spending slash in the next 10 years. That would come through addressing fraud and abuse in the program and cutting payment to hospitals, the Post reported.

Advocates for the elderly slammed the proposal after its release Monday, saying the recommendation “shortchanges seniors.”

“To push the heads of seniors further underwater, the White House budget also proposes to eliminate federal grants that help pay for programs under the Older Americans Act, such as Meals on Wheels and home heating assistance for the elderly poor,” Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, said in a statement. “The tax cuts for the wealthy, the failure to allow Medicare to negotiate drug prices and another budget that pushes more seniors over a financial cliff shows that this administration is not plugged-in to the realities of being elderly in America.”

Trump’s budget limits growth of Medicaid to the pace of inflation. Along with cutting almost $1.5 trillion from the program, the plan would also add $1.2 trillion for block grants starting in 2021, according to the Post. The proposal does not specifically say whether the administration is asking Congress to consider switching to a block grant program, or whether it would do so under its own power.

Politico first hinted at the forthcoming block grant proposal in January. Sen. Ron Wyden (D-OR) also warned of drastic cuts coming to the program during a March 6 hearing on nursing home abuse and neglect.

“The Trump budget is coming out next week, and it’s a safe wager it’ll include another draconian attack on Medicaid,” Wyden said during the hearing. “That program helps cover costs for two out of three seniors in nursing homes. I’ll fight this cut with everything I’ve got, because it would turn back the clock on the effort to improve care, and it would inevitably lead to more nursing homes closing their doors.”

Meanwhile, others, such as the Alex Azar, the head of Health and Human Services, applauded the budget proposal Monday, calling it a “fiscally sustainable” budget that would produce a “stronger economy, and a healthier America.”