The United States House of Representatives voted to approve a budget framework that may result in more than $800 billion in Medicaid cuts, devastating the country’s disability programs, according to advocates. The move this week is essential for House lawmakers as they work to enact a government budget bill before the March 14 deadline to avoid a shutdown. While the plan does not specify exact savings, it directs the House Committee on Energy and Commerce, which controls Medicaid, to reduce spending by at least $880 billion over the next ten years.
“We are gravely concerned,” said Lydia Dawson, vice president for government relations at the American Network of Community Options and Resources, or ANCOR, which represents disability service providers nationally. “This type of a drastic cut will almost certainly lead to significant and devastating cuts to Medicaid funding, which would negatively impact state budgets and reduce access to community-based services for people with IDD.”
The House approved the spending bill by a vote of 217 to 215. There were no Democratic votes for the bill. Republicans are pressing for spending cuts to offset the extension of President Donald Trump’s tax cuts while also delivering on other administration promises.
However, prospective Medicaid cuts have alarmed even some Republicans, nearly derailing the House vote this week. The Medicaid home and community-based services system, which serves as the backbone of care for people with intellectual and developmental disabilities in this country, is already under severe strain.
According to KFF, a nonprofit that does health policy research, more than 700,000 people are on Medicaid waiver waiting lists for home and community-based services. Meanwhile, even those with waivers have struggled to receive services. A recent national study of almost 500 community-based service providers discovered that almost all had moderate or severe staffing shortages the previous year.
As a result, 69% had turned down new clients and 39% discontinued programs or services, with more than a third indicating they were considering further cuts. Now, the House and Senate must reach an agreement on legislation that includes specifics about the budget proposal and its implications for Medicaid and other programs.
Disability advocates are warning that the size of the cuts proposed in the House plan would directly jeopardize home and community-based services, which are considered optional Medicaid services under federal law. “If cuts of this magnitude are allowed to become law, it is not hyperbole to say that the results would be catastrophic for people with disabilities, family caregivers, direct support professionals,” said Nicole Jorwic, chief of advocacy and campaigns at Caring Across Generations, an organization advocating for caregivers and people who rely on them. “Service providers will have to close, the workforce crisis that already exists will get exponentially worse and waiting lists around the country will grow.”
As a person with cerebral palsy, Medicaid impacts me every single day. Medicaid allows me to live in my apartment where I receive around-the-clock care. In September of this year, at the age of 26, Medicaid will be my only source of health insurance.
Medicaid provides coverage for home and community-based services. There are many different types of home and community-based services available under Medicaid. Examples of covered home and community-based services include physical, occupational, and speech therapies, durable medical equipment, home healthcare, home-delivered meals, and dietary management. These services are intended to help people remain in their communities.
In my case, Massachusetts Medicaid provides the funding for my PCAs (Personal Care Assistants). My PCA helps me with activities of daily living, including bathing, dressing, and toileting. Without Medicaid, I wouldn’t be able to pay for PCA services, which cost more than $50,000 annually.
Medicaid is more than healthcare insurance for low-income Americans. Cuts to Medicaid coverage would mean millions of lives would change in an instant. Medicaid is the difference between life and death for many. People’s lives should be more important than money and politics.
Sources:
Chang, Daniel. “Medicaid ‘unwinding’ Decried as Biased against Disabled People.” KFF Health News, KFF, 14 May 2024, kffhealthnews.org/news/article/medicaid-unwinding-people-with-disabilities-home-health-benefits/amp/.
Diament, Michelle. “Already Battered Disability Providers Say More Cuts Could Be Coming.” Disability Scoop, Disability Scoop, 20 Dec. 2024, http://www.disabilityscoop.com/2024/12/20/already-battered-disability-providers-say-more-cuts-could-be-coming/31229/.
Diament, Michelle. “Trump’s Return Sparks Worry about Cuts to Medicaid, Disability Services.” Disability Scoop, Disability Scoop, 21 Jan. 2025, http://www.disabilityscoop.com/2025/01/21/trumps-return-sparks-worry-about-cuts-to-medicaid-disability-services/31251/.
Diament, Michelle. “House Vote Tees up Billions in Cuts to Medicaid, Disability Services.” Disability Scoop, Disability Scoop, 27 Feb. 2025, www.disabilityscoop.com/2025/02/27/house-vote-tees-up-billions-in-cuts-to-medicaid-disability-services/31321/.
Goldstein, Amy. “Millions of Vulnerable Americans Likely to Fall off Medicaid Once the Federal Public Health Emergency Ends.” The Washington Post, WP Company, 15 Mar. 2022, https://www.washingtonpost.com/health/2022/03/14/medicaid-loss-of-coverage/.
“Home- and Community-Based Services.” Centers for Medicare & Medicaid Services, United States Department of Health and Human Services, https://www.cms.gov/outreach-and-education/american-indian-alaska-native/aian/ltss-ta-center/info/hcbs.