Across the United States, thousands of people with intellectual and developmental disabilities rely on Medicaid not just for healthcare but for survival. Often, people with intellectual and developmental disabilties cannot walk, speak, or care for themselves. They depend on caregivers, therapies, and 24-hour care.
In North Carolina, the story of Jennifer Shigley, a resident of TLC in Raleigh, brings this reality into sharp focus. TLC is a nonprofit care facility that provides around-the-clock support to residents like Jennifer. Proposed federal cuts to Medicaid are putting facilities like TLC and the people they serve in jeopardy.
The Trump administration’s plan to reduce Medicaid spending by $2.3 trillion over the next decade has raised alarms throughout the disability community. While some recipients may be exempt from new work requirements, the broader implications of these cuts could destabilize the entire system of care.
This issue is not unique to North Carolina. It is a national crisis. Medicaid is the largest source of funding for home and community based services for disabled people in the United States.
It covers everything from in-home care, and day programs to residential facilities. Without it, many families would be unable to afford the staggering costs. At TLC, the average annual cost per resident is $230,000. That figure is not unusual. Across the country, similar facilities face the same financial realities. Without Medicaid, these organizations would be forced to close their doors or drastically reduce services, leaving vulnerable people without the care they need to survive.
The recently passed One Big Beautiful Bill introduces work requirements for many Medicaid recipients and reduces provider tax rates. These changes limit states’ ability to draw down federal matching funds. Jay Ludlam, who oversees North Carolina’s Medicaid program, warns that this could result in billions in lost funding not just for his state but nationwide.
States already struggling to meet the needs of their disabled population may find themselves forced to make impossible choices. They may have to cut services, reduce staff, or turn away those in need.
This financial strain is already becoming obvious. North Carolina’s Department of Health and Human Services announced plans to cut provider reimbursement rates by up to 10 percent due to a $319 million budget shortfall. Although lawmakers have temporarily paused the cuts, the underlying budget crisis remains unresolved.
Other states are watching closely, knowing they may face similar decisions. The domino effect is real and dangerous. Corye Dunn of Disability Rights North Carolina points out that lowerreimbursement rates could worsen the national shortage of direct support professionals.
Direct support professionals are the individuals who feed, bathe, and assist disabled people with their everyday needs. Many of them earn poverty-level wages. Further cuts could drive them out of the field entirely. That is not just a staffing issue. It is a threat to the safety and dignity of vulnerable Americans. When facilities cannot retain qualified staff, the quality of care suffers. And when care suffers, lives are at risk.
The human cost of these cuts cannot be overstated. Disabled people and their Families across the country are already stretched thin, navigating complex systems to secure care for their loved ones. Many have waited years on Medicaid waiver lists, hoping for a spot in a residential facility or access to in-home support.
According to data from 32 states, in 2024, people on waiting or interest lists received services after an average of 40 months. That number is down from 45 months in 2021. However, it is an increase from 36 months in 2023.
People with intellectual and developmental disabilities waited the longest with an average of fifty months. Other waiver populations faced significant delays as well, ranging from six months for individuals with mental illness to forty-four months for children. These wait times reflect a system already under strain. Cuts to Medicaid would only deepen the backlog and prolong the suffering.
Hal Shigley, Jennifer’s father, believes that how a society treats its most vulnerable members is a reflection of its values. His daughter’s life depends on the care she receives at TLC. Without Medicaid, that care would be impossible. Jennifer is not alone. She represents thousands of Americans whose voices are rarely heard in policy debates but whose lives hang in the balance.
This is not just a policy debate. It is a moral reckoning. The decisions made in Washington will impact every state, every facility, and every person who depends on services.
Sources:
Baxley, Jaymie. “Medicaid Cuts Could Threaten Care for North Carolinians with Severe Disabilities.” North Carolina Health News, North Carolina Health News, 5 Sept. 2025, http://www.northcarolinahealthnews.org/2025/09/05/cuts-threaten-idd-care/.
Wolk , Abby, et al. “A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2024.” KFF, KFF , 31 Oct. 2024, http://www.kff.org/medicaid/issue-brief/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2024/.