Lawmakers have long recognized how vital Medicaid is for older adults and disabled people. Yet recent actions show that many were willing to support policies that would strip coverage from those who need it the most. Medicaid is not just a line item in a budget; it is the foundation that helps millions of people stay healthy, stable, and independent.
It funds long-term services that Medicare does not cover, supports caregivers, and addresses gaps for those on fixed incomes. The people making these laws are not unaware of this reality. They were repeatedly warned that cuts and administrative barriers would hurt older adults and disabled people, but they chose to proceed anyway.
Across the country, millions of disabled people depend on Home- and Community-Based Services to live outside of institutions. These services include home healthcare. Home healthcare workers assist with tasks such as bathing, eating, dressing, and cooking. They can also assist with complex medical tasks including tube feedings and urinary catheterization.
In Massachusetts, this support is provided through the Personal Care Attendant program, but every state has its own HCBS program. All of them rely on Medicaid funding. Now, due to severe cuts in federal Medicaid funding, HCBS programs nationwide are facing changes that threaten the independence they have supported for decades.
This issue is personal for me. I have cerebral palsy and have relied on personal care since childhood. My PCA assists me with toileting, dressing, bathing, meal preparation, and transportation. These are not luxuries; they are essential tasks that allow me to live at home, pursue my goals, and engage in my community. Without this support, independence becomes impossible. The possibility of these services being reduced or destabilized is not just alarming; it can change my life.
What makes this situation especially concerning is that the effects of these policy choices were not unforeseen. They were predictable, documented, and communicated. Work requirements were presented as harmless because older adults and many disabled people are technically exempt.
However, lawmakers were informed that these rules would still lead to significant coverage losses. People are misclassified, paperwork gets lost, and reporting systems often fail. Disabled people and older adults are frequently the first to experience bureaucratic errors and are often the least able to navigate complicated administrative processes.
This issue applies to increased documentation requirements and shorter renewal timelines as well. These changes are the hardest for those with limited internet access, mobility issues, or cognitive challenges. Still, these measures were pushed through despite full awareness of who would be affected.
The decision to cap federal Medicaid funding was another intentional choice. States that face reduced funding typically cut home- and community-based services first because they are optional. Medicaid is required to cover nursing home and hospital care, but home and community-based services are optional.
Lawmakers were aware of this. They understood that older adults with disabilities, chronic illnesses, and limited income would be the first to feel the effects. They knew families would face greater caregiving responsibilities and costs. They recognized that HCBS programs—the very programs that enable people like me to live with dignity—would be destabilized. Yet they voted in favor of these cuts.
These cuts are even more shortsighted because they do not actually save money in the long term. When people lose access to HCBS, they do not suddenly stop needing care. They end up in crises, emergency rooms, or nursing homes—settings that are significantly more expensive.
Institutional care can cost several times more than providing assistance at home, and once someone enters a nursing facility, the chances of returning to independent living drop sharply. By undermining HCBS, lawmakers are not only taking away people’s autonomy; they are also increasing long-term costs for states and the federal government. The supposed savings from cutting Medicaid today will lead to much higher expenses tomorrow, measured in both dollars and human impact.
Older adults and disabled people are especially vulnerable to these decisions. We often have complex medical needs, limited financial flexibility, and fewer options when coverage disappears. Losing Medicaid does not just mean missing a doctor’s appointment; it can mean losing the ability to stay at home, losing access to crucial medications, or losing the support that keeps a family together. When lawmakers implement policies that clearly reduce Medicaid enrollment, they choose outcomes that threaten people’s lives.
The report from Justice in Aging highlights a truth that deserves more attention: these cuts were not an accident. They were known, anticipated, and accepted as the cost of pushing a political agenda. Accountability is important because policy choices reflect priorities, and in this case, the priority was not the well-being of older adults or disabled people.
The way forward depends on advocates, caregivers, and communities refusing to accept the narrative that these cuts were unavoidable. They were not. Protecting Medicaid means insisting that lawmakers face the real-world consequences of their actions and demanding policies that strengthen, rather than weaken, the systems that allow people to live with dignity and independence.
Sources
Carpenter, Alexandra, et al. Trends in Users and Expenditures for Home and Community-Based Services as a Share of Total Medicaid Long-Term Services and Supports Users and Expenditures, 2023. Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, 17 Oct. 2025. https://www.medicaid.gov/medicaid/long-term-services-supports/downloads/ltss-rebalancing-brief-2023.pdf
Kean, Natalie. “Lawmakers Knew All Along They Were Voting to Cut Medicaid for Older Adults.” Justice in Aging, 4 Mar. 2026. Justice in Aging, https://justiceinaging.org/lawmakers-knew-all-along-they-were-voting-to-cut-medicaid-for-older-adults/.