Just weeks after the U.S. House of Representatives approved billions in cuts to Medicaid, the Senate is considering chopping the program even more, a move that advocates say would have dire consequences for people with disabilities.
Senate Republicans unveiled legislation last week detailing sweeping changes to Medicaid that are part of a broader effort to make good on President Donald Trump’s domestic agenda. The measure includes more aggressive changes than the version passed by the House in May.
Both chambers are seeking to impose work requirements on many Medicaid beneficiaries and mandate that states check individuals’ eligibility for the program more frequently, among other changes, but some of the Senate’s requirements would be more stringent.
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Notably, the Senate is also seeking to limit Medicaid provider taxes, a workaround that states use to collect more federal dollars for the program.
“The Senate took a rotten bill and made it worse,” said Elena Hung, co-founder and executive director of Little Lobbyists, a national group advocating for kids with disabilities. “The Senate text cuts even more money from Medicaid and will result in even more harm to medically complex and disabled children.”
While neither bill explicitly calls for spending on disability services to be slashed, advocates say that reducing federal investment in Medicaid will put financial pressure on states leading to cuts in optional programs like home and community-based services.
“History shows that when Medicaid budgets are cut, home and community-based services are among the first services cut,” said Hung, whose group brought families from across the country to Capitol Hill last week to pressure senators to reject Medicaid cuts. “Millions of Americans, including disabled and medically complex children, are in imminent danger of losing Medicaid. The threat is dire.”
The latest proposal comes after more than 1,100 organizations from across the nation led by the Disability and Aging Collaborative and the Consortium for Constituents with Disabilities sent a letter to Senate leaders decrying the potential Medicaid cuts as “dangerous and life-threatening.”
“As we’ve repeatedly emphasized, there is no way to carve out people with disabilities and older adults from the harm of these cuts,” the advocates wrote.
The vast majority of optional Medicaid spending — 86% — goes toward services and supports for people with disabilities and older adults, with home and community-based services accounting for more than half, the letter indicates. When federal Medicaid funding was reduced between 2010 and 2012, every state cut home and community-based services in some fashion, the advocates said, and waiting lists “greatly increased.”
Republican lawmakers insist that their proposal would achieve savings and extend tax cuts instituted during Trump’s first term while ensuring that Medicaid serves those it’s intended for.
The bill targets “waste, fraud and abuse in spending programs while preserving and protecting them for the most vulnerable,” said Sen. Mike Crapo, R-Idaho, who chairs the Senate Finance Committee.
Nicole Jorwic, chief program officer at Caring Across Generations, an organization advocating for caregivers and people who rely on them, rejected that characterization and said the Senate proposal took her and other advocates by surprise.
“This is a significant threat because we weren’t expecting the Senate to actually make the Medicaid cuts deeper,” she said. “These cuts would be historic and would have an outsized impact on services for people with disabilities. This bill does nothing to change that home and community-based services are optional under the law, so when cuts come to the state level, the first place they will cut is optional services, waiting lists will grow, providers will close and the DSP shortage will worsen. We know at least 2.6 million HCBS jobs would be at risk.”
“We have to take action and tell the Senate to pull out Medicaid cuts,” Jorwic said.
