Congress Approves Nearly $1 Trillion In Cuts To Medicaid Threatening Disability Services

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Republicans in Congress pushed through the largest Medicaid cuts in history, a move advocates say will inevitably shrink services for people with disabilities across the nation.

The U.S. House of Representatives narrowly voted to approve almost $1 trillion in cuts to Medicaid just before the Fourth of July holiday as part of a sweeping bill designed to make good on many of President Donald Trump’s domestic priorities. A similar scenario played out in the Senate just days prior.

No Democrats in either chamber voted for the measure, which President Donald Trump is expected to swiftly sign into law.

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The legislation calls for work requirements for many Medicaid beneficiaries and directs states to check individuals’ eligibility for the program more frequently. It also limits Medicaid provider taxes, a workaround that states use to get more federal money from the program, among other changes.

Savings from Medicaid as well as reduced spending on food assistance for low-income families and other areas will help pay for an extension of tax cuts from Trump’s first term and support other administration priorities.

The Medicaid cuts will take effect at the end of 2026 and roll out over 10 years, according to the American Association of People with Disabilities.

“This is a devastating day for disabled Americans,” said Maria Town, the group’s president and CEO. “The catastrophic effects of this bill will reverberate for generations to come.”

While the measure does not explicitly include changes to disability services, advocates have been warning for months that there is no way to insulate people with disabilities if the federal government chops its investment in Medicaid.

Advocates are particularly worried about the impact on optional Medicaid offerings like home and community-based services, or HCBS.

“Because states are not required to provide these services to everyone who needs them, states faced with a huge loss of federal funding for Medicaid will cut HCBS first,” said Zoe Gross, director of advocacy at the Autistic Self Advocacy Network. “This will lead to disabled people going without lifeline services like assistance with eating, dressing, using the bathroom, going to work, etc.”

There are also concerns that more frequent eligibility checks and work requirements will lead to added paperwork and additional opportunities for eligible individuals to inadvertently lose their Medicaid coverage. At the same time, states will have no choice but to devote limited resources toward creating systems to implement the new requirements, advocates say.

Republicans have repeatedly pushed back on the idea that their legislation will take away services from people with disabilities.

“As the president has said numerous times, there will be no cuts to Medicaid,” reads a recent fact sheet from The White House. “The One Big Beautiful Bill protects and strengthens Medicaid for those who rely on it — pregnant women, children, seniors, people with disabilities, and low-income families — while eliminating waste, fraud, and abuse.”

However, advocates say that’s simply not true.

“Despite Congress’ stated intent of protecting people with IDD, this bill cuts the very funding on which people with disabilities depend for critical supports and life-saving health care,” said Barbara Merrill, CEO at the American Network of Community Options and Resources, or ANCOR, which represents disability service providers across the nation. “Make no mistake: this bill will cause direct harm to anyone who depends on Medicaid to continue living in their community.”

In a letter to senators last month, more than 1,100 organizations led by the Disability and Aging Collaborative and the Consortium for Constituents with Disabilities noted that 86% of optional Medicaid spending is used for services and supports for people with disabilities and older adults, more than half of which is for home and community-based services. When federal Medicaid funding declined between 2010 and 2012, they said that every state cut home and community-based services to some degree and waiting lists grew substantially.

The new Medicaid cuts come as the home and community-based services system is already under intense pressure. More than 700,000 people are on waiting lists for Medicaid waivers, which provide these services, according to KFF, a nonprofit that conducts health policy research. Meanwhile, a survey late last year of almost 500 community-based services providers across the country found that nearly all had experienced moderate or severe staffing shortages in the previous year. As a result, 69% had declined new clients and 39% closed programs or services, with over a third saying they were considering further cuts.

“This is a dark day for people with disabilities and their families. This bill puts essential support at risk for millions,” said Katy Neas, CEO of The Arc of the United States. “It will force states to make impossible choices that could strip people of the services they need to live with dignity, safety and independence. The harm will be real. Families will feel it in their homes, their schools and their communities.”

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