Jason acquired a traumatic brain injury from a car accident at the age of 18 and lived his entire adult life in group homes, but he longed to live independently and teach chess in elementary schools. At the age of 44, Jason’s dreams have begun to come true. He now lives in a subsidized one-bedroom apartment, attends a day program where he builds skills and participates in community activities, and earned an Early Childhood Education certificate. All of this was possible because of Medicaid.
The state of Maryland, where Jason lives, adopted a Medicaid Home and Community Based Services (HCBS) waiver that covers Housing Support Services that helps people with intellectual and developmental disabilities move from group homes or institutional settings into the community. Through this Medicaid waiver, service providers like Maryland Inclusive Housing can help people like Jason find an apartment, apply for a rental subsidy, assist with paperwork, and receive regular support to find day programs, educational and employment services, and participate in community activities.
Medicaid Home and Community-Based Services and Money Follows the Person
All 50 states and the District of Columbia have similar HCBS programs that help people with intellectual and developmental disabilities (I/DD) live fully in the community and avoid more restrictive settings that they no longer need. In fact, according to a 2022 study, the vast majority of the estimated 1.58 million people living with I/DD known to state I/DD agencies in the United States are assisted through Medicaid 1915(c) HCBS waivers.
A report by the Centers for Medicare and Medicaid Services indicates that, in 2022, states spent $129.4 billion on Medicaid HCBS services for people with disabilities, at least half of which is estimated to be covered by federal Medicaid funding. Many states also participate in Money Follows the Person, a federal Medicaid demonstration under which states receive $3.7 billion in federal grant dollars to fund efforts to help transition people with disabilities who no longer need institutional care into community-based housing with supportive services.
How federal Medicaid cuts would impact people with disabilities
The Trump Administration and Congress are proposing cutting federal Medicaid spending by as much as $880 billion over the next ten years. These cuts would:
- Result in significant reduction, if not elimination of HCBS and Money Follows the Person programs and the services they fund for people with disabilities. For many, this can be life-threatening. For others, it can result in loss of independence, loss of jobs, institutionalization and overall reduced quality of life.
- Increase demands on family caregivers causing job loss, impoverishment and burnout.
- Cause shutdown of providers and loss of jobs to Direct Support Professionals (DSPs) and other workers who are providing support within HCBS systems.
Loss of services and support systems will result in the rollback of advancements made around human and civil rights for people with I/DD. These advances have made it possible for full inclusion of people with disabilities in all service systems and communities.
For people with disabilities themselves and their families and loved ones, these cuts would be nothing short of devastating. States would no longer have the resources to provide the supports that enable people like Jason to live independently, apply for housing assistance, find housing, obtain education and employment services and participate in the community. Those without family members to care for them, or access to institutions, would wind up homeless, or in more costly and restrictive settings such as emergency departments or jails, having no ability to afford housing and no help to connect to available services.
Medicaid cuts would also devastate many providers. These workers provide crucial support and services to people with I/DD to ensure their health and safety and meet their daily living needs. A 2024 report to Congress by the United States Department of Labor notes that, due to historically low wages and stressful job demands, the I/DD field lacks sufficient workforce nationwide. The pandemic worsened the I/DD provider workforce crisis because of workers’ high risk of exposure to COVID-19, mask and vaccine mandates, and the increased need for safety and enhanced preventive measures on the job. A higher proportion of this workforce are women, people of color or older people. Significant cuts to Medicaid-funded HCBS services could further decimate this already vulnerable workforce and roll back significant efforts that states have undertaken to strengthen it.
The proposed federal cuts to Medicaid are not only harmful, but they would also violate the fundamental rights of people with disabilities to live and fully participate in community life. Medicaid is not just an abstract federal program. It is an essential source of help for people with physical, mental, intellectual and developmental disabilities, and their families and loved ones. Members of Congress should recognize how cuts to federal Medicaid spending would affect their constituents with disabilities, their constituents with family members who have disabilities, and the vast network of providers and workers who support them.
Anna Lansky is a senior advisor with Manatt Health and the former interim director of the Oregon Department of Human Services’ Office of Developmental Disabilities Services. Richard Cho is a managing director with Manatt Health and a former senior advisor for housing and services and the U.S. Department of Housing and Urban Development.
Editor's note: Manatt Health received permission from Jason and Maryland Inclusive Housing to be described in this article.