How Medicaid Cuts Threaten the Lives of People with Disabilities
Imagine waking up and not knowing if your personal care assistant (PCA) will be able to show up for work tomorrow. Not because they quit, but because their job was defunded. For millions of Americans with disabilities, that nightmare could become reality under proposed Medicaid budget cuts currently (5/6/2025) circulating through Congress.
To prevent any potential confusion, Medicaid is known by different names across the United States. In Massachusetts, it’s MassHealth. In California, it’s Medi-Cal. In Washington, it’s Apple Health. No matter the name, Medicaid is far more than a health insurance program. It is a lifeline. It covers in-home caregivers, wheelchairs, therapies, accessible transportation, and for some people, the very roof over their heads. Without it, many individuals with disabilities would be forced into institutions or left completely without care.
What’s at Stake?
The proposed federal budget includes major reductions to Medicaid through two key strategies: block grants and per capita caps. These might sound like bureaucratic terms, but they come with very real consequences. Block grants would provide states with a fixed amount of federal funding, regardless of how many people actually need services. Per capita caps would limit how much the federal government contributes per person (Center on Budget and Policy Priorities [CBPP], 2024). Both approaches would shift financial pressure to states, many of which already face budget shortfalls. As a result, states would likely reduce or eliminate vital services.
On a personal note, I’m fortunate to receive veterans benefits that cover my care. Because of that, I don’t currently rely on Medicaid. But many of my peers do. I belong to support groups and disability communities filled with people whose daily lives, safety, and independence depend on programs like MassHealth. I see firsthand how fragile the system can be—and how devastating these proposed cuts would be for people who are already fighting just to live with dignity.
This isn’t hypothetical. These are real people. These are our friends, neighbors, and loved ones. And they need our voices now more than ever.
Let’s look at what some real-life consequences could look like:
Scenario 1: PCA Hours Get Slashed
Maria is a 38-year-old wheelchair user in Minnesota. She relies on PCA services for six hours a day to help her bathe, dress, and prepare meals. If federal Medicaid funding is reduced and Minnesota is forced to cut back on its Medical Assistance program, Maria’s support could be reduced to only three hours. She might have to choose between eating or getting to the bathroom safely. Many people in her position would have no choice but to go without care or rely on unpaid family members who are already stretched thin.
Scenario 2: Nursing Homes Close
In rural Kentucky, Medicaid—referred to locally as Kentucky Medicaid—funds care for over 60 percent of nursing facility residents (Kaiser Family Foundation [KFF], 2024), including people like Ruth, an 89-year-old woman with advanced dementia whose daughter, Linda, visits her daily at a nearby nursing home. When federal Medicaid cuts force the state to slash long-term care funding, Ruth’s facility announces it will close, leaving families like Linda’s scrambling for alternatives that are either too far away or unequipped for specialized dementia care. For Linda, this means the heartbreaking reality of watching her mother be uprooted from the only place where she feels safe.
Scenario 3: Young Adults Lose Independence
Chris, a 24-year-old with cerebral palsy in California, recently moved into supported housing thanks to Medi-Cal’s In-Home Supportive Services (IHSS). This program allows him to live independently and contribute to his community. If Medi-Cal faces budget reductions, Chris could lose this support and be forced to return to institutional care or move back in with family. This would undo years of progress under the Americans with Disabilities Act and the Olmstead decision, which affirms the right to live in the least restrictive setting possible.
Scenario 4: A Massachusetts Resident Loses Critical Support
David is a 32-year-old Boston resident living with a spinal cord injury. He uses a power wheelchair and receives daily assistance through MassHealth’s PCA program. This support allows him to live independently in his apartment, pursue a college degree, and volunteer as a peer mentor in his community.
If federal Medicaid cuts force Massachusetts to reduce funding for MassHealth, the state could respond by tightening eligibility requirements or cutting back on PCA hours. David might lose half of his care, making it difficult—or impossible—for him to get out of bed, use the bathroom safely, or prepare meals. Without consistent support, he could face hospitalization or even be forced into a long-term care facility, undoing years of effort to live independently.
A Wider View
The National Association of Medicaid Directors (2023) reports that nearly one in five Americans depend on Medicaid. Over 10 million of those are individuals with disabilities. These are not just numbers on a spreadsheet. They are children who need therapy, veterans who rely on mobility aids, and seniors who depend on medications and medical equipment. Budget cuts are not about eliminating waste—they are about eliminating care for real people.
This is not a debate about fraud or inefficiency. It is a question of whether people with disabilities will continue to live in their communities with dignity, or whether they will be forced into institutions due to lack of support. It is about whether parents can work knowing their children are safe, whether aging adults can stay in their homes, and whether society values all of its members equally.
We must speak up. Call your elected officials. Share your story. Vote with these issues in mind. Because when Medicaid is cut, it is not just funding that disappears. It is someone’s independence, safety, and future.
References
American Association on Health and Disability. (2024). Health policy updates. https://aahd.us
Center on Budget and Policy Priorities. (2024). Proposals to cap federal Medicaid funding would shift costs to states, reduce access to care. https://www.cbpp.org
Justice in Aging. (2023). The threat of Medicaid block grants and per capita caps to older adults.https://justiceinaging.org
Kaiser Family Foundation. (2024). Medicaid’s role in nursing home care. https://www.kff.org
National Association of Medicaid Directors. (2023). Medicaid 101: Key facts about the nation’s largest health insurer.https://medicaiddirectors.org
National Disability Rights Network. (2024). Policy priorities: Protecting Medicaid services. https://www.ndrn.org
Pifer, R. (2025, May 5). Trump White House budget proposes major healthcare, HHS cuts. Healthcare Dive. https://www.healthcaredive.com/news/trump-white-house-budget-healthcare-hhs-cuts/747062/
Romm, T. (2025, May 2). Trump’s 2026 Budget Proposal Calls for $163 Billion in Cuts: Live Updates. The New York Times. https://www.nytimes.com/live/2025/05/02/us/trump-budget-2026
The Arc. (2024). Medicaid and people with disabilities. https://thearc.org
U.S. House of Representatives, Committee on the Budget. (n.d.). Time table of the budget process. https://budget.house.gov/about/budget-framework/time-table-budget-process/