New York Elder Law Attorney
For millions of Americans caring for disabled children, aging parents, or loved ones with developmental disabilities, Medicaid-funded home and community-based services are not a luxury. They are a lifeline.
These programs allow family caregivers to provide care at home while receiving compensation for the physically and emotionally demanding work they perform every day. For many families, Medicaid home care programs have prevented the heartbreak of placing loved ones in nursing facilities where living conditions and quality of care can range from inadequate to devastating.
Now, those supports are being dismantled.
Why Home and Community-Based Services Matter
The community-based care model has transformed life for people with disabilities and seniors who would otherwise face institutionalization. An estimated 94% of Americans with intellectual and developmental disabilities live at home or in community settings rather than institutions because of Medicaid-funded Home- and Community-Based Services (HCBS).
These programs allow disabled individuals to remain connected to their families, schools, workplaces, faith communities, and neighborhoods. They also give families stability and dignity while reducing the emotional and financial strain associated with long-term institutional care.
Federal Medicaid Cuts Are Already Reaching the States
The sweeping federal spending package passed last July included roughly $1 trillion in Medicaid cuts. Advocates for seniors and people with disabilities warned lawmakers about the consequences, but Congress was not listening.
While many of the reductions are scheduled to take effect in 2027, several states have already begun scaling back programs.
Maryland is among the first states to make significant cuts, reducing $126 million from programs serving people with developmental disabilities. Beginning July 1, family caregiver wages and approved work hours will be sharply reduced.
Nursing Homes Are Already Overwhelmed, Beds are Limited
As Medicaid home care programs shrink, millions of elderly and disabled Americans could be forced into nursing homes or institutional settings simply because families can no longer afford to care for them at home.
The long-term care system is already strained beyond capacity. Facilities across the country face severe staffing shortages, growing waiting lists, and persistent concerns about quality of care.
Reducing Medicaid-funded community care will not eliminate the need for services. It will merely shift vulnerable individuals into systems that are more expensive, less personal, and already overwhelmed.
Medicaid Home Care Is More Cost-Effective Than Institutional Care
These cuts don’t make economic sense. Providing support for a disabled person in their home or community costs approximately $70,000 annually. Institutional care can exceed $395,000 per year. Hospital-based care and public institutional settings are often even more expensive.
Family Caregivers and Direct Support Professionals are Good for Communities
Medicaid-funded caregiving programs do more than support disabled individuals. They help entire communities remain economically stable. Direct support professionals and family caregivers make it possible for parents, spouses, and adult children to remain in the workforce. Employers retain experienced workers instead of losing them to full-time caregiving responsibilities. Families avoid financial collapse. Without these programs, many caregivers will face impossible choices between employment and caring for loved ones.
Fraud Concerns Don’t Justify Broad Medicaid Cuts
A growing conservative campaign focused on alleged Medicaid abuse and fraud has placed Home- and Community-Based Services under increased scrutiny. No one disputes that fraud should be identified and prevented. But broad cuts to essential caregiving services punish the very people these programs were designed to protect.
Most Medicaid recipients do not have lobbyists or political influence, making them vulnerable to poor decisions by lawmakers. They are low-income families, seniors, and disabled individuals already struggling to navigate a complex healthcare system.
Many were not always poor. Long-term care costs often consume lifetime savings and force middle-class families into financial hardship.
Sweeping reductions to Medicaid caregiving programs target some of the nation’s most vulnerable citizens while leaving larger spending priorities untouched.
The Fight to Protect Medicaid Has Moved to the States
Because many Home- and Community-Based Services fall under optional Medicaid categories, states have significant discretion over whether to continue funding them. The future of Medicaid home care will increasingly be decided in state capitals.
Most states already maintain lengthy waiting lists for in-home care assistance, and as funding shrinks, those lists are expected to grow dramatically. Families who rely on Medicaid caregiving services are now facing a painful reality: programs that once allowed loved ones to live safely at home may soon disappear.
Nobel laureate and Pulitzer prize winning novelist Peal S. Buck wrote this in her autobiography, My Several Worlds (1954):
“Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members.”
I’d like to think we can do better.
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