Lawmakers knew all alongside they had been voting to chop Medicaid for older adults

The battle to guard Medicaid for older adults and other people with disabilities now strikes to state capitals — the place care hangs within the steadiness.

Final July, Congress voted to move the Funds Reconciliation Act of 2025 (H.R. 1) and enact the most important Medicaid cuts in historical past. For months earlier than the vote, advocates, older adults, and other people with disabilities repeatedly warned lawmakers that reducing federal Medicaid funding would put residence and community-based companies (HCBS) first on the chopping block. However lawmakers took to the airwaves dismissing these claims, asserting they had been solely reducing “wasteful” spending, and promising that key Medicaid applications, together with HCBS, could be protected and even strengthened as they reduce federal Medicaid funding to states by $1 trillion. This was at all times an empty promise.

Medicaid’s protection of HCBS is just not a luxurious. For most individuals, it’s the one possibility for at-home care. HCBS assist with on a regular basis actions like dressing, bathing, cooking, and taking drugs that enable older adults and other people with disabilities to stay at residence and a part of their communities. HCBS lower your expenses too, relieving prices for households who can’t afford to pay for care out of pocket and avoiding far dearer institutional care that Medicaid would in any other case must pay for. Analysis reveals individuals who want however don’t obtain HCBS are way more more likely to have to enter nursing services.

Ellie was a caregiver for her mom, Jane, who had Alzheimer’s, and likewise her father. When she was not capable of steadiness her job and full-time caregiving, she left her job. With out her revenue, Ellie was unable to financially assist each her household and her mother and father. Medicaid supplied the lifeline she wanted: paying Ellie to be her mother’s full-time caregiver underneath an HCBS program.

“With the ability to maintain my mother at residence the place issues are acquainted, and to be cared for by household, was an unimaginable reward,” Ellie says. “Medicaid let my mother and father be cared for by the individuals who know find out how to take care of them greatest, within the consolation of residence, and within the final stage of their lives the place they deserved to be honored and cherished.”

Regardless of the shortage of alternate options, Medicaid protection of HCBS is non-compulsory underneath federal legislation, which means states have discretion to chop these applications when federal funding is reduce and budgets tighten. In reality, historical past reveals that following the Nice Recession, when Congress reduce federal Medicaid funding, each single state responded by reducing HCBS.

Lower than a 12 months after H.R. 1 handed, states — together with Colorado, Idaho, Missouri, Nebraska, Utah, and North Carolina — have already proposed cuts to Medicaid HCBS. Disabled folks, older adults, and their households who spent 2025 combating H.R. 1 on the federal stage at the moment are pressured to take the struggle to their state capitals, demanding that their legislators keep the Medicaid companies that allow them to reside at residence.

With cuts to the very Medicaid applications Congress and the Trump Administration promised to guard now a actuality, some policymakers are doubling down on disingenuous justifications. They insist these cuts are rooting out waste and even fraud, not reducing care — however this declare is basically solely a pretext to slash advantages that assist older adults and other people with disabilities at residence and shift prices onto households. In the meantime, measures comparable to focused audits, knowledge‑pushed oversight, and strengthened safeguards that might really handle fraud are being discounted and dismantled. The true deception is lawmakers promising safety whereas stripping away the care folks rely on.

These cuts are usually not an summary line merchandise on a spreadsheet. They may pressure folks like Jane into establishments, push prices onto households, deepen the caregiver disaster, and fall hardest on girls and communities of colour. They may worsen well being outcomes and in the end enhance state spending. Analysis reveals that cuts to HCBS will show dearer for states by growing nursing facility use, whereas considerably harming the standard of lifetime of older adults and other people with disabilities. In different phrases, quick‑time period “financial savings” from cuts turn into lengthy‑time period losses for households and public budgets alike.

To date, these air‑wave assurances—that Medicaid would stay intact for individuals who want it most—are nothing greater than political cowl for gutting Medicaid. If lawmakers are critical about these guarantees, they should act. And we should demand that they do. Neither the federal authorities nor states are with out choices.

Federally, Congress might restore Medicaid funding and make actual investments in our long-term care system. States might elevate income and cease tax giveaways to the ultra-wealthy and companies — selections that protect care with out forcing households to shoulder the associated fee. If lawmakers don’t fund Medicaid, our mother and father, mates, neighbors – all of us – pay the value.