This article is part of “Disabled and Denied,” a series examining cuts to Medicaid home care and the fallout for disabled people and their families.
NBC News is looking to speak to people who rely on Medicaid-funded care at home, as well as family members, workers and advocates who support them.
For decades, Medicaid home- and community-based services have helped millions of disabled and older Americans live independently rather than in institutions or nursing facilities. Now, a series of changes at the state and federal levels is threatening that system.
President Donald Trump’s “big, beautiful bill” is projected to reduce federal Medicaid spending by nearly $1 trillion over the next decade. Conservative officials and activists have increasingly portrayed home care as wasteful and rife with fraud. And the Justice Department has backed away from the federal government’s long-standing interpretation of a landmark Supreme Court ruling protecting the right of disabled people to receive services in their communities.
The Trump administration denies that it’s targeting disability programs, arguing that its efforts to root out waste and abuse will protect Medicaid for vulnerable Americans who need it.
The biggest federal cuts won’t begin to hit until next year, but the system is already showing signs of strain.
In some states, officials have cut wages or capped hours for paid family caregivers. Fraud crackdowns have jeopardized care for families who say they did nothing wrong. And some disabled people have had their caregiving slashed by new algorithmic assessments.
For families who depend on these programs, the stakes are profound. Many fear the changes will unravel a fragile system built over generations to help disabled and older Americans live outside of institutions.
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