What Medicaid cuts mean for those who rely on home healthcare

Among the provisions of the big Republican tax and spending law that President Donald Trump signed a little more than a year ago are significant changes and cuts to Medicaid, which provides healthcare for eligible low-income people. That includes older adults and people with disabilities.

As a result of the funding reductions, states have been slashing their Medicaid budgets by making cuts to services like home healthcare for those with disabilities and for the elderly. These are services that were already stretched thin. Now, even more folks may struggle or be unable to access the services.

For many, that will mean being forced to live at a nursing home or other institution rather than receiving care at home.

Jayme Fraser, an investigations and data journalist, wrote about this for USA Today, and she recently joined “Marketplace Morning Report” host Kimberly Adams for more. The following is an edited transcript of their conversation.

Kimberly Adams: Your story focuses on one man, Nick Papadopoulos in Georgia. Can you tell us about his story?

Jayme Fraser: Nick was born with cerebral palsy, and, for most of his life, lived independently. You know, he used crutches or canes to get around, and when his mobility started to decrease, he signed up for a special Medicaid program for people with disabilities to help him get dressed in the morning or get undressed in the evening. Then later in life, he had a medical crisis, and, as a result, lost his job and his home, and then ended up in a nursing home for 10 years.

Adams: And you write that cases like this could become more common. Why is that?

Fraser: The cuts to Medicaid under the One Big Beautiful Bill were expansive — largest ever made in the program's history. And so, as states figure out how to provide these required services with less money, voluntary programs like home-based services become easy targets for cuts. They've also been struggling to expand these programs through things like provider pay rate increases, because there's a huge workforce shortage in this sector.

Adams: Advocates say that these government concessions are eroding civil rights under the Americans with Disabilities Act. Can you get into what they're arguing there?

Fraser: The Americans with Disabilities Act made a promise that people with disabilities are part of society, should be part of any kind of public life. And the later Olmstead decision by the United States Supreme Court in 1999 affirmed that right, saying in particular that a state can't choose to put a person with a disability into an institution just because it's convenient; people have a right to live in their homes and in their community whenever possible, and so that set up this tension between people's rights and available services, which is exactly what happened with Nick. He entered a nursing home in 2016 not because he wanted to, not because he had to have that level of care, but because there were not any home-based services available for him, and there were thousands of other people on a state waitlist for those services. And so we see that these funding cuts are only exacerbating that gap between the promise of the Americans with Disabilities Act and the practical way we've funded most of those services, which is Medicaid.

Adams: I'm thinking about the fact that, with our aging population in the United States, it's not just people with disabilities who would be calling upon these services; it's also older Americans who need help at home. So what it seems like you're laying out here is a situation where we've already got this backlog of folks needing these services, states are cutting back on these services due to Medicaid cuts, and even more people are going to be entering the system to need them.

Fraser: The vast majority of people surveyed say that they would rather age in place than move into a retirement home or a skilled nursing facility. When you look at these waitlists, about three-quarters of the people on them have intellectual or developmental disabilities, but most of the rest of them have physical disabilities, and that includes seniors, right? Because the disability label is not always something you're born with, but it's something anyone can gain at any point in their life because of an accident or because of aging. We can all experience reduced mobility or have a change in our cognitive status or our physical abilities, and that's where these programs come in and help people maintain their independence, right? But it's that one critical step that these programs help with and enable people to remain at home.

Adams: So, what does the fact that all this is coming down the pipeline mean for folks with disabilities or the elderly?

Fraser: We're going to see more of the same, right? The passage of the Americans with Disabilities Act in 1990 and the Olmstead decision in 1999 really made clear there's a promise that people with disabilities — whether you're born with them or acquire them in old age — deserve to be part of American life broadly. We haven't always funded our programs enough to make sure that we hold that promise. And now, with the cuts in the One Big Beautiful Bill and states adapting to that by cutting voluntary services like home-based care, I think we're just going to see more people falling into that gap, and maybe that'll bring more awareness of these challenges. And so while some states are cutting the home-based services to fix short-term funding problems, they're actually going to end up spending more in their Medicaid programs to keep people in institutions.

Adams: Let's say that I am a person with a disability, or I have a loved one with a disability. Knowing that this is coming, what should people do?

Fraser: Well, most people with disabilities that need home-based supports are probably already on a wait list, if not already receiving these services. You know, I would recommend families that are watching loved ones age or that are getting closer to needing that kind of support, get on your state's wait list as soon as possible. In several states, the wait can be as long as 10 years to get services, so you can't get on the list too early. And connect with your local disability resource groups; they will have advice on navigating the applications and making sure that all of your needs are adequately documented, so that you can get the types of supports you need.