The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities. Home and Community-Based Services (HCBS) are particularly important.
Thousands of family caregivers of people with intellectual and development disabilities in Maryland are facing a grim future after the Maryland Department of Health’s Developmental Disabilities Administration proposed steep cuts to their wages earlier this summer. Some caregivers are looking at $20 per hour pay cuts. The new wage tables were slated to go into effect July 1, but pushback from disability advocates delayed the changes to October. They say the cuts will force families to make an impossible choice between going bankrupt and institutionalizing their loved ones in facilities that often face higher rates of abuse and neglect.
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Maryland is not an isolated case. Idaho, Indiana, Missouri and Colorado have all introduced proposals in 2026 that would dramatically slash pay for family caregivers and community care. Ohio legislators even proposed banning family members from being certified caregivers before ultimately dropping the measure. These states’ moves are a sign of the deadline looming over state health departments as the $1 trillion Medicaid funding cut tucked in the 2025 GOP-backed tax bill goes into effect Jan. 1, 2027.
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“We know from the past that whenever the federal government reduces Medicaid, almost every state has made cuts to home and community-based services, and that those optional services include paying family caregivers,” said Kim Musheno, senior director of Medicaid policy at The Arc, a national nonprofit that advocates for people with developmental and intellectual disabilities.
Soon after President Trump started his second term and discussed cutting Medicaid funds, disability advocates raised the alarm that home and community-based services probably would feel the brunt of those cuts, since the care is not mandatory. Since then, the Trump administration has targeted family caregivers, with health secretary Robert F. Kennedy Jr. saying in April that Medicaid-funded programs that pay family caregivers are “rife with fraud” and that those caregivers are doing tasks they used to do for free.
