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.
ANCOR, 2026 The State of America’s Direct Support Workforce Crisis
Now, in the wake of H.R. 1 and in anticipation of budget shortfalls to come, some states are already adopting or considering cuts to their Medicaid-funded community-based I/DD services programs. Prominent examples include:
- Connecticut, which is planning cuts to a program that helps people with disabilities remain in their homes known as the Community First Choice Program.
- Colorado, which reversed planned rate increases for Medicaid providers and announced potential caps on Medicaid programs that help people with disabilities engage in activities such as cleaning, cooking, and community-based outings.
- Idaho, which cut $22 million in funding for its Medicaid home- and community-based services program.
- California, which is planning to eliminate its Backup Provider System, a program that pays for temporary backup care for people with disabilities when their primary provider is not available.
These existing and looming threats are creating uncertainty for providers as they look ahead to the next few years. In our survey, we found that 56% of respondents decided not to expand services at the present time because of the threat of state-initiated payment reductions or service cuts in response to H.R. 1. It is also worth noting that H.R. 1 established the $50 billion Rural Health Transformation Program, as well as a new eligibility pathway for individuals to receive home- and community-based services. However, none of this new spending can benefit people with I/DD if providers lack the DSPs needed to render these services due to the law’s other provisions slashing federal Medicaid spending.
