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house energy and commerce committee
Medicaid Cuts Put Services for Vulnerable People at Grave Risk
Medicaid doesn’t just provide healthcare. It is the single largest payer for the community-based services people with intellectual and developmental disabilities need to live, work, and thrive in our communities.
May 22, 2025
With the House passing their budget reconciliation bill with a vote of 215-214, hundreds of billions in proposed cuts to Medicaid have moved one step closer toward very real, harmful consequences, including for people with intellectual and developmental disabilities, or I/DD, whose health, safety, and quality of life depend on Medicaid.
Medicaid doesn’t just provide healthcare. It is the single largest payer for the community-based services people with I/DD need to live, work, and thrive in our communities—services that range from assistance with intimate activities of daily living and personal hygiene, to employment supports to find and maintain a job, to providing residential and in-home supports to support independent living.
If lawmakers approve the proposed cuts to Medicaid, state budgets will be unable to absorb the financial shock. Even if targeted to other groups like those made eligible for services through Medicaid expansion, programs that enable people with I/DD to meaningfully participate and thrive in our society will be the first to go. We know because home- and community-based services for people with I/DD are optional services, meaning they are some of the last services to be funded when there’s a state funding shortfall. We saw this following the Great Recession when, following cuts to federal funding, every single state made cuts to services and 36 states specifically made cuts to services for people with I/DD.
If lawmakers truly care about boosting economies, they would invest in, not divest from Medicaid, because these services actually play a critical yet often invisible role in state economies.
Divesting from Medicaid will be devastating to providers of I/DD services who are already struggling immensely due to insufficient Medicaid reimbursement rates that haven’t kept pace with inflation. As a direct result, 90% of community providers report moderate to severe staffing shortages as workers seek out higher-paying jobs in entry-level retail, convenience, and fast food industries. Without sufficient staffing, 69% of community providers report they’re unable to take new referrals for people with I/DD who need and qualify for services.
Medicaid cuts by another name in the form of increased red tape eligibility requirements or work reporting requirements also threaten people with disabilities, who may lose coverage due to barriers completing onerous reporting requirements, even if they are provided an exemption. Such requirements also threaten to further exacerbate the direct support workforce crisis, as 49% of direct care workers rely on public assistance programs themselves, and approximately one-third work part-time or with inconsistent schedules—two job features that are generally incompatible with work reporting requirements. If direct support professionals, the very backbone of disability services, are unable to meet burdensome reporting requirements, it will only force them to find more stable, higher-paying jobs outside of care work.
If lawmakers truly care about boosting economies, they would invest in, not divest from Medicaid, because these services actually play a critical yet often invisible role in state economies.
New York State’s $6.7 billion investment in home- and community-based services generated $14.3 billion in economic activity, while Maine is estimated to have lost out on over $1 billion due to its shortage of direct care workers. That’s because Medicaid-funded services create jobs, while enabling the family members and caregivers of people with I/DD to remain in the workforce too. Without services, families are also more likely to need public assistance.
The House’s budget proposal will force unthinkable decisions on states and providers. It will undoubtedly lead to people with I/DD losing access to services, potentially being forced to languish in their homes without the assistance they need for using the restroom, supportive hygiene, and preparing and eating meals. It will lead to people with I/DD losing their jobs without the employment supports they need to maintain their careers. And it could mean unnecessary institutionalization of people whose right to live and thrive in their communities was codified by the Americans with Disabilities Act and, later, the Supreme Court’s decision in Olmstead v. L.C.
Senators hold the opportunity to continue protecting our most vulnerable populations by rejecting any cuts to Medicaid and not putting further stress on a system already in crisis.
Update: This piece has been edited to reflect the fact that the U.S. House of Representatives passed their budget reconciliation bill on the morning of May 22, 2025.
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GOP Medicaid Cuts Are a Dagger Pointed Directly at Our Most Vulnerable
Every moment that activists can delay the passage of these Medicaid cuts is more time to mount an opposition. Republicans might not want to admit it, but support for Medicaid is strong and deep.
May 16, 2025
The numbers are clear. Nursing home residents depend on Medicaid. According to the nonpartisan Kaiser Family Foundation, fully 63% of nursing home care in the United States is funded by Medicaid. Some states are even more dependent on Medicaid than the national average. For example, in West Virginia fully 77% of nursing home care is funded by Medicaid.
Politico reported on the morning of May 15 that after a marathon markup session lasting 26 hours, the House Energy and Commerce Committee advanced legislation that “would slash Medicaid spending by hundreds of billions of dollars.” These cuts would directly impact nursing home residents and their families. The Washington Post reports that:
“Their [nursing home residents] coverage will be at risk,” said Katie Sloan Smith, president and chief executive of LeadingAge, a Washington lobbying association for operators of nonprofit senior-care facilities. “Either the home itself will have to make up for that loss in some way or they will simply have to say, ‘We can no longer support people on Medicaid’ and close those beds.”
While the Medicaid cuts would hurt nursing home patients, they would also severely impact those who receive care at home (often referred to as home and community-based care). According to National Public Radio, Medicaid pays for care at home for roughly 4.5 million Americans.
The Medicaid cuts that passed the Energy and Commerce Committee would devastate America’s family caregivers as Medicaid also funds caregiver respite programs and caregiver training. The cuts would hurt our most vulnerable and their families.
Where are our citizens on the question of Medicaid cuts? The evidence clearly shows that the American people oppose Medicaid cuts. In fact, there is support for more spending on Medicaid. Polling from the Kaiser Family Foundation published in March of this year found that 42% want to see an increase in Medicaid spending. Just under 3 in 4 (73%) of respondents say that Medicaid is important to their local communities. Democrats (83%), Independents (74%), and Republicans (61%) all see Medicaid as very important to their local community.
Late Thursday May 15, the fate of the measure that passed the Energy and Commerce Committee was in doubt as the legislation moves to a vote in the House of Representatives. There will no doubt be more twists and turns before the measure heads to the Senate. Every moment that activists can delay the passage of these Medicaid cuts is more time to mount an opposition. Republicans might not want to admit it, but support for Medicaid is strong and deep.
This is the greatest threat to Medicaid since its creation in 1965. The GOP legislation is a dagger pointed directly at our most vulnerable. Many of those who would be impacted by Medicaid cuts are not able to raise their voices. Therefore, it up to those of us who can, to raise our voices and tell our elected representatives to reject these cruel proposals that would devastate our families, friends, and neighbors. The stakes in the debate over Medicaid are far too high for any of us to stay silent.
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Ocasio-Cortez Rips GOP for Rushing Ahead With Medicaid Cuts 'When Everyone Is Asleep'
"We've asked for the opportunity to do this in the light of day so that people can call their representatives' offices in order to stop this disaster," said Rep. Alexandria Ocasio-Cortez.
May 14, 2025
U.S. Rep. Alexandria Ocasio-Cortez castigated House Republicans for pursuing massive cuts to Medicaid "in the dead of night" as a committee markup hearing on the GOP's legislation dragged on into the early hours of Wednesday morning.
Ocasio-Cortez (D-N.Y.) said it is shameful that Republicans are rushing ahead with their proposal "at 2:38 in the morning, when everyone is asleep, when we've asked for the opportunity to do this in the light of day so that people can call their representatives' offices in order to stop this disaster."
As the House Energy and Commerce Committee hearing kicked off Tuesday afternoon, demonstrators gathered in the Rayburn House Office Building and more than two dozen people were arrested for protesting the GOP's Medicaid proposal, which would cut the program by around $800 billion over the next decade and leave around 8 million more people uninsured.
But attention on the hearing naturally dwindled as it continued into the night and early Wednesday morning. As of this writing, the critical markup session is still ongoing.
During her remarks at the hearing, Ocasio-Cortez said Republicans have looked to the state of Georgia as a model for their Medicaid proposals—particularly their push for work requirements that advocates say would endanger coverage for millions of people who are eligible for benefits.
Ocasio-Cortez noted that Georgia is among the states with the highest uninsured rates in the nation.
"The Republican majority has looked at the state with the third-highest number of uninsured Americans and said, 'That's what we want to model our Medicaid system after—this catastrophic failure,'" said the New York Democrat.
Republicans are saying that these cuts will be reinvested into Medicaid for people who "deserve" it.
If that were true, the budget would stay the same. But that's not what's happening. Why?
Because down the hall, they are trying to finance tax breaks for billionaires. pic.twitter.com/98jORYSrTP
— Rep. Alexandria Ocasio-Cortez (@RepAOC) May 14, 2025
The Center on Budget and Policy Priorities (CBPP) noted Tuesday that beginning in 2029, the GOP bill would "require states to deny coverage to people applying for Medicaid if they are not already working (or participating in another qualifying activity) at least 80 hours per month, as well as terminate Medicaid for people already enrolled if they cannot document that they are meeting work requirements."
"Evidence shows that much of the coverage loss due to work requirements would occur among people who work or should qualify for an exemption but nevertheless would lose coverage due to red tape (states should be able to exempt most people with children automatically, but many others who should be exempt, such as people with disabilities, would not be automatically exempted)," the group observed.
CBPP estimated that the Republican plan would put between 9.7 million and 14.4 million people at risk of losing Medicaid coverage by 2034.
"Let me be clear—this is not a moderate bill, and it is not focused on cutting 'waste, fraud, and abuse,'" said Rep. Frank Pallone Jr. (D-N.J.), the ranking member of the House Energy and Commerce Committee. "Instead, Republicans are intentionally taking healthcare away from millions of Americans so they can give giant tax breaks to the ultra-rich who don’t need them."
Politicoreported early Wednesday that "after hours of debate, Republicans in unison voted down a Democratic amendment that would have required the Health and Human Services Secretary to certify that the GOP bill would not reduce any Medicaid benefits offered by states, pointing to President Donald Trump's repeated pledges to protect the program."
Republicans started several markup sessions for key pieces of their reconciliation package at around the same time on Tuesday, reportedly a deliberate effort to disperse and weaken the opposition.
"Down the hallway, they are trying to finance tax cuts for people who are inheriting $22 million houses," Ocasio-Cortez said Wednesday, referring to the House Ways and Means Committee's marathon hearing on the tax section of the reconciliation bill.
Republicans also held a hearing Tuesday for their proposal to slash the Supplemental Nutrition Assistance Program (SNAP) by hundreds of billions of dollars. The markup session lasted more than three hours and is expected to resume Wednesday morning.
"Tonight, you're taking food away from single moms with 7-year-olds at home—as if being a single parent raising a young child wasn't hard enough already. And farmers, too, will suffer from your direct attacks on SNAP," Rep. Angie Craig (D-Minn.), the top Democrat on the House Agriculture Committee, said at the hearing. "Benefits will get cut—and for what? To fund tax breaks for everyone but the middle class."
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