Medicaid Cuts Could Take Away Services People with Disabilities Depend On

Medicaid is more than health insurance. For millions of people with intellectual and developmental disabilities (IDD), it’s what allows them to get medical care, daily help, and the chance to live in their own homes and be part of their community.

But big changes are coming. On July 4, 2025, Congress passed the “One Big Beautiful Bill Act” (OBBBA). This new budget plan will cut almost $1 trillion from Medicaid over the next 10 years. These cuts, plus new rules, could hurt people with disabilities and their families in many ways.
 
1. Fewer Services – Especially Home and Community-Based Services (HCBS)
Medicaid has some services that states must cover, like hospital care. But many important supports for people with disabilities—such as Home and Community-Based Services (HCBS)—are “optional” for states. That means states can cut them if money is tight.¹

HCBS includes things like personal care, job coaching, transportation, and daily living help. These services allow people to live at home instead of being sent to a facility. If HCBS is cut, waiting lists will grow, and people may lose the help they need.

In Massachusetts and Connecticut, most big state-run institutions have closed. If someone loses HCBS, the main options left are nursing homes or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID). Connecticut also has the state-run Southbury Training School, but it only takes new residents in special cases. These settings are often far from family, more restrictive, and cost more—about $47,000 a year compared to $36,000 for HCBS.²
 
2. New Work Rules That Cause People to Lose Coverage
The new law says many people on Medicaid must prove they are working, looking for work, or doing community service to keep their insurance. It sounds simple, but research shows these rules don’t help people get jobs. Instead, they mostly cause people to lose coverage because of paperwork problems.³ ⁴ ⁵

This is especially bad for people with IDD. Many work part-time or in jobs that depend on Medicaid-funded supports. If they lose Medicaid, they could lose the very help that lets them work—making it even harder to meet the requirement.
 
3. More Frequent Eligibility Checks – More Paperwork, More Risk
Before, people had to renew their Medicaid once a year. Now they will have to do it every six months. This means more forms, more proof of income, and more chances for paperwork to get lost or be late.

Studies show that checking eligibility more often makes more people lose coverage by mistake and costs states more money to process.⁶ ⁷ ⁸ For people with IDD, even a short gap in coverage can mean losing access to medicine, in-home care, and therapy.
 
4. Cuts to SNAP Food Assistance
The bill also makes big cuts to the Supplemental Nutrition Assistance Program (SNAP). For the first time, states will have to help pay for it, which could reduce benefits. People will also have to show they work at least 20 hours a week to keep getting help; which without the above supports may not be possible.

For people with disabilities living on small, fixed incomes, SNAP can be the difference between having enough food and going hungry. The maximum benefit in 2024 was $291 a month—already not much to cover all meals. Losing SNAP could mean worse health and higher medical costs later.⁹ ¹⁰
 
Why This Matters

• HCBS costs less than institutions AND gives people more independence.
• Losing Medicaid means losing access to important care and support.
• Families may have to quit jobs to care for loved ones, which can cause money problems and increase the need for government help.

 
Speak Up and Take Action
Lawmakers need to hear from the people most affected. The Massachusetts Developmental Disabilities Council (MDDC) encourages everyone to contact their state and federal legislators and share why Medicaid and HCBS are so important.

Find your MA legislators here: malegislature.gov/Search/FindMyLegislator
Find your CT legislators here: https://www.cga.ct.gov/  (scroll down, located in the middle of the page)

At neba, we believe everyone should have the right to live, work, and thrive in their community. Medicaid cuts put those rights at risk. We stand with advocates, families, and individuals with disabilities to protect these essential services.

Sources

1. Schubel, Jessica, et al. “History repeats? Faced with Medicaid cuts, states reduced support for older adults and disabled people.” Forefront Group, 2025. https://doi.org/10.1377/forefront.20250414.154091
2. Chidambaram, Priya, and Alice Burns. “How Many People Use Medicaid Long-Term Services and Supports and How Much Does Medicaid Spend on Those People?” KFF, 2023. www.kff.org/medicaid/issue-brief/how-many-people-use-medicaid-long-term-services-and-supports-and-how-much-does-medicaid-spend-on-those-people
3. Sommers, Benjamin D., et al. “Medicaid Work Requirements — Results from the First Year in Arkansas.” New England Journal of Medicine, 2019. https://doi.org/10.1056/NEJMsr1901772
4. Ives-Rublee, Mia, and Kim Musheno. “The Truth about the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare.” Center for American Progress, 2025. www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/
5. Gaffney, Adam, et al. “Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health.” Annals of Internal Medicine, 2025. https://doi.org/10.7326/ANNALS-25-00716
6. Haley, Jennifer M., et al. More-Frequent Medicaid Redeterminations Would Reduce Health Insurance Coverage and Increase Administrative Costs. Urban Institute, 2025. https://www.urban.org/urban-wire/more-frequent-medicaid-redeterminations-would-reduce-health-insurance-coverage-and
7. Musumeci, MaryBeth, et al. Reducing Medicaid Churn: Policies to Promote Stable Health Coverage and Access to Care. The Commonwealth Fund, 2025. https://www.commonwealthfund.org/publications/issue-briefs/2025/jun/reducing-medicaid-churn-policies-promote-stable-health-coverage
8. Brooks, Tricia, and Allexa Gardner. Continuous Coverage in Medicaid and CHIP. Georgetown University Health Policy Institute, Center for Children and Families, 2021. https://ccf.georgetown.edu/wp-content/uploads/2021/07/Continuous-Coverage-Medicaid-CHIP-final.pdf
9. Lai, Julianna. “Are There Cuts To SNAP? What The ‘Big Beautiful Bill’ Means For Food Stamps.” Propel, 2025. https://www.propel.app/snap/cuts-to-snap-big-beautiful-bill-food-stamps-changes/.
10. “SNAP Policy Analysis: SNAP Changes from the 2025 One Big Beautiful Bill.” SNAP Screener Blog, 2025. https://www.snapscreener.com/blog/one-big-beautiful-bill.