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.
Advocates are worried about the fate of HCBS, which would be relatively easy for states to abandon under the new administration—and which helps millions of people stay out of hospitals, nursing homes, and group homes, which McLelland says frequently deliver “lower-quality care, often at a higher cost.”
The GOP has put forth several proposals promoting Medicaid per-capita spending, which would change current spending practices by limiting funds through a formula that doesn’t take into consideration the needs of disabled people. Nicole Jorwic, Caring Across Generations‘ chief of advocacy and campaigns, said that what such changes “would ultimately do is cut the amount of money that the federal government is sending to states per person…just on the consumer price index.”
Changes to Medicaid per-capita spending, Jorwic says, “means waiting lists would grow” and that “the types of services being offered are going to narrow” as funding is reduced or withdrawn. Given that federal Medicaid funds already make up, on average, one-third of state budgets, Jorwic believes that state governments coughing up the extra cost “is never going to happen.” She notes that health funding is a popular target even in blue states like Maryland, where a $3 billion state funding shortfall has put hundreds of millions of dollars in funding for its human services department funds—where Medicaid is housed—on the chopping block.
Another attack on Medicaid incorporated into Project 2025 has involved lifetime caps on the support of people on Medicaid—caps that many disabled people may hit at a young age. “A state will have to take up the rest of that spending,” said Ives-Rublee, “or they will reduce the coverage of an individual, either by saying we won’t cover these services or by saying we won’t cover you at all.”
