Today marks the 35th anniversary of the Americans with Disabilities Act (ADA). This landmark legislation, which established civil rights for people living with disabilities under federal law, has profoundly changed countless lives. It made the world accessible to an entire population who, until that point, were typically excluded and isolated from society. It formalized a legal route to equality and inclusion by dismantling long-standing impediments that prevented individuals with disabilities from having the chance to pursue employment, live independently, access transportation and public spaces, and much more.
This essential right for every American to participate fully in society, is foundational to ensuring that those with intellectual and developmental disabilities (I/DD) have equal opportunities to thrive and live with autonomy.
Yet, as we commemorate the ADA’s enduring legacy this year, the future for individuals with disabilities appears less certain. The ADA’s vision is not self-sustaining. Its promise is realized through a network of vital support services, much of which depends on financial support. For millions of Americans living with disabilities, Medicaid is a lifeline that provides access to essential home- and community-based services (HCBS). These services encompass the most basic activities of daily living like bathing, dressing, eating, and more, as well as the residential programs, employment supports, and assistive technologies that enable people with I/DD to live with dignity in their own homes and communities. These services are central to the ADA and critical to making inclusion a reality.
Following the enactment of President Donald Trump’s tax bill, which will reduce funding by approximately a significant sum from Medicaid over the next several years, these support systems are in jeopardy. This assault on Medicaid threatens to reverse substantial gains toward equal opportunity for individuals with disabilities, as access to these services will undoubtedly become more restricted.
Reductions to Medicaid could lead to fewer available care services, longer waiting lists for vital support, and potentially the loss of the very assistance that enables those with I/DD to live independent and fulfilling lives. Imagine losing the career coach who assists you in preparing for work and facilitates steady employment, or the direct support professional (DSP) who helps you bathe and brush your teeth, or the transportation service that connects you to your community. These cuts translate into a forced regression from independence, pushing individuals back into isolation and dependency, often in hospitals or costly, state-run institutions, directly contradicting the ADA’s fundamental principles.
The widespread impact extends to the dedicated community providers who form the backbone of the HCBS ecosystem. These organizations operate on narrow margins, relying heavily, or solely, on Medicaid to finance their services. Cuts of this magnitude may disproportionately affect providers, who are already experiencing a crisis due to long-term underinvestment in community-based services, leaving them struggling to offer their DSPs competitive wages and benefits because of stagnant and insufficient reimbursement rates. Ultimately, these reductions could result in diminished capacity, staff layoffs, and even the closure of programs.
The national scarcity of DSPs is also anticipated to worsen. To compensate their staff, providers depend on Medicaid reimbursements from their states; if states become unable to increase reimbursement rates, providers will lose the DSPs they employ to better-paying prospects in other hourly wage sectors such as fast food and retail. This immense setback to Medicaid funding will make it even harder to find and retain the individuals who provide daily care. Disturbingly, these DSPs, whose work is both physically and emotionally demanding, often rely on Medicaid themselves due to inadequate wages.
When providers are compelled to scale back programs or cease operations entirely, the entire HCBS infrastructure weakens, leaving countless individuals without the necessary support. The burden then falls on the families of people with I/DD, potentially forcing some to leave their own jobs to care for their loved ones. For the many individuals with I/DD who lack family or existing support networks, access to care may be entirely lost.
The full extent of the impact remains to be seen, but there is no doubt that it will be nothing short of devastating.
A nearly $1 trillion reduction to Medicaid is not merely a budgetary adjustment. It will harm individuals with disabilities and undermine the progress we have achieved since the passage of the ADA. Decades of advocacy, innovation, and hard-won triumphs for equality and inclusion are at risk of being reversed.
As we honor the ADA this year, we must recommit to its vision by unequivocally safeguarding the very funding that makes true community living and inclusion a reality for all. We cannot permit the fundamental rights and opportunities of people with disabilities to be undermined. Solutions must be identified, advocates must retaliate, and state leaders need to discover ways to preserve funding for these vital services. Access to care is not a luxury; it is a necessity that is integral to upholding the rights of those with disabilities.