The Trump administration's decision to withhold $2.2 billion in Medicaid funding from California and $550 million from Minnesota has plunged caregivers and disabled people into a state of shock and fury, with many fearing the loss of vital in-home services that keep families afloat.
Federal funding halt hits home-based care
In late July, the Department of Health and Human Services (HHS) announced it would hold back $867 million in Medicaid funding for California, adding to an earlier halt of $1.34 billion, totaling $2.2 billion in withheld payments. Minnesota faces $550 million in withheld funds from the past three quarters. These amounts cover services already paid by the states, for which the federal government normally reimburses them, creating a budgetary strain.
HHS Secretary Robert F Kennedy Jr. alleged at a press conference that "much of the questionable spending involves in-home services." CMS Administrator Mehmet Oz added that such services "can be abused," suggesting families could provide care without federal funding. However, officials have not specified what exactly constitutes fraud, a highly unusual approach, according to Carl Tobias, law professor at the University of Richmond.
Lifeline under threat
For Shannon Rosa, a senior editor at the Thinking Person's Guide to Autism, in-home supportive services (IHSS) in California allow her to care for her disabled son without needing an additional job. "Without this, people become homeless. They lose their income. They lose their stability. Whatever tiny safety net they had is gone," she said. "It's just cruel."
Andy Schneider, research professor at Georgetown University McCourt School of Public Policy, noted that home-based services have become "the flashpoint" in fraud accusations, but growth in spending doesn't equal fraud. More people prefer home care over nursing homes, caregivers need decent wages, and the disability population now requires more hours of personal care, he explained.
Political targeting?
Tobias suggested the halts seem politically motivated, focusing on blue states like New York, California, and Minnesota. "It's not happening in the red states," he said. The burden falls on those who need services, and states are pushing back as best they can.
States are likely to sue, Tobias predicted. Minnesota already has an agreement with CMS to stay court proceedings until early September. However, legal disputes take time, and states may not succeed.
Rigorous qualification process
Rosa described the qualification process for IHSS as rigorous, involving an "interminable" stack of forms, meetings, and annual home inspections. "I don't know how people do it if English isn't your first language or you struggle with language," she said. The process is designed to screen out fraud, but a small minority of recipients abuse the system. "The vast majority of the people who use this are depending on it," Rosa noted.
The administration's policies have also cut other programs, like Snap, adding more paperwork requirements. "It is unconscionable, to me, for us to be moving backwards when we haven't even gotten to the point where we've achieved parity and reasonable living conditions for people like my son," Rosa said.
Community reaction
Within the disability community, the reaction has been "yet another tidal wave of shock and disgust," Rosa said. "We're almost getting inured to them at this point. But we can't, right? Because all of these blows affect our lives. It's hard to keep reacting to it in the manner in which they deserve – but they're all horrifying."
