PBS report on US funding for adult day care
Will Medicaid cuts land on community-based programs?
On 30 January 2026, Judy Woodruff and Mike Fritz of PBS News Hour reported about the importance of home and community care programs for individuals with disabilities and the pending deleterious effects on those programs of pending cuts in Medicaid and Children’s Health Insurance programs. In an 8-min segment headlined, “How people with disabilities could bear the burden of Medicaid funding cuts,” they described the needs of individuals and their families for day care and the Bright Center, a private day facility outside of Washington, DC, that provides community-base services for individuals with intellectual and developmental disabilities.
Ms. Woodruff and Mr. Fritz explained that most of the individuals receive financial assistance through state-administered Medicaid waivers for home and community-based services, permitting families to secure services other than basic medical care, supporting life outside of institutions. Their conversations with experts on health care indicate that most states anticipate substantial reductions in funds that they receive from the federal government. Although leaders in the federal government say that Medicaid is not being cut, the reality is that there will be fewer funds in the coming years.
Waivers provided by states are not substantial. For example, in South Carolina they are about $80/day (South Carolina Department of Health and Human Services); in Texas, they are about $30/day (Texas Health and Human Services); in Ohio the rates average about $60/day (Medicare Gov Ohio); and, in Virginia, Ms. Woodruff and Mr. Fritiz reported that the reimbursement is $69/day. But the looming cuts in Medicaid funding that are part of the US federal legislation often called “The One Big Beautiful Bill,” may be so great that they will make HCBS even less available, regardless of disability and personal background of the individuals served.
Advocates for individuals with intellectual and development disabilities consider policies promoting community living to be a high priority (see, for example, the joint statement of American Association on Intellectual and Developmental Disabilities and Association of University Centers on Disabilities, 2016). Pressure to expand availability of community-based services in the early 2000s led to growth in programs with HCBS spending through Medicaid as the primary funding source, even through the Great Recession of 2009 (Braddock et al. 2011, 2015) caused shrinkage. According to Levine et al. (2025), who examined enrollments using waivers in programs from 2016-2019, there are inequities in who enrolled in programs (both in type of disability and in ethic background). And, as Ms. Woodruff and Mr. Fritz reported, the Covid-19 pandemic curtailed services substantially, too.
Does the future look bleak to you, Dear Reader? I am not sanguine.
References
American Association on Intellectual and Developmental Disabilities and Association of University Centers on Disabilities. (2016). Community Living and Participation for People with Intellectual and Developmental Disabilities. https://www.aaidd.org/news-policy/policy/position-statements-2/community-living-and-participation
Braddock, D., Hemp, R., Rizzolo, M. C., Haffer, L., Tanis, E. S., & Wu, J. (2011). The state of the states in developmental disabilities, 2011. American Association on Intellectual and Developmental Disabilities
Braddock, D., Hemp, R., Rizzolo, M. C., Tanis, E. S., Haffer, L., & Wu, J. (2015). The state of the states in intellectual and developmental disabilities: Emerging from the great recession. The American Association on Intellectual and Developmental Disabilities.
Levine, A. A., Cole, M. B., Michals, A. L., Wang, N., & Rubenstein, E. (2025). Inequities in medicaid home-and community-based services waiver enrollment among people with intellectual and/or developmental disabilities: A nationwide claims-based analysis. Disability and health journal, 18(3), 101676. https://doi.org/10.1016/j.dhjo.2024.101676