Witnesses warn Medicaid funding changes could shrink home‑and‑community services for people with disabilities

Barbara Merrill, chief executive of the American Network of Community Options and Resources, told the subcommittee that home‑and‑community‑based services sustain people with intellectual and developmental disabilities and are at risk if federal Medicaid funding is curtailed. She said those services currently average about $70,000 per person annually versus roughly $395,000 annually for institutional care, and that more than 550,000 people were on state waiting lists for HCBS in 2025.

Merrill said chronically low reimbursement rates make it difficult for providers to recruit and retain direct support professionals and that states sometimes turn to cuts in optional services such as HCBS when federal matching funds are restricted. “When federal Medicaid dollars to states are limited…states often turn to cuts in optional services like HCBS,” she testified. Members from both parties expressed concern about the potential for increased institutionalization and greater uncompensated emergency care if HCBS access is reduced.

Committee Democrats accused recent federal actions (discussed in the hearing as HR 1 and related administrative steps) of creating fiscal pressures that could push states to reduce HCBS; Democrats asked unanimous consent to enter letters from advocacy organizations into the record. Witnesses asked that anti‑fraud and program‑integrity efforts be narrowly targeted so they do not inadvertently cut essential payments to small HCBS providers that cannot survive long payment holds.

The subcommittee did not adopt policy at the hearing but solicited additional written material and suggested that making HCBS mandatory under Medicaid would be one legislative option to prevent the erosion of these services.