The Trump administration has moved to withhold significant Medicaid funding from California and Minnesota, citing allegations of fraud within home-based care services. This decision has sparked intense criticism from disability advocates and policy experts, who argue the move threatens the stability of essential services for the most vulnerable populations. Officials recently announced that $867 million in Medicaid funding would be held back from California. This follows an earlier suspension of $1.34 billion, bringing the total withheld amount for the state to $2.2 billion. Additionally, the federal government is currently retaining $550 million in Medicaid funding for Minnesota, representing payments from the last three quarters. While the federal government typically provides partial reimbursement for these services, states have continued to cover the costs, creating a significant budgetary strain.
Robert F. Kennedy Jr., secretary of the US Department of Health and Human Services (HHS), justified the action by stating that the agency suspects questionable spending within in-home services. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services (CMS), alleged that the program is prone to abuse, suggesting that some services funded by the government are those families would typically provide themselves. For families like those of Shannon Rosa, a senior editor at the Thinking Person’s Guide to Autism, these programs are a vital lifeline. Rosa, who uses In-Home Supportive Services (IHSS) to care for her disabled son, emphasized that the loss of these funds could lead to economic disaster for many caregivers. She described the administration's stance as "just cruel," noting that without this support, families face the risk of losing income, stability, and housing. She stated that the officials have no idea what they are talking about regarding the invisible labor involved in caregiving.
Legal and policy experts have questioned the administration's approach. Andy Schneider, a research professor at Georgetown University, noted that while home-based services are a flashpoint for fraud claims, federal officials have failed to provide specific evidence. Carl Tobias, a law professor at the University of Richmond, added that shifting the burden to states to prove the absence of fraud without first presenting proof is highly unusual and troubling. Schneider also pointed out that growth in home-based spending does not equate to fraud, noting that more individuals prefer home care over institutional settings, which are often more expensive. Tobias suggested that the debate appears political, targeting blue states like New York, California, and Minnesota, while red states remain unaffected. He noted that states will likely sue, "probably sooner rather than later because I don’t know that they have much choice," though he warned that it takes a long time to resolve disputes in court and states may not be successful.
Qualifying for in-home services is a rigorous challenge that takes months to complete, involving an "interminable" stack of confusing forms. Rosa noted that the process is difficult for those whose first language is not English or who struggle with language barriers, followed by a series of meetings and annual home inspections. She argued that while a small minority may defraud the system, the vast majority depend on it for survival. The administration’s policies have also affected disabled people in other ways, such as cutting Medicaid by adding more paperwork requirements and cutting food programs like the Supplemental Nutrition Assistance Program (Snap). Within the disability community, the reaction has been a "tidal wave of shock and disgust." Rosa concluded that while it is hard to keep reacting to these horrifying blows, they cannot become inured to them because all of these actions directly affect their lives.
