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Want to contribute to Ripple? Share your idea with us here<\/a> and we\u2019ll provide guidance and feedback. Successful pieces may be featured on the site.<\/p>\n Their impact extends well beyond the people they directly support. These caregivers \u2014 often known as direct support professionals \u2014 make it possible for family caregivers to stay in the workforce, for employers to retain valued workers and for communities to remain stronger and more stable.<\/p>\n But right now, this workforce and the home and community-based care system that supports them is in crisis. Administration and congressional actions purportedly aimed at targeting waste, fraud and abuse in Medicaid \u2014 goals we fully support \u2014 have been so broadly construed that the integrity of all home and community-based care is being called into question.<\/p>\n Every dollar lost to fraud is a dollar taken from a family that genuinely needs care, but failing to take an approach that is targeted and precise makes people who need support, and the caregivers that support them, collateral damage. It puts everyone who relies on such care at risk \u2014 including older adults and people with disabilities or other long-term care needs \u2014 because most Medicaid home care is delivered through optional service categories that states are generally not required to provide.<\/p>\n And the timing could not be worse, because the home and community-based care system is already under strain. In 2025<\/a>, 88 percent of community-based providers reported moderate or severe staffing challenges. More than six in 10 were forced to turn away new referrals. Meanwhile, more than 550,000<\/a> people with intellectual and developmental disabilities were already on states\u2019 waiting lists to receive services, often for years or even decades.<\/p>\n New threats now stand to make everything worse as care providers are now bracing for the impacts of federal funding cuts on states\u2019 funding for home and community-based programs. When this workforce shrinks, the impact reaches into the broader labor market, as family members leave jobs to fill gaps and employers lose workers they depend on.<\/p>\n The cruelest irony is that cutting these services does not save money. For example, supporting a person with an intellectual or developmental disability in their home or community costs an average of $70,000 per year<\/a>. In a large, state-run institution, that cost rises to more than $395,000 per year<\/a>.<\/p>\n Reducing access to home and community-based services simply shifts care to hospitals, public institutions and other more restrictive settings, all of which are far costlier. It also runs counter to the longstanding principle that people with disabilities should receive services in the most integrated setting appropriate to their needs.<\/p>\n The broader economic stakes are just as clear. As another example, in 2023, federal and state governments invested a combined $67 billion<\/a> in Medicaid-funded home and community-based services for people with intellectual and developmental disabilities. That investment generated more than $169 billion<\/a> in economic output. Said another way, for every $1.00 of state and federal funding invested, the broader economy generated an additional $1.50<\/a>.<\/p>\n The answer to this problem isn\u2019t to weaken these supports, it\u2019s to strengthen them. If policymakers want to ensure Medicaid dollars reach the right people, our organizations are ready partners in that work. But broadly cutting off funding to entire categories of services in ways that harm the very people they are meant to serve \u2014 creating further instability in the caregiving workforce \u2014 will only exaggerate problems which Congress has sought to solve in a bipartisan manner.<\/p>\n We call on Congress and states to reject proposals that would further reduce Medicaid funding and instead invest in community-based services and the workforce that supports them.<\/p>\n Barbara Merrill is CEO of ANCOR<\/a>. Kendra Davenport is president and CEO of Easterseals<\/a>. Diane Wilush is interim president and CEO of United Cerebral Palsy<\/a>.<\/p>\n