Maryland is implementing Medicaid cuts this summer that reduce funding for programs allowing people with disabilities to receive care at home [1].
These changes threaten the stability of self-directed Medicaid services and reduce wages for family caregivers. Because these programs are designed to keep individuals out of institutions, critics warn the cuts could force vulnerable residents into long-term care facilities.
State officials said the reductions are necessary to ensure the long-term stability of disability-support programs, which are a top priority for Gov. Wes Moore (D-MD) [2]. According to Amanda Hils, a spokesperson for the Maryland Department of Health, the costs of these programs grew by more than 144% [1] over the past five years.
"The changes were necessary to rein in costs of programs supporting people with disabilities, which had grown by more than 144% over the past five years," Hils said [1].
However, families and advocates argue that the financial burden will fall on those least able to afford it. The cuts target the very services that allow disabled individuals to maintain independence, and live with their relatives rather than in state-run institutions.
An advocate said to the Star Democrat that family caregivers are in a "complete tailspin" as budget cuts and looming deadlines threaten the services they rely on [3].
The state's move highlights a growing tension between fiscal sustainability and the mandate to provide community-based care. While the administration focuses on the sustainability of the budget, caregivers said that the loss of wage support makes it impossible to continue providing full-time care at home [3].
“The changes were necessary to rein in costs of programs supporting people with disabilities”
This policy shift reflects a broader struggle in U.S. state governance to balance the rising costs of healthcare with the legal and ethical preference for home-based care over institutionalization. By reducing caregiver wages and self-directed funding, Maryland may see a short-term reduction in program spending, but it risks a long-term increase in costs if more individuals require expensive institutional placements due to a lack of home support.
