For Californians With Disabilities, Medicaid Cuts Could Mean Losing Not Just Services — But Freedom

A fall-themed Snoopy jazz playlist hums throughout the art studio, rising just above the soft scratching of brushes on canvas. One person uses purple paint to carefully outline Squidward, his fourth SpongeBob-themed painting. Another artist prefers to paint airplanes, having previously worked at the airport.

Ron Ansley’s specialty is abstract paintings, often inspired by Tiggy, his cat who passed away. Today, he’s using oil pastels to outline an illustration of plates and cups sprouting cactuses.

“Making art is what I call a relaxation stress breaker,” Ansley said. “Mostly, I just like to express myself in painting.”

Ansley, 64, has autism and several physical disabilities, including deep vein thrombosis and cataracts. Since 2019, he’s been attending art classes three days a week at The Arc San Francisco. As the local chapter of the national Arc organization, the nonprofit serves about 800 adults with intellectual and developmental disabilities in the Bay Area. In addition to art, music and cooking classes, The Arc helps clients find jobs, pursue higher education and navigate their health care.

Now, programs like these are at risk nationwide. When President Donald Trump signed into law his sweeping policy bill, dubbed the One Big Beautiful Bill, it included roughly $1 trillion in federal Medicaid cuts over the next decade.

Medicaid, called Medi-Cal in California, is best known for helping low-income people access health care, but it also funds services for people with disabilities.

The White House website claims Trump’s megabill won’t impact Americans with disabilities: “Rest assured, those with disabilities receiving Medicaid will receive no loss or change in coverage.”

Policy experts, however, say that while nothing in the bill specifically targets disability services, they’re unlikely to be left unscathed.

“Because people with disabilities are more likely to depend on Medi-Cal compared to the general population, we would argue that any cuts to this funding would disproportionately harm folks with a disability,” said Adriana Ramos-Yamamoto, a senior policy analyst at the California Budget and Policy Center. “They’re essentially destabilizing a whole program and system that supports these communities.”

The California Department of Health Care Services (DHCS) estimates the state could lose $30 billion a year in federal MediCal funding for the next decade. It falls to state legislators to close that gap when they take on next year’s budget.

Ramos-Yamamoto expects the state will drain money from a benefit known as home- and community-based care, which serves more than 900,000 Californians, according to 2022 data from DHCS.

Home- and community-based services are programs like those provided by The Arc, which allow people to live and work in their homes and communities rather than in institutions like nursing homes.

“During tough budget years, these home- and community-based services are at risk because they’re optional services and when budgets are tight, those are often times on the chopping block,” Ramos-Yamamoto said.

Federal law requires states to provide certain benefits, like nursing home services, to receive matching Medicaid dollars. Other benefits, like home- and community-based services, are considered optional. That means states can make changes to them — limiting enrollment, reducing benefits or cutting them entirely — when they face budgetary emergencies.

“During the Great Recession, just about every state in the country ended up cutting some of their home- and community-based services,” said William Dow, a professor at the UC Berkeley School of Public Health. “And these account for about half of the Medicaid optional service spending nationwide, and so they’re just ripe for cutting.”

In an email to KQED, the White House disputed that Medicaid changes will jeopardize home- and community-based services and pointed to a provision in the bill providing additional funding to expand access to this care.

However, Ramos-Yamamoto said it’s unlikely states will spend limited resources to make new investments in these services while facing billions of dollars in cuts elsewhere.

“Despite there being some promising revisions related to this HCBS expansion … it is really insignificant compared to the amount that Republicans in Congress and the Trump administration are cutting from Medicaid overall,” Ramos-Yamamoto said.

Kristen Pedersen, executive director of The Arc San Francisco, said even before these changes to Medicaid, disability services were underfunded. Most of The Arc’s programs have a 12-month waitlist with over 125 people waiting.

“What’s really concerning for us is… knowing that funding is going to be sparse for a system that’s already pretty anemic as it is,” Pedersen said.

Pederson is most worried about their clients with complex needs, like Ansley.

“I think those folks are very much at risk of ending up in institutional settings,” she said. “As the funding depletes and you aren’t able to pay direct service workers for very skilled work that they do to support these individuals, I think that options are going to really decrease.”

In addition to attending art classes, Ansley lives at The Arc’s affordable housing project in San Francisco. He receives care from direct support professionals who take him to the grocery store and help him with his laundry, budgeting and medications.

For Ansley, the thought of losing his independent living services is terrifying.

“I’m an independent man. I just have to stay independent,” Ansley said. “I don’t want to end up in no nursing home. If I end up in a nursing home, I’m a nobody. I am just a number.”

Ansley also relies on a health advocate named Arlo Beckman, who takes him to doctor’s appointments and coordinates his health care services like insurance renewal. Beckman said that although home- and community-based care is deemed optional, it’s vital to people’s quality of life.

“In this world, we all consider in-home supportive services to be critical to our participants’ lives and their well-being,” Beckman said.

Many of The Arc’s clients rely on this support to hold jobs, volunteer in their communities and go to school. Any reductions in funding could mean less staff available for individualized services and even longer waitlists.

“I find that the clients that are more homebound are sad, more frequently struggle with mental health issues,” Beckman said. “I think we’re at a point where we understand how significantly being social and getting outside and just moving in general impacts both physical and mental health.”

Many of the changes to Medicaid don’t go into effect until after the 2026 midterm elections, but advocates are already pushing state leaders to uphold obligations as laid out in the Lanterman Act.

The landmark law, passed in California in 1969, ensures people with developmental disabilities have the support to live full and inclusive lives.

“We just want to make sure that the balancing of the budget isn’t done on the backs of people with disabilities,” Pedersen said.

To offset the impending damage of federal cuts, some health care advocates have proposed a ballot measure to raise taxes on the ultra-rich.

Santa Clara County has already put the question before voters, placing a sales tax measure on a November special election ballot to support the county’s health care system.

Pedersen said her organization is also approaching 2026 gubernatorial candidates, asking them to make a campaign pledge to prioritize disability services.

“We don’t really have someone right now who’s taking up that mantle,” Pedersen said. “That’s something we’re really working on at The Arc California level and just educating our new legislators.”

For now, as they wait for state lawmakers to unveil their budget plan, the disability community has to sit with uncertainty and the fear of what’s to come.

“It’s like you have to choose: medicine or food. Medicine or art supplies. Medicine or laundry money. Medicine or bus rides. Medicine or paying your bills,” Ansley said. “It’s the worst thing that is going to ruin people’s physical health and their mental health. I don’t like it at all.”