In recent debates over Medicaid’s future, some have suggested that extending coverage to low-income adults through Medicaid expansion has diverted resources away from people with intellectual and developmental disabilities (IDD) and undermined the program’s original purpose.

That claim is both misleading and dangerous. It risks turning vulnerable communities against one another and distracting from the real threats facing Medicaid that come from significant cuts.

Medicaid Expansion and HCBS Waiting Lists Are Not Connected

The argument that Medicaid expansion led to longer waiting lists for people with disabilities who need home and community-based services (HCBS) is often repeated but easily disproven.

There is no correlation between whether a state expanded Medicaid and whether its HCBS waiting list grew. 10 of the 11 states without HCBS waiting lists are expansion states, and the two states with the largest waiting lists—Texas and Florida—are non-expansion states. In fact, Texas’ waiting list alone represents nearly half of the nation’s total.

Because HCBS programs are optional services within Medicaid, states control their own waiver programs, including how many people are served and how much funding is allocated. Thanks to growing support for HCBS, Medicaid has made significant progress in shifting long-term care away from institutions and into the community. In 2022, 65% of long-term services and supports (LTSS) spending went to HCBS, compared to only 18% in 1995.

Blaming Medicaid expansion for state-level decisions about HCBS funding misrepresents how the program works and distracts from the need for stronger investments in these essential services.

Cutting Medicaid Funding Won’t Help People With Disabilities

Reducing or eliminating federal funding for the Medicaid expansion population would not free up money for people with IDD; it just means less funding overall for the entire program.

Medicaid is a vital part of our social safety net, which ensures that everyone who needs care can get it, whether they are managing a chronic condition, caring for a child with disabilities, or working a low-wage job without access to employer-provided coverage.

We should be fighting to expand services and reduce waiting lists, not blaming other groups of enrollees for long-standing systemic challenges.

A Medicaid Program That Works for Everyone Is the Goal

The truth is Medicaid expansion has strengthened the program overall by bringing in new resources to support people and expanding access to care for millions of people, including many with IDD and care workers. Many people with serious health conditions and disabilities do not meet the strict disability eligibility standards necessary to access Medicaid through the Supplemental Security Income program (SSI) or do not want to impoverish themselves to meet the SSI income and asset limits.

Medicaid expansion has helped many people with disabilities access critically needed health care. What endangers HCBS and other critical supports for people with disabilities are proposals to slash federal support for Medicaid under the pretext of targeting waste, fraud, and abuse within the program.

We should be investing in HCBS, increasing pay for caregivers, and expanding access to LTSS, not rolling back coverage or undermining Medicaid’s foundation.