At least 18 states have proposed or enacted cuts to home- and community-based services, or have otherwise put aging and disability care at risk, since last year's federal Medicaid law. That is the count in a brief from Caring Across Generations, updated July 15, 2026.
The brief, by Leela Berman, Kathy Mendes, Tory Cross and Jaimie Worker, says the list was compiled with help from the HCBS Tracking Project at George Washington University, the Human Services Research Institute, the LTSS Center at UMass Boston and ATI Advisory, and may not be complete. Caring Across Generations is an advocacy group.
Cuts already on the books
The brief points to concrete moves already enacted. Colorado reversed planned reimbursement rate increases for Medicaid providers and finalized rate reductions in its Community Connector program. Maryland cut and consolidated Developmental Disabilities Administration services. Idaho's governor signed a $22 million cut to Medicaid home- and community-based services in late March 2026.
Other states proposed changes, according to the brief. Colorado announced possible caps on personal care and homemaker services and changes to its Developmental Disabilities waiver, and Connecticut proposed cuts to its Community First Choice program.
The budget math behind the cuts
The authors tie those choices to the 2025 federal law's effect on state budgets. Medicaid is roughly a third of state spending, with federal money covering about two-thirds of it. The brief estimates state Medicaid funds falling by $679 billion and state general funds by $82 billion by 2034, on top of new administrative costs for work requirements.
Medicaid finances nearly three-quarters of home- and community-based services, helping 8.4 million older adults and people with disabilities, the brief says. Because those services are optional Medicaid benefits, states often trim them first.
Why this matters for providers and DSPs
The brief's examples show where cuts tend to land: provider rates, specific programs and service levels. Agencies and DSPs can use that pattern to prepare their case to lawmakers before their own state's budget is written.