Bennington
Federal Medicaid Changes Threaten Local Home-Based Disability Care
When Rob Stone finished high school in Bethesda, Maryland, in 2018, he was asked to identify three goals for his life. Stone loves art and baseball. He’s cheerful, sports a cheeky mustache, and he’s always up for an adventure. Stone…
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Key points
- Federal Medicaid funding cuts and changing policy rules are threatening home- and community-based disability services nationwide.
- The U.S. Department of Justice has signaled it will no longer enforce key guidance from the landmark 1999 Olmstead ruling supporting community living.
- Advocates warn that losing community care funding will increase financial pressure on local family caregivers in Southern Vermont and across the country.
NewsWK — Recent federal policy shifts and Medicaid funding reductions are raising concerns for families across Bennington County and Southern Vermont who rely on home- and community-based care for disabled loved ones. As national protections weaken, local advocates worry that family caregivers may face overwhelming financial and emotional burdens.
According to a report first published by Stateline, federal agencies have begun backing away from longstanding requirements that mandate community-level disability services, threatening care models that keep individuals out of institutions.
Reductions in Federal Medicaid Support
The changes stem in part from federal spending reductions under the One Big Beautiful Bill Act, signed into law last summer by President Donald Trump. The legislation is expected to reduce federal Medicaid funding to states by $665 billion overall, putting pressure on state budgets across the country.
While Medicaid requires states to fund institutional care such as nursing homes, home- and community-based services remain largely optional for state programs. As federal dollars shrink, several states have already begun trimming these optional services.
For families in Southern Vermont, where community living programs help residents receive care at home, any loss of federal matching funds could put additional stress on local care networks.
Department of Justice Alters Civil Rights Guidance
Beyond budget cuts, federal regulatory enforcement is changing. In June, the U.S. Department of Justice issued an opinion memo stating that states are not required to fund community-based care for disabled individuals who do not wish to be institutionalized.
The department followed in July by announcing it would no longer enforce its longstanding guidance on Olmstead v. L.C., the landmark 1999 U.S. Supreme Court ruling that established unjust institutionalization as a form of illegal discrimination.
Health policy experts point out that home-based care is significantly less expensive than institutional care. National Medicaid data shows institutional care averages $54,462 per year per recipient, compared to $17,298 for community services.
“We can serve, generally, three people in the community for every one person in an institution. And it leads to better outcomes,” said Alison Barkoff, a health law professor at George Washington University, in an interview with Stateline.
Impact on Local Families and Caregivers
More than 8 million Americans currently receive home- and community-based Medicaid services, compared to 1.5 million living in institutional settings. Disability advocates warn that reducing community support will push family members into difficult choices.
Jeneva Stone, a Maryland mother whose 29-year-old son Rob requires in-home care for a rare movement disorder, told Stateline that reduced support forces families to absorb impossible costs.
“More and more burden falls on family caregivers to fill in the gaps, and that leads to unsustainable economic situations for families,” Stone told Stateline.
How This Affects Our Community
While Vermont has long prioritized community-based living options over institutional care, local providers rely heavily on federal Medicaid partnerships. As federal enforcement priorities shift and funding decreases, Southern Vermont caregivers and service agencies may need to prepare for tighter budgets and increased demands on family networks.
This article was produced with the assistance of AI and reviewed by our editorial team.
Based on reporting by Anna Claire Vollers originally published by Stateline. Read the original story.
