Despite Medicaid cuts, we can still uphold disability inclusion’s promise

by Julie Johnson

July marked the 35th anniversary of the Americans with Disabilities Act (ADA), the historic legislation prohibiting discrimination against people with disabilities and guaranteeing their equal access to employment, transportation, and public services. It remains an incredible civil rights victory—and one that disability advocates have worked tirelessly to protect and expand in the years since.

June marked the anniversary of the Supreme Court’s critical decision in Olmstead v. LC (1999), a case that empowered the ADA by ruling that people with disabilities have the right to live in the most communityintegrated setting possible. The landmark ruling was handed down after more than a century of institutionalizing people with intellectual and developmental disabilities (I/ DD) in large, state-run facilities, even when living in the community was both possible and more appropriate.

Fast forward to today: institutionalization is no longer the default for people whose disabilities require more intensive levels of support. Nevertheless, it is a practice that remains in place, and as of 2020, it was estimated that more than 15,000 people with I/DD were still living in a large, state-run facility.

That number, though staggering, has been steadily decreasing over the years, down from nearly 38,000 people with I/DD living in large institutions as of 2006. However, many

Minnesotans are now reckoning with the possibility that years of progress could be lost.

This is thanks to Congress’s recent approval of nearly $1 trillion in cuts to Medicaid—the program that funds the vast majority of services that make community inclusion possible for people with I/DD.

To be clear, the nearly $1 trillion in Medicaid cuts signed into law on July 4 will equate to funding cuts for home-and community-based services (HCBS) that support people with I/DD. States are not required to fund HCBS; as a result, more than 500,000 people with I/DD are already languishing on waiting lists across the country. When Medicaid funding is cut at the federal level, states must find ways to reduce the shortfall in state budgets. In turn, optional programs—such as HCBS—are often first on the chopping block.

Here in Minnesota, Medicaid funds essential services that support about 35,000 people with I/DD to live, work, and thrive in their communities through HCBS waivers. These services make possible some of the most basic necessities, as well as programs that support people with disabilities to find work, live in their own homes, build meaningful relationships, and more.

Meanwhile, investing in these supports makes it possible for families of people with I/DD to remain in the workforce while ensuring their loved one receives proper care, thereby enabling them to avoid dependence on social safety net programs themselves.

At my organization, MSS, we’ve already seen the challenges that come with a failure to invest in services like these. Many providers MEDICAID To page 11 mn.gov/dhs/10-ways-en