In the face of proposed federal budget cuts, Medicaid—one of the most crucial social safety nets in the United States—is under attack. These cuts not only jeopardize the healthcare coverage of millions of low-income Americans but also put essential programs like In-Home Supportive Services (IHSS) at risk. IHSS workers, the caregivers who provide vital assistance to elderly and disabled individuals, are staring down the possibility of devastating wage and benefit reductions. The threat is real, and the stakes couldn’t be higher.
With the proposed cuts, and what’s at stake, policymakers in Washington are considering drastic reductions in Medicaid funding under the guise of fiscal responsibility. Some of the most concerning proposals include: turning medicaid into a block grant program which would cap federal contributions to state Medicaid programs, regardless of growing needs or emergency situations, like the COVID-19 pandemic. It would also impose work requirements by making Medicaid contingent on employment, these proposals could strip coverage from some of the most vulnerable individuals, including those with disabilities and seniors who cannot work.
As far as repealing protections for enrollees, regulations that ensure continued coverage for those in need could be rolled back, making it more difficult for people to maintain their Medicaid eligibility. And regarding provider taxes, states rely on provider and insurer taxes to help cover Medicaid costs. Reducing these revenue streams could lead to service cuts and lower provider payments.
These measures are designed to limit government spending but ultimately threaten the well-being of millions who depend on Medicaid for basic healthcare services. Medicaid funds a significant portion of long-term care services, including IHSS. These services help people with daily living tasks such as eating, bathing, and managing medications, allowing them to live at home instead of institutionalized care. In California alone, over 15 million people rely on Medicaid, which funds 56% of IHSS services. Without sufficient Medicaid funding, clients and loved ones risk losing critical in-home care and care providers face reductions in wages and benefits. Essential services such as meal preparation, transportation, and personal care would be drastically diminished. The loss of these services would disproportionately impact the elderly, disabled, and low-income families who already struggle to access adequate healthcare.
IHSS providers are the backbone of in-home care, offering essential services that keep people out of nursing homes and hospitals. However, administrative attacks on their benefits threaten their ability to continue their work. A ruling from the Center for Medicare & Medicaid Services (CMS) aims to prohibit automatic deductions of union dues and health benefits from IHSS workers’ paychecks. This move could weaken unions that advocate for higher wages and better conditions, further exacerbating workforce shortages in the caregiving sector.
Without fair wages and job protections, fewer people will be willing or able to take on these demanding yet essential caregiving roles. This, in turn, will create a crisis in long-term care services, leaving some of society’s most vulnerable individuals without the support they need.
The threat to Medicaid is not a new one. In 2017, advocates successfully blocked attempts to gut the program—and they’re ready to fight again. Organizations like United Domestic Workers (UDW) are leading mobilization efforts to protect Medicaid and IHSS, urging community members to call and visit lawmakers to demand that Medicaid remains fully funded, educate other community members about the real-life impact of Medicaid cuts, and attend rallies and lobbying events to show public support for Medicaid.
Upcoming mobilization efforts include lobbying visits, legislative receptions, hearings on bargaining agreements, and direct engagement with lawmakers in Washington, D.C. These actions are critical in ensuring that Medicaid funding is preserved and that IHSS workers can continue their vital work without fear of wage and benefit reductions.
Medicaid is more than just a government program—it’s a lifeline for millions of Americans. Any cut to Medicaid funding puts lives at risk, disproportionately affecting the most vulnerable populations, including low-income families, seniors, and people with disabilities. We have seen what happens when funding is slashed—reduced care hours, lower provider wages, and ultimately, a decline in the quality of life for those who depend on these services. The message is clear: the fight to protect Medicaid is a fight for human dignity, economic stability, and equitable healthcare access.
Now is the time to act. Contact your representatives, educate your community, and stand with caregivers to ensure that Medicaid remains fully funded. Because when we protect Medicaid, we protect people.
