Trump administration actions have targeted people with disabilities, undermining their ability to receive federal benefits.
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Mia Ives-Rublee has spent her life navigating systems that were not designed with her in mind. A wheelchair user, she started school around the time the Americans with Disabilities Act became law and grew up watching her parents fight to secure her education. Decades later, she is still fighting.
Now, she and other disability advocates say the terrain is shifting again — and not in their favor.
As federal policy evolves under the Trump administration, people with disabilities face growing obstacles to the care and income they depend on. Proposed changes to Medicaid and mounting barriers to Social Security are increasing eligibility restrictions and administrative requirements, raising the risk that many people with disabilities could lose coverage or benefits.
The changes extend far beyond income support, including attacks on vaccines, lies about autism, proposals to send people with mental health conditions or disabilities to “wellness farms” and delays or reconsideration of airline disability rules amid ongoing concerns about wheelchair damage and accessibility enforcement. Moreover, recent U.S. Department of Education budget and staff cuts threaten services for millions of children with disabilities.
Federal workplace policies have also been challenged. While return-to- office mandates allow exemptions for some employees with disabilities, reports suggest accommodations are often not upheld, requiring some to return in person.
The actions have unfolded as the nation is led by a president who continues to publicly mock and disparage people with disabilities, further heightening concerns among advocates about the direction of federal policy and societal attitudes.
Medicaid, the nation's largest source of health coverage for people with disabilities, is at the center of those concerns. New federal requirements are expected to reshape eligibility rules in the coming years. Beginning in 2027, many Medicaid users will be required to report about 80 hours per month of work, or similar activities, to maintain coverage.
Administrative changes and staffing cuts have made it harder for people to apply for disability benefits designed to help them.
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Although people with disabilities are generally expected to qualify for exemptions, experts warn that the reality is more complicated due to red tape, paperwork, inconsistent state definitions and administrative hurdles. All of that could result in eligible people losing coverage, not because they do not qualify, but because they are unable to navigate the system.
Disability leaders say that pinning benefits to work requirements reflects a broader shift in how people with disabilities are viewed in society.
“We're seeing the resurgence of an ableist mindset — that your worth is tied to what you can produce,” said Ives-Rublee, MSW, senior director of the Disability Justice Initiative at the Center for American Progress. “When you add more administrative hurdles or tie coverage to work requirements, you're not promoting independence — you're putting people at risk of losing the care that makes independence possible.”
Medicaid plays a critical role in supporting independence. It is the primary payer for long-term services and supports, including in-home care that allows people with disabilities to live outside of institutions. But a longstanding gap complicates how the program operates. About a third of Medicaid enrollees report having a disability, yet far fewer qualify under the program's strict definition tied to Supplemental Security Income. That gap could become more significant under work requirements.
Many people with disabilities qualify for Medicaid through income-based pathways rather than disability determinations. As rules tighten, some may be required to prove they meet federal disability criteria to maintain coverage.
“To my knowledge, there is not a specific mechanism in place for this proof to occur,” Jean P. Hall, PhD, MS, a research professor emerita at the University of Kansas, told The Nation's Health. “In addition, the six-month eligibility redeterminations could be difficult, especially if they work in nontraditional or seasonal occupations, or if they have a disability that is episodic.”
Lost coverage will lead to adverse health outcomes and greater long-term costs for health systems and federal programs, she said, and people losing home and community-based services may be forced into institutional care, which costs Medicaid about five times as much as community-based care.
Medicaid is often the sole source of essential services for families, health advocates warn.
“There's no corresponding set of services in the private market that will provide home and community-based services for somebody,” said Katy Neas, CEO of The Arc of the United States. “When you cut those programs, there's no safety net to the safety net.”
In light of recent Medicaid cuts, responsibility has shifted to individual states to determine how the reductions will be implemented. To address the challenge, The Arc is collaborating with chapters around the country to support efforts aimed at informing state legislators and governors of the implications of the cuts.
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“Our work is focused on ensuring that key stakeholders fully comprehend the impact these reductions will have on the communities they serve,” Neas told The Nation's Health.
A federal spending bill signed into law in July 2025 also substantially reduces federal matching funds for states that expanded Medicaid coverage under the Affordable Care Act, said APHA Disability Section Chair Katherine Froehlich-Grobe, PhD. Medicaid covers both medical services and long-term services and supports for children, low-income parents and older adults and adults with disabilities.
As a result, states that expanded Medicaid eligibility now face tough decisions as major shortfalls force lawmakers to decide where to cut services. In Colorado, where Froehlich-Grobe lives, Medicaid cuts have already created a projected $1.5 billion budget gap tied to changes in federal Medicaid funding, she said.
“As states weigh cuts, the outcome will determine whether people with disabilities can continue living independently or face reduced support and fewer options for care,” Froehlich-Grobe told The Nation's Health.
The challenge is not exclusive to Colorado; 41 states have expanded Medicaid and are currently facing similar funding concerns. To balance their budgets, states will have to reduce Medicaid spending, Froehlich-Grobe said. Strategies being considered in Colorado include adjusting eligibility criteria, reducing reimbursement rates for Medicaid providers, limiting dental and vision benefits and reducing hours paid for home-care services that help older adults and people with disabilities perform self-care tasks like toileting, bathing, dressing and eating.
For families, that gap can mean going without care or taking on the burden themselves — a reality that underscores how policy decisions made in Washington are increasingly playing out in homes across the country.
“Current policy priorities appear to be centered on the needs of the healthy and wealthy, often neglecting those who are truly underserved,” Froehlich-Grobe said.
Medicaid is only part of the picture. At the same time, the Social Security Administration — another critical lifeline for people with disabilities — has undergone major changes. Since 2025, the agency has implemented significant staffing reductions and has consolidated many regional offices. Those actions have reduced access to in-person services and increased reliance on online systems, making an already complex system even harder to navigate.
A recent report from researchers at Binghamton University and others found that administrative changes, staffing cuts and innovative technologies have created additional barriers for people applying for or maintaining disability benefits.
Based on interviews with benefits specialists across the country, the report found consistent patterns across regions, with specialists reporting longer wait times, difficulty reaching agency staff and growing challenges resolving errors.
“We found that access to benefits for Social Security in 2025 have gotten a lot worse,” said lead study author Katie Savin, PhD, MSW, an assistant professor of social work at California State University in Sacramento.
Some respondents described the system as a “black hole” where applicants and advocates struggled to get answers or assistance, Savin said, noting that the consequences can be severe. Delays and administrative hurdles can leave people without income or support during critical moments, including periods of serious illness or housing instability.
“We can't run the Social Security Administration without staff,” she said. “There are always people who die as a result of waiting for Social Security benefits.”
The shift toward online systems and automation has also created new challenges. As the agency emphasizes digital tools and artificial intelligence to assist applicants, people with disabilities may face additional barriers, particularly those with cognitive, psychiatric or communication disabilities.
The effects of Social Security changes may also ripple into Medicaid, Savin said. In many states, Social Security disability status is used to determine eligibility for Medicaid exemptions. If people lose benefits, are wrongly denied or remain stuck in long appeals processes, they may also struggle to maintain health coverage.
“It could be a lot harder for them to prove that they're disabled and keep their Medicaid,” Savin said.
For more information, visit www.americanprogress.org/disability-justice-initiative and https://thearc.org.
- Copyright The Nation’s Health, American Public Health Association
