July is Disability Pride Month, a time to honor disability identity, culture, and the ongoing fight for full inclusion. But inclusion does not happen by principle alone. For millions of people with disabilities, it depends on caregivers, family members, and home- and community-based supports that make daily life, community living, and self-determination possible. At the very moment we are celebrating disability pride, Medicaid funding changes are putting new pressure on the caregivers who help disabled people remain safe, connected, and included in their communities.  

That pressure is no longer theoretical. The passage of the One Big Beautiful Bill Act (or H.R. 1) last year ushered in a wave of Medicaid cuts and additional regulatory hurdles that threaten access to vital care for disabled individuals. The legislation, along with recent guidance from the Centers for Medicare and Medicaid Services (CMS), installs strict new work reporting requirements and redetermination reviews that raise the risk for disabled individuals losing their coverage for mere procedural reasons. During bill deliberations, the Congressional Budget Office estimated 10 million people would become uninsured due to Medicaid and Affordable Care Act marketplace cuts. Considering around 15.5 million people with disabilities access their health care through Medicaid, the fall out will be immense.  

But that’s not all that’s at risk. H.R. 1 prohibits states from creating new or increasing existing taxes on healthcare providers, which is a key mechanism for financing their share of Medicaid program costs. The budget shortfall will necessitate program cuts, which historically affects Home- and Community-Based Services (HCBS), which are critical services that ensure disabled people, individuals with chronic illnesses, and older adults can stay in their communities and connected to their networks. The budget cuts have already translated into reduced caregiver wages and caps on paid hours, making difficult jobs even more unsustainable. 

These policy shifts will likely strain caregivers financially and physically while making it harder for people with disabilities to stay at home, participate in community life, and access the inclusive future that Disability Pride Month is meant to affirm (1). Between H.R. 1 and existing structural inequalities, disabled individuals face an uncertain future where basic services needed to live a thriving, equitable life are now in jeopardy. Truly reaffirming the vision inherent in Disability Pride Month would mean not just a return to, but an improvement on the services needed to be for the disabled community to be fully included, respected, and supported.