Federal Medicaid Cuts Are Coming: A Virginia Family’s Guide to Protecting Your Loved One’s Services
If you’re a family caregiver in Virginia – especially if your loved one receives services through Medicaid…
There’s a conversation happening in Washington right now that will affect your life directly.
And not in some vague, far-off-in-the-future way.
Changes are starting this year.
Last summer, Congress passed what’s known as the “One Big Beautiful Bill Act” (H.R. 1), which includes roughly $911 billion in reduced federal Medicaid spending over the next decade.
According to the nonpartisan Congressional Budget Office, these cuts could result in roughly 10 million more people becoming uninsured nationally – with the majority of those losses coming from Medicaid.
Now, before you stop reading because this sounds like a political debate, it’s not.
This is a practical conversation about what’s changing, what it means for families like yours in Hampton Roads, and what you can do right now to stay ahead of it.
What’s Actually Changing?
The law introduces several major shifts to how Medicaid works.
Here are the ones that matter most to families supporting loved ones with intellectual and developmental disabilities:
Work requirements are coming.
Starting in January 2027, most Medicaid recipients will need to show they’re working, volunteering, or in school for at least 80 hours per month to keep their coverage.
There are exemptions for individuals who are “medically frail,” which includes people with physical, intellectual, and developmental disabilities.
Parents and family caregivers of people with disabilities are also exempt.
But – and this is the critical part – qualifying for an exemption requires paperwork.
It requires someone at the state level to process and approve that exemption.
And if there’s one thing families in the disability community know, it’s that paperwork can fall through the cracks.
The Arc of the United States has been vocal about this concern.
As their Medicaid policy director recently noted, the details on verification, lookback periods, and whether exemptions are short-term or permanent will determine whether people who should be exempt end up losing care anyway.
More frequent eligibility checks.
By the end of 2026, states will be required to verify Medicaid eligibility at least every six months, up from the current annual review.
That means more forms, more deadlines, and more chances for eligible families to accidentally lose coverage because a letter got lost or a deadline was missed.
Reduced federal funding to states.
The enhanced federal matching rate that encouraged states to expand Medicaid under the Affordable Care Act sunsets on January 1, 2026.
This puts financial pressure on states like Virginia that rely on federal Medicaid dollars to fund home and community-based services – the exact services that help people with IDD live in their communities instead of institutions.
Why This Matters for Disability Services Specifically
Here’s the part that doesn’t get enough attention in the headlines.
Home and community-based services – things like personal assistance, respite care, companion care, behavioral consultation, supported living – are not required under federal Medicaid law.
They’re considered “optional.”
States provide them through waiver programs, and they’re funded largely with Medicaid dollars.
That means when federal Medicaid funding gets cut, these are historically the first services states reduce.
A KFF analysis found that Medicaid spends about seven times more annually on adults with IDD compared to adults without IDD.
That’s not waste – it reflects the genuine support needs of this population.
But it also makes IDD services a target when budgets tighten.
We saw this play out between 2010 and 2012, when federal Medicaid funding declined.
Every state cut home and community-based services to some degree.
Waiting lists grew. Families lost access to care they depended on.
Right here in Virginia, the WHRO reported in January that the developmental disability community was already worried about a $3.2 billion Medicaid shortfall over the next three years.
Advocates from the Arc of Virginia pointed out that the previous governor’s budget failed to include rate increases for personal care, nursing, and respite – services that are essential for people with the most complex support needs.
Meanwhile, over 550,000 people with IDD are on waiting lists for home and community-based services nationally, a number that grew 8% last year alone.
What About the Direct Support Workforce?
This is connected, and it’s important.
A national “Case for Inclusion” report released in January found that after years of crisis-level staffing shortages, direct support professional turnover finally dropped below 40% in 2023.
Wages rose to a national average of $17.20 per hour. Vacancies declined.
Those gains were the direct result of $26.3 billion in pandemic-era funding that went toward recruiting and retaining caregivers.
That money has now expired.
Advocates are warning that without continued investment, the workforce improvements will reverse.
The CEO of ANCOR, which represents disability service providers across the country, said the situation plainly: failing to invest in home and community-based services and the direct support workforce will profoundly impact people with IDD and their families.
If you’ve ever struggled to find or keep a reliable caregiver for your loved one, and if you’re reading this blog, chances are you have – this is why.
The system was already stretched thin. These cuts could stretch it further.
It’s a cycle that feeds on itself. When funding drops, wages stagnate.
When wages stagnate, good caregivers leave for better-paying work.
When caregivers leave, families are left scrambling – calling agency after agency, interviewing people who don’t understand their loved one’s needs, and ultimately shouldering more of the care burden themselves.
We wrote about this dynamic in our recent post on why it’s so hard to find good caregivers, and these federal cuts are poised to make an already difficult situation worse.
What You Should Do Right Now
We’re not here to alarm you. We’re here to help you prepare. Here are the most important steps you can take as a Virginia family:
Keep your paperwork current.
When the six-month eligibility checks start, you’ll want everything organized and ready to go.
Keep copies of your loved one’s disability determination, any waiver documentation, medical records, and correspondence with your Support Coordinator.
Don’t wait for the letter, start organizing now.
Understand your exemptions.
If your loved one has an intellectual or developmental disability and is on Medicaid, they should be exempt from the new work requirements.
But “should be” and “are” are different things.
Talk to your Support Coordinator or case manager now about how the exemption process will work in Virginia.
Get it in writing if you can.
Lock in your services.
If you’ve been on a waiver waitlist or have approved hours you haven’t been using, now is the time to get active.
Connect with a provider. Start services.
Established service relationships are harder to disrupt than unused authorizations sitting in a file.
Stay connected to advocacy organizations.
Groups like the Arc of Virginia, Virginia’s disAbility Navigator, and the Virginia Board for People with Disabilities track these policy changes in real time and can alert you to developments that affect your family.
Sign up for their newsletters and follow them online.
Talk to us.
If this feels overwhelming, and we understand if it does – you don’t have to figure it out alone.
Our team at CDS has been navigating Virginia’s Medicaid waiver system for nearly 20 years.
We know how this works, and we can help you understand what your family’s options are right now.
The Safety Net Is Getting Thinner. That’s Why Your Next Move Matters.
We’re not going to sugarcoat it. The landscape for disability services is shifting in ways that create real uncertainty for families.
But uncertainty doesn’t mean helplessness.
It means preparation.
It means getting informed, getting organized, and getting connected to providers and advocates who are in this for the long haul.
CDS has been serving families in Hampton Roads since 2005.
We’ve weathered funding changes, policy shifts, and workforce challenges before.
We’re still here.
And we’re still doing what we do best: providing personalized, person-centered care that sees your loved one as a whole person – not a line item in a budget.
We’re not a national chain. We’re not backed by investors looking for a return.
We’re a local team that built this organization because we believe everyone deserves dignified, compassionate support, and because we’ve lived the caregiving experience ourselves.
That’s what drives us, and it’s what will keep us here regardless of what happens in Washington.
If these changes have you worried, let that worry move you to action.
Call us.
Let’s talk about where your family stands and what we can do together to make sure your loved one’s care isn’t interrupted.
Have questions about how these Medicaid changes affect your family?
Call Community Direct Services at (757) 965-4899 or visit communitydirectservices.com to connect with our team. We’re here to help you navigate what’s next.
Sources
Disability Scoop, “Congress Approves Nearly $1 Trillion In Cuts To Medicaid Threatening Disability Services” (July 3, 2025): disabilityscoop.com
Disability Scoop, “Medicaid Changes Could Limit Access For People With Disabilities, Advocates Warn” (January 5, 2026): disabilityscoop.com
Disability Scoop, “Medicaid Cuts Put Disability Services At Risk, Advocates Warn” (January 27, 2026): disabilityscoop.com
KFF, “5 Key Facts About Medicaid Coverage for People With IDD” (September 2025): kff.org
American Psychological Association, “Update on Cuts to Medicaid Funding”: apaservices.org
WHRO, “Virginia developmental disability community fears funding cuts in 2026” (January 6, 2026): whro.org
Virginia DMAS, DD Waivers: dmas.virginia.gov
