Advocates across the country are warning that proposed federal Medicaid reductions could jeopardize programs that help people with disabilities live at home rather than in institutions. Home- and community-based services, which fund caregivers assisting with daily activities, are considered optional under Medicaid and may be among the first areas states reduce to balance budgets.

Families and disability advocates say such cuts could force many individuals into institutional care, which is often more costly and disruptive. National groups also note that hundreds of thousands of Americans are already waiting for these services.

Advocates fear states will increasingly limit eligibility, reduce services, or cut caregiver pay as they respond to expected federal funding reductions.