L'Arche GWDC
June 19, 2025
An in-depth look at how Medicaid Cuts would impact L’Arche GWDC and disability services in the U.S.
Alice Felker, Director of Human Services & Advocacy
The House of Representatives passed the “Big Beautiful Bill,” which proposes significant cuts to Medicaid, on May 22nd, 2025. The reconciliation process for the bill is ongoing, and this week, the Senate Finance Committee proposed even bigger cuts to Medicaid than what was originally proposed. We’ve shared that if enacted, cuts to Medicaid would be devastating, not only for our core members, but for all Americans with Intellectual Disabilities, and for the disability service system as a whole.
L’Arche GWDC is a Home and Community Based Services (HCBS) Medicaid Waiver provider. The HCBS Medicaid Waiver program gives people with intellectual and developmental disabilities the opportunity to “waive” the option of living in a more restrictive setting, like an institution, hospital, or nursing home, and instead receive services at places like L’Arche. The funding L’Arche GWDC receives from Medicaid, through the HCBS program, makes up approximately 65% of our operating budget; this funding goes directly to paying our assistants for providing direct care to core people.
Home and Community Based Medicaid Waivers (HCBS Waivers) are not federally mandated, unlike many of the other services provided by Medicaid. Each state and the District of Columbia can decide how many waivers to fund and the funding amount per waiver. This means that if Medicaid is cut on the federal level, states will look to scale down this program first, either by reducing the funding amount per waiver and/or by decreasing the amount of HCBS waivers available in the state. This isn’t just conjecture. We know from past experience that any cuts to Medicaid disproportionately impact HCBS waivers: From 2010-2012, all 50 states reduced HCBS program spending in response to federally mandated Medicaid cuts.[1] Cuts to Home and Community Based Services would have significant consequences for people with intellectual and developmental disabilities, their families, and disability service providers, like L’Arche GWDC.
Cuts to Medicaid would impact how direct support professionals are compensated across the country.
As L’Arche has often shared, disability services are already in a precarious position in our country as it stands: In 2024, 90% of disability service providers in the U.S. experienced moderate or severe staffing shortages.[2] Staffing shortages lead to lapses in quality care–45% of providers across the U.S. reported more frequent injuries and adverse incidents to people with disabilities in their care due to the impacts of turnover and inadequate staffing. In 2024, staffing shortages also led to 69% of providers in the U.S. closing programs or services. These staffing shortages are directly related to Medicaid provider reimbursement rates: when caregivers are not paid living wages, they find other work.
Prior to these proposed cuts, L’Arche, ANCOR, and the Arc of Northern Virginia were advocating for increases in Medicaid reimbursement rates, so that we can better pay our assistants, and direct support professionals across the country, for the work they do. Lucy Beadnell, Director of Advocacy at the Arc of Northern Virginia, recently shared with NBC news, “For perspective, Medicaid caregivers in Northern Virginia that are expected to do really complex lifting, care, behavior supports for people with disabilities, make just over $17 an hour with zero hours of paid vacation each year, and, at a maximum, five paid sick days.”[3]
Because of our committed community members and donors, L’Arche has already supplemented wages for our assistants over and above the reimbursement rate, including providing vacation time, healthcare, and other benefits. Further cuts to Medicaid could jeopardize our ability to pay our assistants the wage they deserve and would require L’Arche to rely on donor support even more to pay a living wage to our assistants.
The work of our assistants is essential, beautiful, and challenging: Assistants are the best and most meaningful vehicle for our mission to create a more human society, where every person’s unique and sacred value is honored. L’Arche GWDC firmly believes that our assistants must be paid living wages. In the past few months, I have witnessed on multiple occasions the incredible dedication of our assistants:
- Two Assistants coordinated an elaborate birthday gift for a core person, surprising her with a full new outfit and shoes, which they paid for out of their own pockets.
- After working 8 hours in the hospital with a core member, an assistant decided to sleep overnight in the core person’s room to make the core person more comfortable. He was not asked to do this, but did so because of his friendship and commitment to the core person.
- Another assistant brought paint and canvases to a hospital room to transform the hospital into a paint studio, to cheer up the core person.
- Two assistants enabled two core people to go on a long-hoped-for trip to New York City for three days, leaving behind their personal responsibilities to help accomplish the goals of these two core people.
- Two assistants held both hands of a core person as he took his final breaths at home. They sang to him and read to him from his favorite books.
The work of our Assistants is the core of the work of L’Arche. Valuing our assistants, not only in how we speak about them but also in how we compensate them, is essential to supporting our core members in leading big lives. Medicaid cuts would impact L’Arche and many disability service providers’ ability to pay our caregivers, furthering an already ongoing workforce crisis that has been the focus of L’Arche GWDC’s advocacy efforts in recent years.
Medicaid Cuts would further lengthen waiting lists for people with disabilities to receive services.
Already, HCBS waivers are significantly underfunded. For L’Arche GWDC, this is particularly relevant for Virginia: As of December 2024, there were 15,200 Virginians with disabilities waiting for a waiver so they could live in a place like L’Arche or receive services in their own homes. L’Arche knows and loves many people with Intellectual Disabilities who are on this waiting list, and many of our core people spent too long on this very same list. If these Medicaid cuts are enacted, many states will decrease the number of available waivers: the state waiting lists will increase significantly, and there will be more barriers for people with disabilities to live in homes and communities of their choosing.
Charles Clark, L’Arche Representative of the USA and founding core member of 6th Street house, spent much of his life advocating specifically for more funding for these waivers. It is disheartening to know that this program, instead of being further invested in as Charles advocated for, will be on the chopping block if this legislation is passed.
Enacting Work Requirements and requiring Medicaid redetermination every 6 months would lead to more administrative time for L’Arche staff, bringing us farther away from our mission and our core people.
The Big Beautiful Bill also calls for Work Requirements and more frequent Medicaid re-determinations for those who receive services. If this bill passes the Senate, our staff would spend more time completing lengthy Medicaid recertification processes and exemption paperwork for work requirements. L’Arche resources would be diverted to more administrative work instead of hands-on work with our core people and community. I strongly believe this is not in the best interest of our core people, and that it would not serve the goal of eliminating any “waste, fraud, or abuse.” Instead, it would bring disability service staff farther away from the people they support, leaving them stuck behind desks completing paperwork.
Cuts to Medicaid are indicative of a greater cultural devaluing of people with disabilities and their caregivers.
The Medicaid program is designed to provide healthcare to some of our society’s most vulnerable: people with disabilities, the elderly, and those experiencing poverty. Cutting from Medicaid further casts aside people who are already on the margins. As a faith community, L’Arche GWDC opposes these cuts. I’m reminded of Pope Francis’s words: “To live charitably means not looking out for our own interests, but carrying the burdens of the weakest and poorest among us.” [4]
The proposed cuts to Medicaid in the “Big Beautiful Bill” directly oppose L’Arche GWDC’s mission and are a clear threat to us as an organization. Cuts to Medicaid would push an already stretched disability service system to the brink, putting many providers, including L’Arche, in the position of needing to make extremely difficult financial decisions. Our core people and people with disabilities in the U.S. would have fewer services, caregivers, and options as a direct result.
We need your help, and particularly your voice, this summer.
Contact your Senators, urge them to vote AGAINST the “Big, Beautiful Bill” when it comes to the Senate Floor. This is an urgent and important issue that directly impacts our core people and the disability services system as a whole.
Our partners at L’Arche USA, The Arc, and ANCOR have a number of easy ways to learn more, get involved, and make your voice heard. You can use the links below to read more about the proposed cuts to Medicaid and send a message to your Senator instantly.
Our core people and assistants, in particular Eileen and Ty, have already been hard at work advocating on behalf of L’Arche GWDC against cuts to Medicaid. We invite you and your friends and family across the nation to join us in spreading the word about the true, lived impact these cuts would have on our core people and way of life.
[1] https://geigergibson.publichealth.gwu.edu/sites/g/files/zaxdzs4421/files/2025-04/Kaye%20HCBS%20Cuts%202010-2012%20%282%29%20%281%29.pdf
[2] https://www.ancor.org/resources/the-state-of-americas-direct-support-workforce-crisis-2024/
[3] https://www.nbcwashington.com/news/local/parents-of-children-with-disabilities-say-medicaid-cuts-will-put-livelihoods-kids-health-at-risk/3871381/
[4]https://www.archivioradiovaticana.va/storico/2014/01/07/pope_invites_us_to_spare_a_place_for_the_poor/in2-761894