Disability Rights California’s Letter to California's Congressional Delegation - Vote No on Cuts to Medicaid

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May 14, 2025

Disability Rights California’s Letter to California's Congressional Delegation - Vote No on Cuts to Medicaid

To: California Congressional Delegation

Dear California Congressional Delegation,

We are writing to voice Disability Rights California’s opposition to the reconciliation bill that passed out of the Energy and Commerce Committee on Wednesday, May 14, 2025, and to ask you to stand up for Californians with disabilities by voting “no” when the bill comes to a vote on the House floor. Medicaid is a life-sustaining benefit for millions of Californians with disabilities, and the provisions in this bill would harm disabled Californians. 

Cuts to Medicaid are not inevitable, and this bill is not a middle ground. We do not have to take away health care from poor and disabled people to fund tax cuts for the wealthiest Americans. These Medicaid cuts would hurt our clients and community members by terminating eligibility or reducing services for those who remain eligible. We urge you to make the right choice for your disabled constituents by voting against these cuts to Medicaid. 

Below, we highlight some of the provisions that would have particularly dire consequences for California and for people with disabilities. 

DRC opposes Section 44141 because it penalizes people for their unemployability or not reporting their work correctly

Although Medicaid work requirements are intended to exclude people with disabilities and caregivers, this policy will inevitably hurt these groups. Based on estimates from the work requirements in Arkansas and New Hampshire, which are similar to the policy outlined in Section 44141, one million Californians would likely lose Medi-Cal on this policy,1  and this group would include:

  • Disabled people who struggle to submit proof of work on time, such as people with limited internet access or proficiency (older adults, unhoused people) or disabled people who already have to prove their eligibility for multiple government benefits on an ongoing basis.
  • Disabled people whose accessibility needs cannot be met by the forms and cannot fill out forms by themselves, putting the responsibility on caregivers to perform an administrative task rather than provide actual care.
  • Caregivers who struggle to “prove” that they spent sufficient time caregiving or who provide so much time caregiving that they do not have time to devote to completing these forms without any errors.
  • People with disabilities whom evaluators deem as not exempt from work due to new and arbitrary standards that will require administrative appeals. For example, people with health conditions requiring long-term treatment like severe pain, fatigue, mental illness, or substance use disorders, may not be considered “disabled enough” to be exempted from work requirements.
  • People with disabilities who change addresses frequently, like disabled people who live in group homes or long-term care facilities or miss mail while hospitalized.

Punishing disabled people who cannot find work by taking away their health insurance makes them sicker and keeps them out of the workforce. This policy goes against the stated goal of incentivizing work and creates a paradox: disabled people who are not working and will not have Medicaid will be unable to access the care they need to “prove” they are disabled enough to be exempted from work requirements. 

DRC opposes Section 44142 because charging premiums for the Medicaid expansion population will make health care unaffordable for disabled Californians

Many disabled people and their family members qualify for Medicaid via Medicaid expansion. Adding premiums for people who are between 100% and 138% of the federal poverty level will create a barrier to health care for this group of poor Californians. Under this proposal, a family of 4 with a total income between $32,150 and $44,367 per year would need to pay Medicaid premiums.2 But, the average annual cost of living for a family of 4 is $134,902 per year in the Los Angeles area, $211,473 in San Francisco, and $95,036 in Bakersfield.3 This policy further impoverishes Californians who are already making far below the actual cost of living.

Disabled and chronically ill people will be the ones impacted by this policy, since they use health care more frequently. In practice, this takes away care from chronically ill people with low incomes who cannot afford health care expenses for their additional medical needs.

DRC opposes Section 44108 because increasing the frequency and burden of eligibility redeterminations increases the likelihood of disabled people losing health care coverage

Medicaid redeterminations result in inadvertent disenrollment for qualifying people. For example, during the Medicaid unwinding period from June 2023 to May 2024, 90% of the people disenrolled in California were disenrolled for procedural reasons, not because they were found ineligible. Older adults and people with disabilities were more likely to be procedurally disenrolled than the general population.4 Increasing the frequency of redeterminations will increase the likelihood of these incorrect disenrollments.

Incorrect disenrollment creates gaps in services, which will also hit disabled people the hardest. Many disabled people cannot go one day without access to Medicaid services. One example is a paralyzed Californian whose Medicaid funds a personal care attendant. A gap in Medicaid due to mistaken disenrollment means they would be stuck in bed. This means they risk injury and infection if the care attendant cannot be paid to provide the paramedical services that keep the person alive. 

New eligibility checks are unnecessary administrative work for disabled people which results in incorrect disenrollment that costs lives.

DRC opposes Section 44111 because it punishes states that use their own funds to provide coverage to undocumented people with 10% decrease to Medicaid expansion FMAP

California spoke through its legislature to use state-only taxpayer funds to provide health care access to all low-income children and adults, regardless of immigration status to ensure all California hospitals and medical providers receive compensation for their services. Lowering the federal FMAP from 90% to 80% will double the current amount California must spend to provide affordable health care to millions of their residents under Medicaid expansion. California cannot afford that.

Assuming this section even passes constitutional inquiry, reducing matching federal funds will result in people in Medicaid expansion being disenrolled, will add to uncompensated care costs for California hospitals, and further exacerbate the health care provider crisis in California.

DRC opposes 44125 & 44201 because it limits access to gender-affirming healthcare

Medicaid supports all Californians, not only cisgender Californians. The intersection of disability and gender identity must be accurately represented in discussions regarding health, wellness, and procedural changes to better create inclusion and access in the health space. In fact, LGBTQIA+ individuals, especially transgender individuals, are disproportionately likely to acquire disabilities in large part due to healthcare discrimination.5 Section 44125 and 44201 will result in a categorical increase in healthcare disparities & costs. 

Currently, transgender, gender diverse, and intersex (TGI) Californians with disabilities are facing relentless attacks on their healthcare and their very personhood. TGI Californians with disabilities have the right to choose healthcare such as gender affirming care. In California, gender affirming health care and gender affirming mental health care cover a wide variety of empirically based and scientifically appropriate standards.6 If Medicaid is cut, the onus remains upon California to uphold the standard of care.

Transgender, gender diverse, and intersex individuals must wade through profound systemic discrimination and lackluster healthcare, including being wrongfully withheld care for their disability-related needs because of their identity. Cutting all access to gender-affirming care will create a chilling effect, dismaying the community from seeking appropriate, timely preventative care,7 thus resulting in a significant increase in physical and mental health needs.8 From an economic perspective, denial of healthcare will increase ER visits, hospitalizations, and healthcare expenditures upon the state.9

DRC opposes Section 44122 because reducing retroactive Medicaid coverage from three months to one month saddles unexpectedly disabled people with excessive medical debt

Cutting the retroactive eligibility to only one month will harm vulnerable Californians who become unexpectedly disabled. It then jeopardizes the financial stability of hospitals that support them.

Disability can happen at any time, and Medicaid applications take time to process. Retroactive Medicaid eligibility helps people get coverage for care they receive while they work on their application as well as while their application is being processed. For example, a change in life circumstance, such as a pregnancy, may make someone eligible for Medicaid, but it may take time for them to discover that they are eligible and how to apply. Similarly, the birth of a medically fragile child or sudden traumatic injury to a child may bring unexpected expenses not covered by commercial insurance and eligibility for Medicaid will be needed to pay for the necessary care. No family should be forced to incur insurmountable medical debt to care for a family member who meets Medicaid eligibility requirements. The three months of retroactive coverage allows people in this situation to avoid medical debt.

Further, retroactive coverage allows hospitals to get paid, rather than leaving them with uncompensated care. Uncompensated care is then sent to debt collectors and often is not recouped, let alone in the same fiscal year. Uncompensated care is a major concern of rural hospitals, who serve millions of disabled Californians and risk closing if policies such as this one are implemented. 

DRC opposes Section 44126 which will prohibit funding to certain reproductive health providers that serve disabled Californians

Disabled people face numerous barriers in accessing reproductive health care, such as inaccessible exam tables or clinic entrances that are not wheelchair accessible.10 But this provision, which is only meant to target Planned Parenthood, which does provide accessible reproductive health care, could also be interpreted to include reproductive health clinics throughout the state that provide a variety of needed services to disabled Californians.

Prohibiting any reproductive health providers from accepting Medicaid will further narrow the already very limited availability of accessible reproductive health services in California. This means that disabled Californians who already face health complications outside of pregnancy will have fewer providers to use to obtain necessary fertility or prenatal care necessary for healthy pregnancies. 

Without clarity, we expect that providers who cover a wide range of health services including reproductive health will preemptively stop taking Medicaid patients, exacerbating inequities in access to care. 

DRC opposes Section 44109 which will punish disabled seniors who wish to age in place and receive services in their own home

At DRC, we see clients who have acquired a disability as they age and make no or very low income but live in a home passed down through generations. One of the promises of Medicaid as a social safety net is that the person can remain in their home and receive services there. In fact, this situation saves the government money, because care at home is less costly than in a congregate facility. But this policy will force disabled Californians to sell their home and either experience housing insecurity or move into a facility. 

The median cost of a home nationwide is $416,900,11 but statewide in California the median is over $900,000,12 with higher costs in areas like San Jose, where the median cost of a single family home is over $2 million.13 Unlike the rest of the country, this policy will force the average owner of a modest home in California to sell their house to receive long-term services and supports necessary to age in place. 

Homes in California are extraordinarily expensive compared to many other parts of the country. Capping the home equity limit permanently at $1 million for non-agricultural homes and $750,000 for homes on agricultural land, without future adjustments for geographic differentials or inflation, will hurt Californians who financially planned to age in place. 

DRC opposes Section 44121 that removes safe staffing ratio requirements in nursing homes

As California’s Protection and Advocacy organization, we receive reports of abuse and neglect in nursing homes and other long-term care facilities. Lack of adequate staffing in nursing homes contributes to the mistreatment and neglect that we work to prevent. This proposal is particularly concerning given the likely cuts to home- and community-based services (HCBS) that would result from the other policies in the budget proposal. Without adequate HCBS and with the enactment of some of the specific provisions, nursing homes will be the only option for disabled people, and they will be profoundly unsafe due to the lack of staff needed to maintain adequate care for their disabled residents.

Each of these provisions alone will hurt disabled Californians, but cumulatively this bill will have a disastrous impact on California’s overall health system. Over 100,000 Californians would be expected to lose their jobs from these cuts. Hospitals would not be able to stay afloat with increased uninsured population contributing to increased uncompensated care. Services deemed “optional” by federal policy, like home- and community-based services, which are not optional for the people who need them, would face drastic cuts. Optional services include things like in-home nursing provided under the Home and Community Based Alternatives (HCBA) Waiver. Without optional services, like those authorized under the HCBA Waiver, medically fragile children would be forced to live in hospitals or facilities rather than with their families and adults with disabilities who require nursing would be forced to leave their communities and receive care in a nursing facility.  

California is already facing a $12 billion deficit in state funds before any federal cuts.14 This proposal will increase that deficit each year and create a budget crisis for our state legislature to ensure disabled Californians receive the promise Medicaid was meant to fulfill. 

Every day, DRC receives calls from Californians concerned about how these Medicaid cuts will affect their well-being. We urge you to vote no on this bill in order to help us build a state where Californians can access the care they need, regardless of disability or income. If you have questions or would like more information contact Sabrina Epstein, Policy Analyst, Sabrina.Epstein@disabilityrightsca.org or (213) 213-8147.

 Sincerely, 

Sabrina Epstein
Policy Analyst
Disability Rights California

Andrew J. Imparato
Chief Executive Officer
Disability Rights California 

CC:
Representative Doug LaMalfa, 1st District
Representative Jared Huffman, 2nd District
Representative Kevin Kiley, 3rd District
Representative Mike Thompson, 4th District
Representative Tom McClintock, 5th District
Representative Ami Bera, 6th District
Representative Doris Matsui, 7th District
Representative John Garamendi, 8th District
Representative Josh Harder, 9th District
Representative Mark DeSaulnier, 10th District
Representative Nancy Pelosi, 11th District
Representative Barbara Lee, 12th District
Representative John Duarte, 13th District
Representative Eric Swalwell, 14th District
Representative Kevin Mullin, 15th District
Representative Anna Eshoo, 16th District
Representative Sam Liccardo, 17th District
Representative Ro Khanna, 18th District
Representative Zoe Lofgren, 19th District
Representative Jimmy Panetta, 20th District
Representative Vince Fong, 21st District
Representative Jim Costa, 22nd District
Representative David Valadao, 23rd District
Representative Jay Obernolte, 24th District
Representative Salud Carbajal, 25th District
Representative Raul Ruiz, 26th District
Representative Julia Brownley, 27th District
Representative George T. Whitesides, 28th District
Representative Judy Chu, 29th District
Representative Tony Cárdenas, 30th District
Representative Adam Schiff, 31st District
Representative Grace Napolitano, 32nd District
Representative Brad Sherman, 33rd District
Representative Pete Aguilar, 34th District
Representative Jimmy Gomez, 35th District
Representative Norma Torres, 36th District
Representative Ted Lieu, 37th District
Representative Sydney Kamlager-Dove, 38th District
Representative Linda Sánchez, 39th District
Representative Mark Takano, 40th District
Representative Young Kim, 41st District
Representative Ken Calvert, 42nd District
Representative Robert Garcia, 43rd District
Representative Maxine Waters, 44th District
Representative Nanette Barragán, 45th District
Representative Michelle Steel, 46th District
Representative Lou Correa, 47th District
Representative Katie Porter, 48th District
Representative Darrell Issa, 49th District
Representative Mike Levin, 50th District
Representative Scott Peters, 51st District
Representative Sara Jacobs, 52nd District