Medicaid Is Where Disabled Americans Will Judge the New Congress

“I do not want to die because of a political issue.”

Sloan Meek said that at a North Carolina hearing on 19 November 2025. The state had cut Medicaid provider reimbursement rates by 3 to 10 per cent in October during a budget standoff. Wendy Lincicome, who had supported him for 31 years, feared she would no longer be able to afford to provide his care.

Meek has cerebral palsy and uses a speech-generating device. He plays in a band and serves on his community’s residents council in Durham. At the hearing, he was defending the support that lets him remain part of that community.

North Carolina later restored the rates following court rulings. Those cuts arose from inadequate state funding, not directly from the federal law Trump signed in July 2025. They offered a preview of what a funding squeeze can do to someone whose eligibility for Medicaid has not changed.

Democrats’ control of both chambers after the 2026 midterms gives them an opportunity to challenge the Trump administration. Disabled Americans should judge them by whether they use it to protect care and make government answer for the harm it causes.

Two distinct threats need Congress’s attention. Some people risk losing Medicaid coverage through reporting and exemption paperwork. Others can remain covered while funding pressure reduces the home care available to them. Meek’s testimony concerns this second threat: keeping the people and services that support his daily life.

The deadline arrives before the new Congress

For certain adults covered through Medicaid expansion, new work requirements generally begin on 1 January 2027. People entitled to an exemption can still lose coverage if the system fails to recognise or verify it. This is a separate issue from the provider-funding pressure Meek described. The incoming Congress’s term starts on 3 January. Its members cannot arrive in Washington and prevent a deadline that has already passed.

Nor does control of Congress put repeal within Democrats’ reach on their own. As of 8 November, their Senate caucus has secured 54 seats, including two independents; Alaska and Mississippi remain uncalled. Ordinary legislation faces a 60-vote threshold to overcome a filibuster. Budget reconciliation can bypass that threshold for eligible provisions, but it cannot bypass Trump: overriding a presidential veto requires two-thirds of each chamber.

That leaves difficult, useful work. Committees can investigate coverage losses and demand answers from the officials responsible. Spending negotiations give Democrats opportunities to seek protections and implementation funding, although any deal still needs enough votes and the president’s signature. Members can also press governors and state legislators to maintain home-care funding, and use their offices to help constituents resolve wrongful denials.

They should begin preparing those inquiries now. The people already struggling to keep their care cannot wait for a campaign promise to become a repeal strategy.

A court has already changed the rules

The dispute over who counts as “medically frail” shows why scrutiny matters. In June, a coalition representing 25 states and the District of Columbia challenged the administration’s Medicaid rule. On 29 October, in Massachusetts v. Oz, Judge Richard G. Stearns rejected the extra requirement that people with qualifying conditions demonstrate that those conditions limited their ability to work or volunteer.

The ruling removed that additional test nationwide. For the plaintiffs representing 25 states and the District of Columbia, the court also granted a six-month stay of enforcement concerning determinations of whether someone qualifies as medically frail, to accommodate errors or delays as verification systems change. The order expressly left the 1 January implementation deadline in place; it did not suspend the work requirements altogether.

Congress should ask whether state application forms and computer systems now reflect that ruling. It should require CMS to explain how it will identify people wrongly denied an exemption and restore their coverage. A successful court challenge needs to reach the person filling in a form.

This is also where “Imagine Being Scared of Diversity But Not Dictatorship” becomes more than a provocation. Disabled people need both an equal claim to participate and institutions through which they can contest exclusion. A government that makes either harder threatens their freedom.

Criticising a DEI programme does not make someone an authoritarian. Disabled people should challenge initiatives that advertise inclusion while leaving them unable to participate. My objection here is to the Trump administration narrowing protections beyond what Congress authorised, putting eligible people’s coverage at risk. The Medicaid ruling shows why those institutions are worth defending.

Keeping coverage can still mean losing home care

The second threat does not depend on work requirements or a failed exemption. Someone can keep their Medicaid coverage and still find that fewer hours of assistance are available, or that their provider can no longer afford to deliver care.

KFF’s analysis of the enacted 2025 reconciliation law put the reduction in federal Medicaid spending at $911 billion over 2025–2034, about 14 per cent below the amount otherwise projected. That is a ten-year estimate against a baseline, not a claim that spending immediately falls by 14 per cent.

Home care has been cut under financial pressure before. KFF reports that, during the last major reduction in federal Medicaid spending, every state reduced home-care spending: 40 served fewer people, while 47 cut benefits or payment rates for long-term care providers. Those groups overlap.

Lower payments can make it impossible for someone to keep doing paid care work, even when they want to stay. Meek and Lincicome’s experience puts a relationship behind that budget mechanism. A state can leave someone entitled to assistance on paper while making the people who provide it harder to find or retain.

Democrats should use hearings to examine those consequences state by state. Ask how many people are waiting for home support and whether providers can afford to deliver it. Bring recipients into the hearing room alongside the people who assist them. Meek uses a communication device; a committee that invites him must allow him time to use it. That should shape the hearing’s rules from the start.

Disabled people have reasons to remember

In Buck v. Bell (1927), the US Supreme Court upheld Virginia’s compulsory sterilisation order against Carrie Buck. The court authorised the state to take away her reproductive freedom. Its place in disability history is a warning against assuming that a lawful process necessarily respects the person subjected to it.

Under Nazi rule, disabled people were systematically murdered. The United States Holocaust Memorial Museum records the T4 programme’s own count of 70,273 people killed at six gassing facilities between January 1940 and August 1941. Its estimate for the broader Nazi “euthanasia” programme is 250,000 victims across all phases. Personnel and killing methods were later used in the Holocaust.

Medicaid cuts are not equivalent to those crimes. The reason this history belongs in a disability-rights argument is the repeated claim that other people may decide whose life is worth supporting, with little regard for the wishes of the person concerned. Defending democratic checks on power must include asking whose testimony those institutions hear.

On 12 March 1990, disabled protesters climbed the Capitol steps during the campaign for the Americans with Disabilities Act. The Capitol Crawl confronted lawmakers with exclusion built into their own workplace. Today, a hearing that rushes someone using a speech-generating device can exclude them just as effectively as a staircase.

Accessible participation costs money and takes preparation. So does dependable home care. Lawmakers should defend that spending openly, and involve disabled people while budgets and bills can still be changed. An invitation after the decisions have been made offers very little power.

Meek’s testimony deserves an answer from the people now preparing to run Congress. They cannot promise an easy repeal. They can explain which protections they will demand in negotiations, investigate whether people are losing care, and let the people affected shape that work. Disabled Americans will have reason to judge them by whether someone can keep their support and remain in the community they call home.

Conceived, directed, and finalized by human leadership, this article was guided by the Editor of URevolution, who conducted the literature review, steered the narrative, made all editorial decisions, and edited the final piece. AI tools were utilized in a supporting capacity to assist with preliminary research, drafting, search optimization, content adaptation, and visual creation.