Stripping the South: How Medicaid Cuts Could Break Black Disabled Families
With up to $880 billion in cuts recently approved in the House, advocates warn that the threat to Medicaid is greater than ever — and Black families are bracing for what comes next.
Update: Since publication, the House of Representatives has passed the “One Big Beautiful Bill,” which includes up to $880 billion in proposed Medicaid cuts over the next decade. The bill now moves to the Senate for consideration.
In the Deep South, Medicaid isn't just a support system — it is the system. With many Southern Black families lacking access to employer-sponsored insurance and living in states that long rejected its expansion, the program serves as the only lifeline for thousands with disabilities.
But now, a GOP-led bill is on the table that would cut up to $880 billion from Medicaid. Last week, the proposal — dubbed the “One Big, Beautiful Bill” — failed to advance out of the House. Notably, three Republican lawmakers from the South played a pivotal role in blocking the bill: Rep. Andrew Clyde (Georgia), Rep. Chip Roy (Texas), and Rep. Ralph Norman (South Carolina). Their opposition wasn’t in defense of Medicaid, though. Instead, they criticized the proposal for not cutting deeply enough or enforcing work requirements fast enough.
Such division and setbacks show that negotiations are far from over, as the proposal is expected to return in some form. And leaders at United Cerebral Palsy say disability support in the South is still under threat — with families, workers, and caregivers already stretched to their breaking point.
“The cuts would be devastating,” says Todd Perkins, Executive Director of UCP of Mobile, Alabama. “These aren’t extra benefits. These are essentials that allow people to live in their homes, go to school, and participate in their communities.”
In Alabama, nearly all of UCP’s programs are Medicaid-funded. That includes in-home personal care, respite services, adult day programs, and therapy for children with disabilities. Without federal investment, Perkins says, there is no safety net.
The Hidden Workforce Holding It Together
Behind every home visit, school therapy session, and daily care routine funded by Medicaid is a workforce often overlooked. Direct Support Professionals (DSPs) — many of whom are Black women, especially in the South — provide critical services like bathing, feeding, medication support, mobility assistance, and job coaching. Despite their critical role, stagnant Medicaid reimbursement rates have kept their wages at poverty levels, averaging just $11–$13 per hour in most Southern states.
“DSPs are the backbone of this system,” says Armando Contreras, President and CEO of United Cerebral Palsy.” And yet, many live in poverty themselves. If we keep losing them, the entire system collapses.”
At the local level, Perkins says that collapse is already taking shape.
“The DSP shortage is dire,” Perkins says. “We’ve had to turn down referrals because we don’t have enough staff. Our employees are deeply committed, but they can’t support themselves on $11 or $12 an hour. And when we lose staff, it’s not just a job vacancy — it’s the loss of a trusted relationship for a client who depends on that person for daily living. It’s emotionally devastating for families and disruptive to care continuity.”
While the UCP has advocated for increased Medicaid reimbursement rates tied to DSP wage standards, those reforms are now at risk, as policymakers are pushing for cuts that would gut the very workforce holding disability care together.
Black Families Face a Double Burden
The South is home to 57% of the nation’s Black population, and in many Southern states, 30–35% of Black residents are enrolled in Medicaid. But as national debates rage over budgets and fraud, Contreras says the lived realities of the people most affected often go ignored.
“What gets erased in national debates is the intersectional nature of their experience,” Contreras says. “Poverty, systemic racism, and ableism converge. These individuals are often left out of both civil rights conversations and disability policy discussions—and that erasure leads to policy decisions that ignore those most vulnerable.”
Moreover, these families often face the dual pressure of caring for loved ones with disabilities while working multiple jobs to stay afloat.
“They rely on Medicaid for therapies, for home health aides, and for respite programs that give them a much-needed break,” says Perkins. “These cuts would mean more family caregivers being forced to quit jobs, more burnout, and more isolation.”
That threat extends beyond the home, too. Many Black children also receive speech, occupational, and behavioral therapies at school through Medicaid. With chronic absenteeism already high in Southern districts, deeper cuts could erase access to in-school support, leading to more disengagement, misclassification, or institutional referrals.
Erasing Care in the Name of Reform?
While supporters of the cuts claim they are targeting fraud and inefficiency, Contreras says the opposite: “Fraud is rare and heavily monitored,” he says. “The real inefficiency comes from underfunding and bureaucratic hurdles that hurt families and providers alike.”
Perkins echoes this concern: “In Alabama, I think some lawmakers are far removed from the day-to-day realities of the people they support,” he says. “The myth that Medicaid is riddled with fraud or overuse leads them to believe it’s an easy place to cut.”
“But come experience any of our programs,” he adds. “Talk to a mother caring for her adult son with cerebral palsy, who relies on Medicaid to afford a home health aide. These are not people abusing the system. These are people doing everything they can to build a life of dignity, despite overwhelming odds.”
Contreras says what’s more troubling, is how these cuts repeat a familiar historical pattern seen after deinstitutionalization — when, between the 1950s and 1980s, the government moved people with disabilities out of large institutions but failed to fully fund the promised community-based services to replace them.
“Medicaid serves a large population of Black families who have historically lacked access to employer-sponsored coverage. Lawmakers often overlook or don’t consider these racial and geographic realities. “So when care is pulled back, he adds, “it’s Black families who are expected to pick up the pieces with no resources and no reprieve.”
Fighting for Justice from the South
While the bill is currently stalled, the stakes in the South are still rising. And both Perkins and Contreras stress that this is not just about healthcare policy — it’s about justice.
“These programs are your right, not charity,” Perkins says. “No family should be left behind because Congress won’t protect what we fought so hard to build.”
“We will not allow these programs to be dismantled without a fight,” adds Contreras. “Because for the South, this isn’t just about cuts. It’s about protecting hard-won care that generations fought to secure.”
13 & South is a new publication covering news, investigative stories, and insights on social justice, policy, and systemic inequities impacting Southern Black communities. I value your insights and feedback, and invite your perspectives to contribute to future issues. Please email me at editor@13thandsouth.com. Also, feel free to connect with me on my socials! LinkedIn, Twitter, IG, BlueSky, and Threads.