(C) North Dakota Monitor
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Medicaid cuts threaten the rights and lives of North Dakotans with disabilities • North Dakota Monitor [1]
['Kirsten Dvorak', 'Tony Leys', 'Kff Health News', 'Michael Achterling', 'Amy Dalrymple', 'Jeff Beach', 'Mary Steurer', 'More From Author', 'May', '.Wp-Block-Co-Authors-Plus-Coauthors.Is-Layout-Flow']
Date: 2025-05-22
As executive director of The Arc of North Dakota, I’ve witnessed firsthand how essential Medicaid-funded services empower individuals with intellectual and developmental disabilities to live independently and engage fully in their communities. But today, that independence is under serious threat.
On Thursday, the U.S. House of Representatives passed the “One Big Beautiful Bill Act,” which includes sweeping cuts to Medicaid. For many in North Dakota, these cuts aren’t abstract figures. They mean losing access to critical services that make daily life possible, like bathing, commuting to work, or attending community programs, robbing them of their place within the community.
This threat to Medicaid is more than a fiscal issue. It’s a rollback of decades of hard-won progress. In 1980, six North Dakota families partnered with The Arc to challenge the inhumane conditions at Grafton State School and San Haven State Hospital. That lawsuit led to the closure of San Haven, reduced the population at Grafton, and shifted our state toward more humane, community-based care. Now, that legacy is in danger of being erased.
In addition to deep funding cuts, the legislation introduces policy changes that restrict access to care in multiple ways:
Work requirements : The mandatory Medicaid work requirements start date has been moved to Dec. 31, 2026. Although people with intellectual and developmental disabilities are technically exempt, real-life implementation often fails to protect them. Many individuals with disabilities and their family caregivers get caught in confusing eligibility rules, risking wrongful loss of coverage.
Increased costs : States can now charge Medicaid recipients up to $35 per service. Annual out-of-pocket costs could shoot up even for those near the poverty line, making necessary care unaffordable for many.
Frequent eligibility checks : Medicaid eligibility will be reviewed every six months instead of annually. For people with limited access to technology or help navigating paperwork, this change drastically increases the risk of losing coverage due to missed notices or simple errors.
Limits on provider taxes: New federal restrictions on provider taxes limit how states fund their Medicaid programs. This could reduce available dollars for crucial services, including supported employment, in-home care, and day programs. These services allow individuals with intellectual and developmental disabilities to live and thrive in their communities.
While it’s difficult to pinpoint precisely how many North Dakotans with intellectual and developmental disabilities will be affected, the overall impact is clear: Medicaid is the backbone of their support system. Even if some individuals are exempt from specific requirements, the broader funding cuts and program restrictions will limit access, increase delays, and force many to go without the help they need.
Families are already facing long waitlists and strained service systems. These cuts will only make things worse. When services disappear, people don’t just “fall through the cracks”; they face real, lasting harm.
Consider one individual with intellectual and developmental disabilities who’s waited months for a supported employment slot. Without a job coach, they remain unemployed, despite being ready and eager to work. Medicaid cuts push that opportunity further out of reach for them and hundreds of others like them.
And the alternative? Institutional care may sound like a backup plan, but it isolates people, limits opportunities, and costs the public far more. Supporting people in their communities is the right and the fiscally responsible choice.
At The Arc, we believe people with disabilities deserve the supports they need to live full, meaningful lives. But today, families and providers are navigating a maze of shifting rules, disappearing services, and uncertain futures. The confusion alone makes it harder to get help when needed most.
To pursue this direction is to court the resurgence of systems we consciously moved beyond. Our collective experience, however, and the resources now at our disposal, equip us to forge substantive improvements rather than reenact previous failings.
North Dakotans of all abilities deserve more than just survival. They deserve a future built on dignity, inclusion, and respect.
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