In a new letter about H.R. 1, the so-called “One Big, Beautiful Bill” that passed the U.S. House of Representatives on May 22, United Cerebral Palsy (UCP) said the organization remains “deeply concerned about the bill’s indirect consequences on the disability community and the providers that serve them.”
The letter, signed by UCP’s President/CEO Armando Contreras, was addressed to Sen. Mike Crapo (R-Idaho), chair of the Senate committee on finance, “as you and your colleagues lead the Senate’s consideration of changes to the Medicaid program through the budget reconciliation process.”
Describing UCP as “one of the nation’s leading providers for individuals with disabilities,” Contreras said the organization and its affiliates serve more than 350,000 children and adults with cerebral palsy and other disabilities via a large range of diverse programs. “These services include information and resource referral, advocacy, research, educational instruction, home-and-community-based services (HCBS), early-intervention therapies, job coaching, integrated employment support, recreational opportunities, and community-based residential programs. We are committed to the belief that all people with disabilities should be treated as equal members of an inclusive society.”
While Contreras said UCP was “grateful” that the version of the bill that passed the House “took care to avoid direct harm to individuals with disabilities,” the CEO expressed concern over “sustainable and reliable funding for HCBS,” which is not a mandatory benefit.
“HCBS programs are vital, helping individuals remain in their homes and communities while providing essential support to family caregivers,” Contreras said. “These services improve health outcomes, reduce reliance on institutional care, and support caregiver participation in the workforce. They can include anything from respite for caregivers to health-care administration to day programming.”
Contreras added that HCBS “is already under strain due to workforce shortages and low reimbursement rates” and said HCBS are particularly vulnerable to funding cuts “when states must shift resources to meet new administrative obligations like those required under the community engagement provision.”
The letter said community engagement requirements would “likely require states to establish entirely new administrative systems, adding substantial cost and strain to state resources.” The additional administrative work “could jeopardize existing Medicaid services that are critical to individuals with disabilities.”
The House-passed freeze on state-levied provider taxes, Contreras said, would remove “a key tool” that states can use to fund their Medicaid programs. “If administrative costs increase while states are barred from adjusting provider taxes to generate revenue, non-mandatory services like HCBS may be among the first to face reductions or elimination,” Contreras said.
The letter closes by expressing gratitude for “the thoughtful carve-outs the House included to protect people with disabilities from changes to their coverage,” but also asks the Senate, in its bill deliberations, “to consider the cumulative impact of increased administrative burdens and the broader policy landscape facing individuals with disabilities. Protecting this population requires not only safeguarding direct services, but also ensuring that indirect pressures do not erode the programs they depend on.”
