THIS TIME ON CODE WACK!
What’s already changing for people with disabilities now that President Trump’s “One Big Beautiful Bill” has been signed into law? From pediatric clinics closing their doors to looming cuts in home and community-based services, the fallout is just beginning — and it’s hitting hard.
Today we’re joined by two staff members of Disability Rights California, Executive Director Andy Imparato and Policy Analyst Sabrina Epstein, who have been working to track the bill’s impact and fight for the rights of those with disabilities across the state. This is the first episode in a two-part series with Disability Rights California. .
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
What’s already changed for people with disabilities now that Trump’s ‘One Big Beautiful Bill’ has been signed into law?
[Sabrina Epstein]
“Although many of the specific provisions haven’t taken effect yet, we are already seeing two big categories of changes for people with disabilities. The first is that some of the changes that are starting now and are to come, are already causing cuts for people with disabilities in many different ways. For example, we know of a pediatric specialty care clinic that serves children with disabilities that is closing its doors, likely because of the incoming cuts, because they disproportionately serve children on Medicaid. And limiting access to care is another way to cut it, and that’s really heartbreaking….
“The second is, it’s really terrifying and … as a disabled person, I can say I’m terrified. It’s awful to see all of these politicians vote against the interests of disabled people, immigrants, of working class people of so many groups. And it’s disheartening and it’s scary for what it means for our futures.”
[Andy Imparato]
“Sabrina and I did a lot of work with the California Congressional delegation and their staff throughout the process. … And … we heard … they were being told by leadership that the cuts weren’t really gonna affect people with disabilities because the disability community is kind of a traditional Medicaid population.
“… And the people that they were trying to have the cuts target were people that were part of an expansion population. And in their mind, nobody was trying to hurt people with disabilities … we tried to explain to them in many different ways with lots of good data that that was not accurate.
But the reason I bring it up is … they thought it was important at a leadership level to message to us that they’re not going after disabled people … I think they realize that that’s not a good look for them.”
Tell us more about the cuts that are coming down the pipeline – the future cuts you’re concerned about.
[Sabrina Epstein]
“ .. the bill [results in] far less money for the state to use to finance Medicaid (or Medi-Cal as we call it here in California) overall.
“And as a result of that, we are really concerned that when the state budget is down, that could cause cuts to services for people with disabilities, especially home and community based services. We know that those cuts would be shortsighted because home and community-based services not only help us to protect our civil rights to live in the community, but they’re also fiscally responsible. It’s much less expensive to serve people in their own homes than to institutionalize people.
“But in the past … states have chosen to then cut home and community based services because they only have limited options on what they can cut. And certain services are mandatory under federal law, home and community based services are not considered mandatory under federal law. So right now one of our focuses is to work with the state government and prevent as many cuts as possible … But at the end of the day, it’s a lot less money coming from the federal government and the state has to balance its budget. Andy, do you wanna add anything to that?
[Andy Imparato]
“It’s the Medicaid cuts. It’s also the SNAP (food stamp) cuts that are gonna affect a lot of folks with disabilities.
“… as the state starts to figure out how to make up for things that they used to get from the feds and they try to plug holes over here, they’re gonna have to take money from somewhere else to plug the hole … we’re afraid that this is gonna create a horrible dynamic where different, different vulnerable constituencies are going to be fighting with each other to say, ‘don’t take it from here, take it from there’.
“… So are they going to cut immigrants in order to protect children? Are they gonna cut seniors in order to protect single parent households? I mean, these kinds of trade-offs can get very ugly very quickly. And I think at disability rights, California, we recognize there are disabled people in every one of these communities. So disabled people are going to lose. There’s, there’s no way, there’s no scenario where these cuts don’t affect disabled people in some way.”
How do people with disabilities benefit from Home and Community- based Services?
[Sabrina Epstein]
“Home and Community Based Services includes assistance with activities of daily living, which is feeding oneself, getting out of bed, going to the bathroom, working, getting to your appointments, grocery shopping, basically every part of your daily routine. People need varying amounts of assistance for, you know, the truth is we’re all deeply interdependent and rely on other people for help and some people need more help than others.
“There are also services like supported employment to help people find employment and seek jobs who, and maintain their jobs, who need more accommodations or more assistance. There are services that help people learn skills to live independently, services that help people with behavioral health issues. So just a huge range of services that help people to live in the community.”
[Andy Imparato]
I just wanted to follow up on a couple points. One … you may feel like, ‘well, this doesn’t really apply to me.’ [But] the thing about Home and Community-based Long-term Services and Supports is there’s really no insurance that’s gonna protect you against that.
There is a private long-term care insurance market, but it’s not very good insurance. So … let’s say you get in a car accident and you need help getting outta bed and help getting dressed and help toileting. If you don’t have access to these services funded through Medi-Cal it’s gonna be very hard for you to live independently.
“So what ultimately is gonna happen is you’re gonna end up in a nursing home ’cause as Sabrina mentioned, Medicaid is required to pay for care in a nursing home, but not to pay for care in the community, even though it’s more cost effective to be served in the community.
“So it’s just important to recognize that this affects everyone. It’s not just the people that currently use home, home and community based long-term services and supports.
“…I think it is just important to recognize the costs associated with Medicaid in a nursing home. It’s not just that it’s a money thing, it’s also a civil rights issue that the Americans with Disabilities Act requires that if you have a disability, you should be served in the most integrated setting possible for your disability. So if we’re forcing people into congregate settings, because that’s the only thing that Medicaid will pay for, it’s gonna raise civil rights concerns thatwe’re taking people who have full lives in the community forcing them to give that up to go into a nursing home.”
Helpful Links
What the One Big Beautiful Bill Act Means for People with Disabilities, Disability Advice
What Lies Ahead For Medicaid In Budget Reconciliation?, Health Affairs
Citing Trump order, Justice Department cuts disability guidance for businesses, USA Today
In the fallout from Trump’s health funding cuts, states face tough budget decisions, CBS News
Episode Transcript
Read the full episode transcript.
Guest Biographies:
Sabrina Epstein
Sabrina Epstein (she/her) is a Policy Analyst at Disability Rights California. She works on issues that affect people with intellectual and developmental disabilities, including health care and housing. Her policy work is informed by her experience as a disabled person.
Andy Imparato
Andy Imparato is a disability rights lawyer and policy professional who has been working inside and outside government to advance policies and practices to improve employment outcomes for people with disabilities for over 30 years. His perspective is informed by his lived experience with bipolar disorder. He is the Chief Executive Officer of Disability Rights California, a $51 million legal services and policy advocacy organization based in Sacramento with 25 offices across California. Since 2024, he has served as the chair of the National Disability Advisory Council for Centene, a fortune 50 healthcare company. He has been an advisor on disability inclusion and accessibility to a number of other large businesses, including Walmart, Verizon, AT&T, Microsoft, IBM, Walgreens, and SAP.
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