Juxtaposition

On April 7, the Maryland legislature adjourned after a grueling 90-day session. Central to this years session was the 2026 Maryland budget. Many of you will have seen Makom’s e-Blasts and Calls to Action; and, many of you answered that call and wrote, called, e-mailed and even visited with your elected leaders. For that advocacy, it would be hard to find the right words to express the depth of our gratitude…

But, this blog is about both what happened anyway in Annapolis, what is happening as I type this in Washington, DC, and the inevitable threats the lurk around the corner.

When all was said and done on sine die, when the Maryland General Assembly adjourned its 2025 legislative session, approximately $188 million in funding cuts remained standing. Now, $188 million is a whole lot better than where we started in mid-January when Maryland Governor Wes Moore proposed $457 million in cuts to services for Marylanders with intellectual and/or developmental disabilities (IDD). Still, $188 million in cuts are, by any definition, deep cuts. For Makom, the cut will be about $1 million.

To be clear and reassuring to our community, we can withstand this level of cut. We will not need to close programs or discontinue services.

But, just because we can withstand cuts doesn’t make them right or just.

“C’mon, David. Everyone is tightening their belts. It’s only 3%.”

Sure. It’s 3%. At the same time, costs continue to escalate. If Makom would seek to increase staff wages by 3%, simply to keep up with inflation—perfectly reasonable for our workforce on whom we rely for, well, everything—it will run us about $600,000 or so. Meantime, health insurance premiums are trending at a 10% uptick for the new year. Gas is higher. Food costs remain high and haven’t yet been impacted by on-again/off-again tariffs. Utilities, hell even postage stamps! All higher and heading higher still. That’s the nature of the world, it seems. If we apply a 3% inflation-based accelerator to the whole of Makom’s operating costs, it’s another $1 million.

So, we lose $1 million in revenue (calculated on fiscal year 2025 revenue actuals and year-end forecast), and we lose a further $1 million in purchasing power. That’s some belt tightening. As is seemingly ever the case, nonprofits like Makom will be charged to “do more with less.” In the spirit of the season, Ma nishtanah (מה נשתנה)! And, it doesn’t end there.

Simultaneously with the budget goings-on in Annapolis, there’s the small matter of proposed radical changes to federal Medicaid policy in Washington, D.C.

Typically, POTUS proposes a federal budget in February. This year has been anything but typical, so by mid-April, we don’t have POTUS’ budget proposal and, more alarmingly, we don’t have details. Nonetheless, we’ve heard the highlights:

• Federal spending reductions of as much as $2 trillion over the next 10 years. Of that amount, the House of Representatives’ 2026 budget resolution targets $880 billion in cuts to spending that is under the jurisdiction of the House Energy & Commerce (E&C) Committee alone. What’s in E&C’s jurisdiction?

• So, think about the numbers. House leadership has set an $880 billion spending cut over the next ten years for everything in E&C’s jurisdiction. Even if they zeroed out everything but Medicaid, it gets them to $482 billion, leaving the remaining $398 billion from, you got it, Medicaid. Virtually everyone Makom supports relies on Medicaid for access to both their healthcare AND their home and community-based services. Oh, and one more thing. Stripping $398 billion from current (projected) spending over the next ten years is a cut of 48.5%. Given the unlikelihood that E&C will zero out everything but Medicaid, that 48.5% become the least that Medicaid will be reduced.

• Cuts to the Supplemental Nutrition Assistance Program (SNAP), historically referred to as ‘food stamps.’ This program provides assistance to more than 40 million Americans, including people with IDD. For example, at Makom, more than 50 people who receive Community Living Supports alone qualify. Countless more people with IDD who live far too frequently in forced poverty, with chronically high unemployment rates that have, for decades, ranged from 70-80%, rely on SNAP benefits.
• Threats to Social Security. The vast majority of adults with IDD receiving any sort of formal home and community based services or other Medicaid-funded services (estimated to be just a bit fewer than 800,000 adults) quite literally live on their social security benefits. Already suffering chronic poverty as a condition of eligibility for Medicaid, losses of Social Security benefits will exacerbate an already dire reality for people with IDD.

Most recently, in a non-budget threat every bit as significant as the three federal budget cut threats above, the US Department of Health and Human Services announced the dismantling of the Administration on Community Living (ACL). It is hard to describe the impact of this decision, never mind its rationale. The National Alliance for Direct Support Professionals (NADSP) President and CEO—and my friend—Joe Macbeth goes closest to capturing it in his recently published OpEd.

“Dismantling [the] ACL is not reform, it’s regression. The ACL was [formed] to unify and elevate the federal response to our aging and disability communities, bringing voice and visibility to two of the most historically marginalized populations in America. It centralized responsibility, accountability, and coordination. It meant something.

Its proposed dismantling—done hastily, without public input or understanding of its purpose—is not a reform. It’s not streamlining or building efficiencies. It’s a thoughtless concession to extremist calls to ‘burn down the government’ without any plan for rebuilding.”

Naturally, Americans with IDD are, well, terrified. When Maryland’s budget cuts of nearly $460 million were proposed, Marylanders with IDD were terrified. Systems on which people with IDD rely are being dismantled dollar by dollar, brick by brick. And, while the $460 million ultimately became “only” $188 million in state cuts to Marylanders with IDD, forgive us our lack of enthusiasm.

What to make of this juxtaposition of state and federal attacks on people with IDD? Maryland is a so-called ‘blue’ state politically. The Governor is a Democrat. The House and Senate in Maryland are dominated by Democrats. The President is a Republican. Congress is controlled by Republicans. Perhaps, as I’ve long said, issues of consequence to people with IDD and their families truly are non-partisan! We needn’t worry anymore whether attacks on our community come from a particular political party—they come from both! The rest is simply the scale of attacks, attacks that target a community of people least enfranchised, least able to withstand cuts to critical funding, least equipped to advocate for themselves.

For now, Makom enters into a 2026 budget year already shorn of $1M in revenue and facing a further $1M in loss of purchasing power. In October—the start of the federal fiscal year 2026—we will know of direct impacts of Medicaid cuts, social security changes, and more. For people with IDD and for Makom, these state first and federal next cuts will be cumulative. It isn’t “just 3%.” It isn’t just belt-tightening. And as ever, it’s a community of people who literally comprise about 2.4% of our population who will suffer the worst of the consequences.