Shelby Wallington is seeing her clients and staff begin to panic as President Donald Trump’s administration proposes historic budget cuts that could impact Medicaid, a service on which nearly a quarter of Washington, D.C. residents depend.
“If those funds are not allocated, there’s a huge chance that we won’t be able to recover from homelessness,” Wallington, who is the director at Housing for Community Family Life Services, said in reference to efforts to reduce homelessness.
Many D.C. organizations like Community Family Life Services, which helps clients experiencing homelessness find housing and consistent health care, are at least partially funded through Medicaid or refer clients to services that rely on Medicaid funding. The benefits program, which ensures access to health care for low-income and disabled adults, helps fund both medical services and some voucher programs for people experiencing homelessness in the city. Providers worry any cuts will put the city’s most vulnerable at risk, and potentially even lead to increases in homelessness.
For Wallington, who helps people with HIV and AIDS, any cuts to Medicaid could be devastating. Besides covering basic physical care, Medicaid also helps to cover mental health services, which Wallington said are essential for people facing housing insecurity.
“Some of these communities already face tremendous barriers to facing life, and they will only increase if Medicaid is cut,” Wallington said.
According to the Kaiser Family Foundation, an independent health policy nonprofit, approximately 79 million people in the U.S. are enrolled in Medicaid. Congress’s proposed budget for the next year would cut $880 billion, or half of Medicaid’s budget, which makes up the majority of the $1.9 trillion the government spends on health care services.
The House budget resolution, which passed April 10, calls on the House Energy and Commerce Committee to propose the cuts, and while some Republican officials say they can find savings through fraud and waste without cutting benefits to most recipients, experts are skeptical. According to Politico, the committee is expected to begin meeting to discuss the cuts in early May.
Even if Congress does not go through with promises to cull Medicaid, proposed legislation in both the House and the Senate could make benefits more difficult to access, as eligibility requirements could change, requiring recipients to work a minimum number of hours each week and verify their place of work.
And besides federal threats of funding cuts, Medicaid funding in D.C. is already at risk. According to a public notice issued in early March, the D.C. Medicaid program is facing “unprecedented challenges” due to program growth requiring an additional $173 million in funding and a projected $1 billion decline in city revenue over the next four years due to federal job losses. The statement was issued before Congress declined to fix the $1.1 billion hole federal legislation left in D.C.’s budget, further threatening local programs. Mayor Muriel Bowser issued a city government-wide freeze on spending in mid-April.
The Department of Health Care Finance said in the notice the upcoming budget, the release of which has been delayed due to the $1.1 billion hole, is attempting to take into account these financial hits, but the agency has no plan for how to cover any federal funding removed from the city’s Medicaid budget. The city would have to consider changing eligibility, benefits, and the amount it pays providers, the notice says, adding “everything is on the table.”
Dorian Warren, the co-president of Community Change, a grassroots organization focused on uniting low-income individuals across the country to address anti-poverty concerns, said the rollout of these potential cuts could have severe consequences.
“Taking away health care from a large population will, in fact, hurt that population, and it will lead to death, plain and simple. People will die,” Warren said.
Community Change marched to Capitol Hill on April 8, demanding Congress and Trump preserve federal Medicaid funding. Along with the immediate health concerns associated with cutting Medicaid, Warren said longer-term impacts could wreck the D.C. community, causing more people to fall into homelessness.
If Medicaid is cut, low-income Washingtonians could rack up increasing medical debt, making it more difficult to pay housing and utility bills, and placing them at a greater risk of eviction, Warren said. In addition, the services Medicaid offers to homeless individuals, which help them achieve a more stable place of residency, could go away if the program is cut.
Karen Cunningham, the executive director of Everyone Home DC, said cuts could also affect the city’s Permanent Supportive Housing (PSH) programs, which Medicaid has partially funded since 2022, by reducing the number of clients they can serve. Through PSH, people experiencing homelessness with chronic health concerns or disabilities are able to move into housing at little to no cost. Any cuts to the program’s funding could make it more difficult for those with disabilities to achieve stable housing and would threaten one of the main resources the city uses to end homelessness.
“It’s hard because we just don’t have a lot of answers right now, we are living through quite a bit of uncertainty,” Cunningham said. But increased homelessness is not the only risk of a weakened Medicaid system. Those with disabilities are particularly in danger, said Shawn Ullman, the CEO of Quality Trust for Individuals with Disabilities, which helps to advocate for those with mental and physical disabilities. Without Medicaid, many of her clients who live on their own would be in institutions or family care, as they could not live independently without the services Medicaid offers, Ullman said.
“When funding is cut, these are where the choices of the District make us nervous,” Ullman said, in reference to the potential that any Medicaid cuts lead the city to reduce funding to disability-centered programs. The increased institutionalization of those with disabilities that might result from such cuts would “set us back 40 years,” Ullman said.
But Cunningham encouraged people not to lose hope. While organizations wait for the federal government to decide what the cuts will look like, Cunningham said organizing must begin so nonprofits can turn to each other instead of the government for help.
“A lot of us are ready and willing to fight,” Cunningham said. “We’re going to try really, really hard to hang on to the funding and the support for the most essential programs that people rely on.”
