L.A. resident Joshua Erenmark is autistic and fully relies on Medi-Cal for care. The 28-year-old, who lives in Westchester, has high support needs autism and requires around-the-clock support, including six in-home staff workers who administer medicines, make meals, keep up with hygiene and more.
“He doesn’t have safety awareness, and his verbal skills are limited. If there were a fire, he wouldn’t know what to do,” said Judy Mark, Erenmark’s mother. While many autistic people can live and take care of themselves on their own, Erenmark cannot, and his family fears he could soon be losing the benefits he relies on daily.
The hired support staff “allows Joshua to be in the community every single day, supports him at his volunteer job and allows him to be a good community member, to have friends and go to the movies,” Mark said. It “keeps him out of an institution.”
Erenmark is among thousands of Southern California’s disabled residents who rely on public insurance — Medi-Cal — for care. Now, with President Donald Trump’s signature tax legislation slashing social safety net programs like Medicaid and food stamps, their health is at risk. Many cuts in the bill are expected to hit the hardest for existing patients. including disabled people, under Medicaid, disability advocates said.
Officials said the Republican-backed new tax spending bill — dubbed the “One Big Beautiful Bill Act,” signed into law on July 4 — aims to fulfill much of Trump’s domestic policy agenda, including cutting taxes and increasing spending for border security.
The law will gut Medicaid funding by nearly $1 trillion over the next several years, which White House officials called an attempt to “eliminate waste, fraud, and abuse” in the U.S.’s largest public insurance program. But it would also leave more than 10 million Americans without insurance, the nonpartisan Congressional Budget Office estimated.
Joan Chang, an attorney at Orange County-based Community Legal Aid SoCal, called the bill’s massive cut to Medicaid “unprecedented,” and the largest in the history of the public insurance program launched 60 years ago as a health care safety net for millions of lower-income Americans.
For residents with physical or developmental disabilities, Chang said, the breadth of these “devastating” impacts — and how long it would take for them to be felt — is still up in the air. The tax bill could affect funding for in-home supportive services, adult care centers and other community-based programs, she said, but these programs could be greatly reduced — increasing waitlists for services — or cut entirely in the future.
“Because these programs are labeled ‘optional’ (for coverage) they are technically on the chopping block,” Chang said. “This may cause a potentially devastating impact on those residents living with disabilities who heavily rely on these day-to-day services.”
In a June post dispelling misconceptions of the “Big Beautiful Bill,” White House officials said the new law “protects and strengthens Medicaid for those who rely on it,” including pregnant women, children, seniors, people with disabilities and low-income families, while delivering “the largest middle-and working-class tax cut in U.S. history.”
“The president’s legislation will put more than $10,000 a year back in the pockets of typical hardworking families,” officials said. “This is the most pro-growth, pro-worker, pro-family legislation ever crafted.”
White House spokesperson Kush Desai said Tuesday that the bill will “protect and preserve Medicaid for the Americans who the program was meant to serve as a lifeline for” by “phasing out financing gimmicks” that states use to force the federal government to pay several times Medicare rates.
The bill, Desai added, would not jeopardize home- and community-based services for disabled people.
Disability advocates and health care professionals warn these cuts will cause long-term harm to the community.
Judy Mark, Erenmark’s mother, is also the co-founder and president of Disability Voices United, an L.A.-based nonprofit providing resources to disabled families navigating the healthcare system, and other aspects of living with a disability. She called the spending cuts law an “assault.”
“People with disabilities tend to use health care significantly more than people who are able-bodied,” she said. “Disabled people are terrified right now. People think they’re going to die, because their lives depend on the support they have… every single person will be impacted, whether you have a disability or not.”
It’s a somber reality, advocates say, as the law was signed during Disability Pride Month, which normally celebrates and brings awareness to physical and developmental disabilities — and on the 35th anniversary year of the Americans with Disabilities Act (ADA), which in 1990 opened up opportunities in employment, transportation and health, among other areas, for disabled people.
Many health care workers and disability advocates, like Mark, worry the bill will add “more red tape” for people to obtain or keep health insurance; such as strict work requirements and other barriers. Mark expressed concern about ways the disabled community, she feels, is being targeted amid the Trump administration’s moves — including the withdrawal of some ADA Title III sections from the U.S. Department of Justice, which advocates say protect equal access.
Before, states were required to retroactively provide Medicaid insurance for the three months before an enrollee’s application date. As a way of shifting costs, the tax bill will reduce the requirement to two months, come 2027, and impose work requirements on those receiving aid.
Attorney Chang said these moves would have a “huge financial impact” for those who might incur large medical bills to pay for disability support.
Some exemptions exist for disabled people, including those considered to be “medically frail,” those with physical or developmental disabilities that greatly impair their ability to perform daily activities. But some states could define these exemptions differently, Chang said, while people who may be eligible could face “administrative burdens” — making it easier for them to be cut off from Medicaid coverage entirely.
“We’re not sure how that’s going to be implemented in California,” Chang said. “It could cause more paperwork and potentially barriers for even those who are disabled to ‘prove’ their disability.”
Rep. Young Kim, R-Anaheim Hills, voted in favor of the spending bill. She said in a recent op-ed that it “protects and strengthens Medicaid services for the most vulnerable American citizens who really need it,” including people with disabilities. It also gives states the option to expand home and community-based services, she said.
“The legislation implements common sense accountability measures,” she wrote. “For example, if you’re an able-bodied adult between the ages of 19 and 64 currently on Medicaid, you simply must prove you’re working, volunteering or learning at least 20 hours each week. This means that an able-bodied adult must apply themselves for 20 hours a week, or for four hours per day, five days a week. Elderly individuals aged 65 and older and able-bodied adults caring for disabled individuals or dependents under 13 years of age are exempt from these work requirements.”
The Inland Regional Center, a nonprofit serving those with developmental disabilities across Riverside and San Bernardino counties, said its clients fear the loss of critical services with the spending cuts.
There’s been “a lot of confusion” since Trump’s bill was passed, said CJ Cook, IRC program director. “These changes could jeopardize access to essential supports — especially for those from low-income, underserved backgrounds. These services are not ‘extras;’ they are critical supports that allow individuals with developmental disabilities to live with dignity, independence and safety in the community.”
Soon after the “One Big Beautiful Bill” cleared the House of Representatives on July 3, Disability Rights California organizers called on the state legislature and Gov. Gavin Newsom to “ensure that any changes California makes in response to the devastating cuts” will include consultations with those “most directly impacted, especially Californians who are disabled, older and from immigrant communities.”
A spokesperson for Newsom, who has criticized the spending cuts, did not respond to specific questions about future impacts to disabled people, instead directing them to the state’s health department. In an earlier statement, the governor called Trump’s bill a “big, beautiful betrayal.”
Huntington Beach resident Claire Raymond has Spina Bifida, a condition that affects the spine and can cause physical and neurological issues. She called the bill “deadly,” and worries about the future of Medi-Cal to pay for her treatments. In order to walk or sit, the 27-year-old requires an intrathecal pain pump in her abdomen, which delivers medicine to her spinal cord.
Without insurance, Raymond said, she and her family wouldn’t be able to afford the $8,000 a month medication that allows her mobility — and without the “life-saving” medicine, she’d be bed-bound.
“This medicine has been my ticket to living a more independent life,” Raymond said. “It’s non-narcotic, so I’m able to drive, I’m a student, I’m a community leader. It’s given me my life back.”
Staff writers Kaitlyn Schallhorn and Allyson Vergara contributed to this report.