Maze
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Republicans Want Disabled People To Die
In Washington, 34 Wait. In Texas, 175,193. Who Chose That?
Nationwide, nearly 700,000 Americans with intellectual or developmental disabilities are waiting for home and community-based services right now. These numbers are the result of Republican policies: cutting Medicaid, underfunding front-line workers, and defending outdated institutions instead of community living. The cost is measured in closed group homes, families pushed to collapse, and preventable deaths.
For those folks who are born with a developmental disability, where you live can be particularly impactful on your wellbeing. In Democrat run sU.S. states, services arrive more effectively, though they’re still far from perfect. In Republican run states, people wait for years as the state waits for you to die, so they can funnel more money to themselves.
The massive disparity in care is the result of laws, votes, and budgets that we can name and date. National data shows a deep split on core measures like wait times, community living, oversight, and worker pay. Since 2016, many Democrat run states have expanded coverage and funded community life. Republican states cut that coverage. People die because of that choice. \[1]\[2]
These waits track policy. States that expanded Medicaid and shifted attention into community support reported better access. States that refused expansion or kept money in old institutions report longer waits and repeated crises. That is what the national comparisons show. \[1]\[2]\[3]
“Best” and “worst” are not arbitrary labels, measurable results matter. In 2019, the Case for Inclusion ranked Arizona, Oregon, Vermont, Missouri, and Hawaii at the top. They placed people in community settings, kept wait lists low or near zero, and let families direct services. Mississippi ranked last. Arkansas, Texas, Montana, and Oklahoma were also at the bottom. They kept people waiting, held money in institutions, and underpaid the workforce, so approved services went unstaffed. They did a bad job, because Republicans are terrible at governance. \[2]
The human stakes are in the numbers each state posts. Texas is the largest example. As of December 31, 2024, Texas reported 175,193 people on its six Medicaid waiver interest waiting lists. By June 30, 2025, a Texas HHS spreadsheet showed 357,765 total entries across those lists. Interest lists are not the same as formal eligibility lists, but they show demand and delay at scale. Providers warn that low rates and vacancies are closing group homes in places like Houston right now. Families are scrambling when entire houses shut overnight. This isn’t bad luck, it’s bad management. \[13]\[14]\[16]
Washington State shows what a different set of choices can do. Its formal waiver service request list dropped from 1,411 people in 2020 to 34 in 2023, a 98 percent decline. The state did that by funding new waiver slots and managing intake. Washington still has thousands of eligible people with no paid services. Even so, the formal queue is almost gone. \[12]
The workforce crisis is just one of many problems. Direct support professionals help with eating, bathing, work, and safety. Turnover and vacancies spiked after COVID. Many providers closed programs or had to turn clients away. In May 2024, the federal government set a floor. The Biden Administration’s “Ensuring Access to Medicaid Services” rule requires states, within six years, to ensure that at least 80 percent of Medicaid payments for personal care, home health aide, and homemaker services go to the workers who do the work. The rule also requires public reporting on wait lists and access. Dollars must reach the front line, and the data must be public. \[11]
Federal watchdogs found that in some states up to 99 percent of critical incidents in group homes were not reported properly. That includes serious injury and likely crimes. The federal report set out fixes. Some states acted. Others did not. New York created a dedicated Justice Center to investigate abuse and maintain a staff exclusion list. Massachusetts has a stand‑alone abuse commission with powers in statute. These systems do not make abuse impossible. They do however make it easier to detect, stop. \[8]\[9]\[10]
When oversight fails terrible things happen. In Iowa, at the Glenwood Resource Center, federal investigators found dangerous experiments and poor medical care. Men with severe disabilities were used in sexual arousal studies without proper consent. The U.S. Department of Justice sued the state for violating residents’ constitutional rights. The state agreed to close the facility and accept oversight. This was 2019 through 2022. Not the 1970s. \[6]\[7]
Policy choices also shaped schools. For years, Texas held special education enrollment near 8.5 percent. In 2018, the U.S. Department of Education told Texas that this violated federal law. The cap denied services to children who needed them. Reporting traced the pressure back to Republican legislative cost cutting in 2004.\[20]\[21]
Medicaid expansion is the clearest fork in the road. As of May 2025, forty one states and DC had adopted expansion. Ten had not. The holdouts include Texas, Florida, Mississippi, Alabama, Georgia, Kansas, South Carolina, Tennessee, Wisconsin, and Wyoming. Expansion brings a 90 percent federal match for adults up to 138 percent of poverty. Expansion states leaned on those dollars to shore up home care and related services. Holdouts left money on the table over ideological, murderous Republican nihilism. \[3]
Fiscal choices can harden these gaps. In Kansas, Substitute for House Bill 2117 cut taxes and blew a hole in revenue. The State Senate passed it 29 to 11. The House later concurred 64 to 59. The Governor signed it on May 22, 2012. Medicaid was privatized as KanCare in 2013 with promises that wait lists would shrink. By 2016, families still reported waits of about seven years for IDD services, and officials said there was little money to cut the list. That is what austerity did in real lives.\[4]\[5]
If you want the moral bottom line, here it is. Budgets and votes are moral decisions, every single one of them. When lawmakers call themselves pro life or pro family, then vote to block expansion, freeze rates, or protect institutions at the expense of small homes, they are making a choice. People with IDD feel that choice in their bodies, their homes, and their safety. The fixes are not secrets. Shorten or end wait lists. Properly fund caregiving. Pay good workers enough to stay and fire workers who aren’t a good fit. Fund respite and family support. Create independent abuse watchdogs with real teeth. Track incidents. Fix what fails. Publish the data. The government is supposed to work for us, let’s try to get there.
