The Bill That Could Reshape Disability Services
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CareCade helps DDA and HCBS providers manage scheduling, EVV, and billing in one platform.
In May 2025, the U.S. House of Representatives passed the "One Big Beautiful Bill Act"—a sweeping reconciliation package that includes approximately $1 trillion in Medicaid cuts over 10 years. As of January 2026, the Senate is considering its own version, and the final impact on home and community-based services (HCBS) remains uncertain but potentially severe.
For developmental disabilities community services (DDCS) agencies in Washington and across the country, this isn't a distant policy debate. It's a direct threat to the funding that sustains your operations and your clients' care.
What's in the Bill
The Medicaid Cuts
According to the Congressional Budget Office and analysis from the Center on Budget and Policy Priorities, the House-passed bill includes:
- $625–$715 billion in direct Medicaid spending reductions over a decade
- Continuous eligibility verification shortened from 12 months to every 6 months for most populations
- Work requirements for Medicaid recipients aged 19–64 who aren't pregnant, disabled, or caring for dependents
- Documentation requirements for citizenship and identity verification
- Site-neutral payment policies reducing payments for hospital outpatient services
HCBS at Risk
Home and community-based services are classified as optional under federal Medicaid law. Unlike nursing facility care, which states must cover, HCBS waivers are state choices—meaning they're vulnerable when budgets tighten.
The bill's mechanisms for cutting Medicaid spending create several risks for HCBS:
- Reduced federal matching rates could make HCBS programs more expensive for states
- Eligibility churn from 6-month redeterminations could interrupt services for people with disabilities
- Administrative burden increases could strain already-stretched state agencies
- Per capita caps or block grants (still being debated) could fundamentally limit HCBS funding
What 6-Month Redeterminations Mean
This change alone could be devastating for people with developmental disabilities.
The Current System
Most states redetermine Medicaid eligibility annually (every 12 months). For people with permanent disabilities, many states use longer periods or simplified renewals because their circumstances rarely change.
The Proposed Change
Under the bill, most Medicaid recipients would need to verify eligibility every 6 months. While individuals receiving SSI-based Medicaid may be partially exempt, the details remain unclear for many disability populations.
The Impact
Research from the Medicaid and CHIP Payment and Access Commission (MACPAC) shows that more frequent redeterminations lead to:
- Procedural disenrollments: People lose coverage not because they're ineligible, but because paperwork gets lost or deadlines are missed
- Service gaps: Even temporary disenrollment means disrupted care, lost caregiver relationships, and health risks
- Provider instability: Agencies can't plan staffing when client rosters fluctuate unpredictably
- Administrative costs: States spend more on processing, which reduces funds available for actual services
For a DDCS agency with 150 clients, even a 5% procedural disenrollment rate every six months means potentially losing and re-enrolling 15 clients per year—each time requiring new authorizations, care plan updates, and caregiver scheduling disruptions.
Impact on Washington State
Washington has been one of the strongest states for HCBS investment, but it's not immune to federal changes.
The Numbers
According to Governor Ferguson's analysis:
- Washington faces $2–3 billion in Medicaid cuts over four years from federal changes
- Over 620,000 Washingtonians could be affected by work requirements and eligibility changes
- More than 105,000 people depend on Medicaid for long-term care services
- Medicaid covers 3 in 8 Washingtonians with disabilities
Washington's Response
The state has signaled it will fight to protect coverage:
- Governor Ferguson called the cuts "devastating" and opposed work requirements
- The 2026 legislative session includes budget proposals to mitigate federal impacts
- DSHS is preparing contingency plans for eligibility processing changes
But state budgets can't fully replace federal funding reductions.
What This Means for Your Agency
Revenue Uncertainty
If clients lose Medicaid eligibility—even temporarily—your revenue is affected:
- No authorization = no billing: You can't bill for services during coverage gaps
- Retroactive coverage doesn't always apply, leaving gaps
- Staff idle time: Caregivers assigned to disenrolled clients can't be billed
Documentation Pressure
When eligibility is being questioned more frequently, your documentation becomes your revenue protection:
- Service delivery proof: Did the visit happen? GPS and time verification prove it
- Medical necessity: Are your services documented as necessary? Care plans must be current
- Claims accuracy: Is every unit billed correctly? Errors invite deeper scrutiny
Compliance Expectations
Federal budget pressure historically leads to increased fraud, waste, and abuse enforcement:
- More audits of HCBS providers
- Stricter EVV enforcement
- Closer review of billing patterns
- Investigation of outlier claims
What Smart Agencies Should Do Now
1. Audit Your Documentation
Every claim you submit should be defensible:
- GPS-verified visit records with timestamps
- Service notes documenting activities and client engagement
- Incident reports filed promptly and completely
- Care plans updated at required intervals
2. Monitor Client Eligibility Proactively
Don't wait for a denial to discover a client lost coverage:
- Track redetermination dates for each client
- Communicate with families about required paperwork
- Build relationships with case managers who can flag issues early
- Have a plan for temporary coverage gaps
3. Strengthen EVV Compliance
Electronic visit verification is your first line of defense against billing disputes:
- Ensure every visit has GPS verification
- Match clock-in/clock-out times to billed units
- Verify caregiver identity at each visit
- Resolve EVV discrepancies immediately, not at billing time
4. Diversify Where Possible
Agencies overly dependent on a single funding source are most vulnerable:
- Explore private-pay client relationships
- Consider additional waiver programs (Community First Choice, PERS)
- Look into emerging funding sources like the WA Cares Fund
- Build referral relationships with multiple case management entities
5. Engage in Advocacy
Your voice matters in the legislative process:
- Contact your U.S. senators about the bill's HCBS impact
- Share real stories about what service cuts mean for families
- Participate in provider association advocacy efforts
- Help families understand how to contact their representatives
How CareCade Protects Your Revenue
When federal funding faces cuts, agencies need every dollar they're entitled to. CareCade is built to ensure you capture and protect revenue through verified, compliant documentation.
Claims-Ready Documentation
Every visit in CareCade generates audit-proof records:
- GPS verification: Timestamped location proof that services occurred at the client's home
- Face verification: Confirm the right caregiver provided the service
- Accurate time capture: One-tap clock-in and clock-out eliminates manual time entry errors
- Activity documentation: AI-assisted session notes capture what happened during each visit
EVV That Prevents Denials
With enforcement increasing, CareCade's EVV system ensures compliance:
- Real-time verification at the point of service, not after the fact
- Automatic discrepancy alerts before you submit claims
- DSHS-ready exports formatted for Washington's reporting requirements
- Hard edit prevention: Catch issues that would trigger claim rejections
Authorization Tracking
When client eligibility fluctuates, knowing your authorization status is critical:
- Real-time unit dashboards per client and service type
- Automatic alerts when units are running low
- Service type validation ensures you're billing authorized codes
- Historical reporting for audit responses
Operational Efficiency
Doing more with less isn't optional when funding tightens:
- AI session notes: Cut documentation time from 15 minutes to 2 minutes per visit
- Smart scheduling: Minimize drive time, maximize billable hours
- Digital onboarding: Get new caregivers working faster when you need to pivot
- Mobile-first tools: No office overhead required
What Happens Next
The Senate is expected to take up its version of the reconciliation bill in early-to-mid 2026. Key dates to watch:
- Senate committee markups: Expected Q1–Q2 2026
- Conference committee: Where House and Senate versions are reconciled
- Implementation timelines: Most changes would take effect 6–18 months after signing
The final bill may look different from the House version. Some provisions may be softened, others may be strengthened. But the direction is clear: Medicaid will face pressure, and HCBS providers need to be prepared.
Stay informed. Document everything. Protect your revenue. Advocate for your clients.