A series of changes at both the state and federal levels is putting Medicaid home- and community-based services at risk. These services have allowed millions of disabled and older Americans to live independently in their homes or communities, rather than in nursing homes or other institutional settings. President Donald Trump's proposed budget, often referred to as his "big, beautiful bill," aims to reduce federal spending on Medicaid by nearly $1 trillion over the next decade. This has raised concerns about the future of critical support programs for vulnerable populations. Conservative officials and activists have increasingly criticized home care services, labeling them as wasteful and prone to fraud. These criticisms have influenced policy decisions at both the state and federal levels. Meanwhile, the Justice Department has moved away from enforcing a key interpretation of a landmark Supreme Court ruling that previously protected the right of disabled individuals to receive care in their own communities. The Trump administration has denied accusations that it is targeting disability programs, insisting that its focus on reducing waste and fraud will ultimately protect Medicaid for those who need it most. Although the largest federal budget cuts are not expected to take effect until next year, the system is already showing signs of strain. In some states, officials have reduced wages or limited the hours of paid family caregivers. Fraud investigations have disrupted care for families who claim they were not involved in any wrongdoing. Additionally, some disabled individuals have experienced reductions in their caregiving services due to new algorithmic assessments used to determine eligibility. For families who rely on these programs, the changes represent a significant threat. Many fear that the modifications could weaken a system that has, over generations, helped disabled and older Americans live independently outside of institutions. The uncertainty surrounding these changes has created anxiety for those who depend on Medicaid services, as they worry about the stability and future of the support they rely on.