Disability advocates are decrying a Trump administration plan to alter Medicaid that they say could ultimately compromise services that people with disabilities rely on.

The Centers for Medicare and Medicaid Services released a proposal late last week giving states the option to accept fixed payments from the federal government to cover some Medicaid expenses. In exchange, states would gain more control over the parameters of their programs.

Traditionally, the federal government has provided states with unlimited matching funds to help pay for Medicaid. Accordingly, payments to states have gone up and down to account for changes in program enrollment and expenses. If states pursue the new option, that would change, leaving them to weather more of the ups and downs on their own.

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As proposed, the plan would only apply to a portion of the Medicaid program affecting adult beneficiaries under age 65 who aren’t eligible due to a disability or their need for long-term care. The change would not pertain to home and community-based services for people with developmental disabilities.

Federal Medicaid officials said that people with disabilities would only be affected by the “improvements that result from states reinvesting savings to improve and sustain Medicaid for everyone.”

However, disability advocates say that by allowing states to accept set payments for any portion of the Medicaid program, the Trump administration is opening the door to future changes and threatening the financial stability of the program as a whole.

“It is very clear that this is another attempt by the administration to cut and cap Medicaid,” said Kim Musheno, vice president of public policy at the Autism Society of America. “While this proposal is limited to the Affordable Care Act Medicaid expansion program, we worry that this proposal lays the groundwork for further cutbacks like those proposed in the president’s previous budget plans and previous congressional proposals that were defeated in Congress.”

Republicans have long sought to convert Medicaid to a block grant program — where states would receive lump sum federal payments each year for all their beneficiaries — or a per capita cap system where the federal government would provide a fixed amount for each beneficiary no matter the true cost of their care.

Advocates say the current plan is a first step toward achieving that goal.

“This decision is a blow to the entire disability community,” said Julie Ward, senior executive officer for public policy at The Arc. “It also begs the question — once they block grant one part of the program, what’s stopping them from moving on to the home and community-based services that make independence and community possible for people with intellectual and developmental disabilities?”

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the optional demonstration program dubbed “Healthy Adult Opportunity” will offer states flexibility and cost savings while maintaining important protections for beneficiaries.

“This opportunity is designed to promote the program’s objectives while furthering its sustainability for current and future beneficiaries, and achieving better health outcomes by increasing the accountability for delivering results,” Verma said.

Disability advocates said they expect to see the proposal challenged in court.

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