Republicans Want Disabled People To Die

---

In Washington, 34 people were on the state’s disability waiver request waiting list in 2023. In Texas, 175,193 people sat on Medicaid waiver interest lists at the end of 2024, some for 15 years.

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 These numbers are the result of Republican policies: cutting Medicaid, underfunding front-line workers, and defending outdated institutions instead of community living.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]

Washington had 34 people on its official waiver request list in 2023. Texas had 175,193 unduplicated people on waiver interest lists as of late 2024.

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]

People with IDD wait longer when states do less up front. In 2023, average wait for IDD in states that do not screen for waiver eligibility before adding people to lists was 61 months. In states that do screen, the average was 45 months. Front end policy choices matter.

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.

Christopher Armitage writes on law enforcement, public policy, and criminology. He recently published The New Blue: A Comprehensive Guide to Innovative Policing.

The New Blue: A Comprehensive Guide to Innovative Policing
The New Blue: A Comprehensive Guide to Innovative Policing [Armitage, Christopher] on Amazon.com. *FREE* shipping on…a.co

Works Cited

[1] KFF. A Look at Waiting Lists for Medicaid Home and Community-Based Services from 2016 to 2023. Nov. 2023. Key findings include ~692,000 people on waiting or interest lists in 2023, average waits of 36 months overall and 50 months for IDD, and 61 vs 45 month differences tied to screening policy. ([KFF][1])

[2] United Cerebral Palsy and ANCOR. Case for Inclusion 2019. State rankings show Arizona at number one and Mississippi at number fifty one, with Arkansas, Texas, Montana, and Oklahoma among the lowest performers.

[3] KFF. Status of State Medicaid Expansion Decisions. Updated May 2025. Map lists forty one expansion states plus DC, with ten holdouts. ([Texas Health and Human Services][2])

[4] Kansas Legislature. 2012 Session, Substitute for HB 2117, Bill History. Official page with roll calls. Senate final action 29–11 on March 21, 2012. House concurred 64–59 on May 9, 2012. Governor approved May 22, 2012.

[5] KCUR. Need Disability Help In Kansas? Thousands Wait An Average Of Seven Years. Oct. 11, 2016. Reports seven-year waits for IDD services after KanCare. ([Texas Health and Human Services][3])

[6] U.S. Department of Justice. Justice Department Secures Landmark Agreement with State of Iowa to End Unconstitutional Practices at Glenwood Resource Center. March 2022. Settlement terms and closure commitment. ([Office of Inspector General][4])

[7] U.S. Department of Justice. Complaint, United States v. State of Iowa, Glenwood Resource Center. Dec. 2020. Findings include dangerous experimentation and inadequate care. ([KFF][5])

[8] HHS Office of Inspector General. Group Homes, Joint Report and Model Practices. 2022. Federal reviews found critical incidents were not reported to law enforcement in up to 99 percent of sampled cases in some states, and set model practices. ([Texas Health and Human Services][6])

[9] New York State Justice Center. About the Agency. Oversight body that investigates abuse, operates a staff exclusion list, and coordinates across systems. ([Justice Center][7])

[10] Massachusetts General Laws. Chapter 19C, Disabled Persons Protection Commission. Statutory powers for an independent abuse commission. ([Massachusetts Legislature][8])

[11] Centers for Medicare & Medicaid Services. Ensuring Access to Medicaid Services Final Rule (CMS-2442-F), Fact Sheet. April 22, 2024. Requires states to ensure that 80 percent of payments for key home care services go to workers within six years. Requires public reporting on wait lists and access. ([Centers for Medicare & Medicaid Services][9])

[12] Washington State JLARC. Preliminary Report, Developmental Disabilities Administration: Managing the list of individuals waiting for services. Jan. 10, 2025. Shows decline in the waiver service request list from 1,411 in 2020 to 34 in 2023. ([Washington State Legislature][10])

[13] Texas Health and Human Services. House Committee on Human Services Hearing, March 2025, Member Handout. States 175,193 unduplicated individuals were on six waiver interest lists as of Dec. 31, 2024. ([Texas Health and Human Services][11])

[14] Texas Health and Human Services. Interest-List-Data-June-2025.xlsx and Waiver Caseload Summary, Interest List and Unduplicated Interest List. Current interest list counts as of June 30, 2025 and the monthly archive hub. ([Texas Health and Human Services][12])

[15] Texas Health and Human Services. State Supported Living Center Long-Range Planning Report 2024. Confirms operation of 13 SSLCs. ([Texas Health and Human Services][13])

[16] Houston Chronicle. Houston-area group homes for people with disabilities shutter as industry faces “crisis”. July 2025. Reports provider closures linked to rate and workforce pressures. ([The Arc of Texas][14])

[17] University of Minnesota, Institute on Community Integration, RISP. States That Have Closed All Public Residential Facilities for People With IDD as of June 30, 2024. Lists nineteen states closed.

[18] Oregon Health & Science University. Beyond Fairview, An Oregon Story of Supporting Inclusive Communities. 2018 timeline of Fairview’s closure and community transition. ([Texas Health Steps][15])

[19] Minnesota Governor’s Council on Developmental Disabilities. Closing the Doors of the Institution, Brandon Training School. 1993 document on Vermont’s closure. ([Texas Health and Human Services][16])

[20] The Texas Tribune. Special education caps were the Texas Legislature’s idea. Nov. 2017. Traces policy pressure behind the 8.5 percent cap. ([Texas Health and Human Services][17])

[21] U.S. Department of Education, Office of Special Education Programs. Results Driven Accountability, 2018 Texas. Monitoring documentation and findings that Texas violated IDEA related to special education identification and services.