Federal cuts championed by President Donald Trump and congressional Republicans are endangering caregiving programs across the country, leaving states scrambling to support caregivers who could lose their jobs as well as the older individuals, people with disabilities, children and others who rely on their services, according to a new report from the Century Foundation.
The progressive think tank published its findings at the end of July in a report titled, “Care Matters: A 2026 Report Card on Care Affordability and Access.”
“Investments in care address needs across the lifespan, enabling people to live, learn, age, and work with dignity,” the report states. “Yet, the majority in Congress and the current administration have cut funding for vital care programs and pursued a sweeping deregulatory agenda that strips away hard-won policies that value care while also using unfounded attacks on program integrity to justify further disinvestment.”
Cuts in funding for Medicaid, Medicare, the Affordable Care Act, and the Supplemental Nutrition Assistance Program, or SNAP, were contained in the budget bill Trump signed into law in 2025. They are expected to cause long-lasting damage to the country’s caregiving infrastructure. As a result of the cuts, already vulnerable populations, such as older individuals and young children, will be left without the support they need, according to the foundation’s report.
For example, Medicaid is the primary source of funding for home- and community-based services, or HCBS, which allow people with disabilities and older individuals to receive care services at home rather than in an institution or nursing facility. Following Republicans’ nearly $1 trillion cut to Medicaid, several states have begun considering cuts to their HCBS programs, while others already have begun paring back their services.
In addition to the cuts in the budget law, the administration has weakened and repealed policies that reduced the cost of childcare, protected wages for homecare workers, and improved nursing home staffing requirements, the Century Foundation wrote.
Aging and disability care
About 8.4 million people receive Medicaid-funded home or community services annually, according to an analysis from the Bipartisan Policy Center. Through those services, people with disabilities and older adults receive help with dressing, cooking and other daily activities.
There have long been challenges for individuals seeking to access this kind of care — hundreds of thousands of people are on Medicaid waiting lists for them — and that limited availability is now exacerbated by Republicans’ cuts to funding for healthcare, the Century Foundation said.
Since Trump signed the One Big Beautiful Bill Act into law in July 2025, nearly 30 states have proposed or enacted cuts to their home and community care programs, according to an HCBS impact tracker from George Washington University’s Milken Institute School of Public Health.
Childcare and early learning
Childcare workers were already struggling prior to the Republicans’ cuts, having long been paid low wages and often receiving no benefits through their jobs. These workers often rely on government programs like SNAP and Medicaid in order to afford food and healthcare, even when they’re employed full time, notes the Center for the Study of Child Care Employment at the University of California, Berkeley. They are likely to suffer substantial financial harm from the federal cuts to these programs, the Century Foundation report said.
Fair working conditions
On average, care workers earn far less than the national median income. In 2025, for example, according to the U.S. Bureau of Labor Statistics, childcare workers made an average of $16.82 per hour, while the national median hourly wage was $24.51. Home health and personal care aides earned an average of $17.21 an hour in 2025. Those aides are often referred to as direct care workers, and they work with people with developmental and physical disabilities.
Care workers now potentially face losing their employment as well because in many instances the jobs they hold are funded by Medicaid.
