Medicaid Provider Cuts Could Impact Disability Services Nationwide: What Raleigh Residents Should Know

A recent report from Disability Scoop highlights growing concerns about Medicaid access and disability services after one state temporarily cut ties with thousands of Medicaid providers in an effort to comply with new federal funding requirements. The move is raising alarms among disability advocates and healthcare providers across the country who fear similar actions could affect access to critical services for people with disabilities. (Disability Scoop⁠)

What Happened?

According to Disability Scoop, state officials reviewing Medicaid providers terminated or suspended relationships with nearly two-thirds of the providers under review while attempting to meet federal oversight and funding requirements. The action was described as temporary, but it immediately created uncertainty for providers and the individuals who depend on their services. (LinkedIn⁠)

The situation comes as states nationwide face increasing pressure to comply with evolving Medicaid regulations while maintaining access to federal funding. Medicaid remains the primary source of funding for many disability support programs, including home and community-based services, personal care assistance, transportation, and healthcare coordination. (KFF⁠)

Why Disability Advocates Are Concerned

Advocates worry that aggressive provider reviews, funding reductions, and administrative changes could reduce access to services for people with intellectual, developmental, and physical disabilities. Even temporary disruptions can create major challenges for individuals who rely on consistent support services to live independently and participate in their communities. (Disability Belongs™⁠)

Many disability organizations have already expressed concerns about broader Medicaid policy changes scheduled to take effect over the next several years. Experts warn that states facing budget pressures may struggle to maintain provider networks, especially for home and community-based services that help individuals avoid institutional care. (KFF⁠)

What This Could Mean for North Carolina

While the Disability Scoop report focuses on actions taken in another state, the issue has relevance for North Carolina residents. Medicaid is a critical lifeline for thousands of North Carolinians with disabilities, seniors, and low-income families.

If provider participation decreases or administrative requirements become more burdensome, residents could experience:

• Longer wait times for services
• Reduced provider availability
• Challenges accessing specialty care
• Increased strain on caregivers and families
• Delays in home and community-based support programs

North Carolina has expanded Medicaid in recent years, increasing access to healthcare coverage for many residents. However, disability advocates continue to monitor federal and state policy changes that could affect long-term service delivery and funding stability. (KFF⁠)

The Bigger Picture

The Medicaid debate is increasingly focused on balancing fiscal accountability with access to care. Supporters of stricter oversight argue that states must ensure providers meet program requirements and prevent waste, fraud, and abuse. Critics counter that broad provider removals and funding restrictions can unintentionally harm vulnerable populations who depend on Medicaid-funded services every day. (KFF⁠)

For people with disabilities, Medicaid is more than health insurance. It often funds the support systems that allow individuals to work, attend school, live independently, and remain connected to their communities. Any disruption in provider networks can have significant consequences for quality of life and independence. (Disability Belongs™⁠)

What Raleigh Residents Should Watch

As federal Medicaid policies continue to evolve, disability advocates, healthcare providers, and community organizations will be watching closely for any changes that could affect service access in North Carolina.

Residents who rely on Medicaid services should stay informed about policy updates, provider network changes, and public comment opportunities that may affect disability services and healthcare access in the years ahead.

For more Raleigh news, community updates, and issues impacting local residents, follow DoRaleigh.com.

Advertise With Us: Interested in Advertising click here.

Connect With Us: Instagram | Facebook | BSky | Linkedin

Share With Us: Post your community News, Events, on our Submissions Page. 

Published by Bryan Tomlinson | DoRaleigh.com

Anyone Can Be Your NDIS Support Worker. Who Is Keeping You Safe?

Reflections from several years on the scheme.

I have been on the NDIS for several years. A recent re-hiring process clarified something I had long suspected. The scheme has a workforce problem, and participants are the ones bearing the brunt.

There Is No Mandatory Registration Requirement

Under current Australian law, participants who self-manage or plan-manage their NDIS funding can hire any person as a support worker. Independent support Workers require no registration or minimum training standards.

The worker who enters your home, learns your medical history, handles your medications, and has significant authority over your daily life may have no formal preparation for any of it.

The NDIS Quality and Safeguards Commission exists and handles serious complaints, including abuse, neglect, and criminal conduct. Boundary violations, confidentiality breaches, and chronic unpreparedness that fall below that threshold leave participants largely without recourse. Skilled and ethical workers bring those qualities from their own formation and prior training. When those qualities are absent, the participant discovers this after the fact, and any remedy is slow, uncertain, and theirs alone to pursue.

That is the baseline. Everything that follows is built on it.

The Dog

My service dog performs specific medical functions. His effectiveness depends on remaining focused and oriented to me.

Some workers reach for him the moment they walk through the door. They do not ask.

Touching a service animal without permission is a safety violation and, in some contexts, carries legal weight under Australian disability discrimination law. A worker entering the home of a participant with a service animal has a professional obligation to understand what that animal does and what it requires. That preparation belongs to the provider. Its absence transfers the risk to the participant.

This is a professional standard.

What the Certificate III Does Not Cover

The Certificate III in Individual Support is the standard qualification in this sector and takes between six and twelve months. For many workers, it is completed online with minimal supervised practice hours, and it does not prepare them for the clinical and ethical complexity of supporting people with invisible or fluctuating conditions.

A worker with their cert may have no framework for how fatigue functions in ME/CFS or autistic burnout. Why pushing through is sometimes dangerous, why capacity varies day to day in ways that cannot be read from a plan approved six months ago, and why the participant’s account of their own condition is the primary source of accurate information.

Workers who arrive without that preparation fill the gap with assumptions. Correcting those assumptions, educating the person sent to support them, translating their own experience into terms the worker finds legible — this falls to the participant. That work is skilled and exhausting, and no NDIS plan funds it.

A Plan Is Not a Person

An NDIS plan records approved supports, written at a point in time by a planner who may have spent an hour with the participant. What it cannot capture is what a Tuesday looks like after a bad night, or how that changes what Wednesday can hold.

Workers who treat the plan as a complete picture end up supporting the document. When the participant’s actual day diverges from what the plan implies, some workers become confused, inflexible, or subtly sceptical. The participant then carries that response throughout the day.

Confidentiality Is Not Discretionary

Support workers enter your home and learn about your health, medications, finances, and relationships. The ethical obligations around that information are clear. Workers routinely underestimate them.

Information moves in cars and waiting rooms, in casual exchanges during handover. Shared without consent in contexts the participant did not choose, each instance is a breach — and the pattern across a working relationship represents a significant, under-reported ethical problem in the sector.

Providers who do not train explicitly for this are not taking their duty of care seriously. The Commission’s framework addresses the most serious breaches. Below that threshold, the everyday end goes largely unmonitored.

A Diagnosis Is a Starting Point

Workers who arrive having already decided how a participant communicates — based on a diagnostic label rather than a conversation — are making a category error with professional consequences.

Autism produces significant variation across individuals, as do acquired brain injury, cerebral palsy, and many mental health conditions. Experience with one person transfers little to the next. The participant is the authority on their own communication and needs. Workers who approach that through the filter of what they already think they know require the participant to work harder to be accurately seen.

Being Present Is the Job

A worker on their phone during support hours has decided where their attention belongs. That decision reflects on the worker and the provider, and on a regulatory environment that permits it without consequence.

Participant time is funded. Divided attention during that time is a failure of basic professional conduct.

Punctuality Has Clinical Stakes

For participants with fatigue conditions, medication schedules, or appointment windows that cannot flex, a late worker is sometimes no worker at all. The window closes, an appointment is missed, and the energy available at nine o’clock is gone by ten.

Workers who treat punctuality as a matter of general courtesy have not been told what the costs of late arrival are in this context. Providers should tell them, in writing, before they begin.

Handover Exists for a Reason

When workers do not read handover notes, participants repeat themselves. Questions get asked that the notes had already answered. Avoidable errors get made. The first portion of support time becomes unpaid orientation, delivered by the person the support was supposed to serve.

Reading the handover is the floor — it signals that a worker understands preparation begins before they arrive.

The Re-Hiring Process

When a support worker leaves, the participant does not simply wait for a replacement. A position description must be written, applications reviewed, interviews conducted, and a hiring decision made with incomplete information about a person who will have access to their home, their medical records, and significant portions of their daily life.

After that comes orientation, and the contextual knowledge that made the previous support functional has to be rebuilt from the beginning.

None of this is funded. The NDIS has no category for the labour of maintaining access to support, and for participants with high support needs or complex conditions, that labour is substantial.

What Competent Support Looks Like

Workers who are good at this job arrive having read the available documentation, ask before they act, and give more weight to what the participant tells them about their own needs than to any plan or file. When something changes during a shift, the response is immediate and adaptive.

Their presence does not generate additional work for the participant — that is the measure. Support that requires the participant to manage, educate, or compensate for a worker’s preparation gaps has redistributed the load rather than reduced it.

What Needs to Change

Mandatory registration for all NDIS workers, regardless of how a participant’s plan is managed, would create a baseline of accountability. Genuine consequences for ethical breaches — including low-level, chronic ones — would change the conditions under which workers operate.

Revised training requirements are long overdue: supervised hours in complex support settings, explicit coverage of invisible conditions, service animal protocols, confidentiality obligations, and fluctuating capacity. These are the preparations the role demands.

Wages need to rise. Turnover in this sector is directly linked to pay, and the continuity of support is a safety condition for many participants — the relationship carries clinical knowledge that cannot be quickly or cheaply reconstructed.

Participants also need a complaints mechanism they can use without fear of losing their support. Accountability cannot depend on participants absorbing the risk of speaking up.

The Principle and the Practice

Participant choice and control sit at the centre of the NDIS. On paper, participants are experts in their own lives and directors of their own support.

That principle requires a workforce framework capable of supporting it. At present, workers enter participants’ lives with significant authority over their access, safety, and daily functioning, operating under training requirements and accountability mechanisms that do not match the weight of what they are being asked to do.

Positioned at the centre of a scheme designed around their needs, the participant often ends up holding the system together when it fails to hold itself together.

That is worth saying clearly, and worth changing.

Share this with someone who trains support workers, manages a disability provider, or influences workforce policy. The problem is documented. The changes required are known. What is missing is the will to treat this workforce and the people it serves with the seriousness they both deserve. #NDIS #DisabilityRights #DisabilitySupport #SupportWorkers #DisabledPeople #DisabilityAdvocacy #Accessibility #AusPol #Australia

Sharing another pic I made in Canva 💚

MUTUAL AID:

And if you know anyone who could help to provide Anna safe accommodation or have another idea how to solve her situation, so she can finally be free from domestic abuse or you are able to do some voluntary work connecting her with support services, message me/write in comment.

TW: domestic violence
https://chuffed.org/project/161937-help-anna-escape - donate
https://www.thecanary.co/global/world-analysis/2025/04/01/anna-severe-me-cfs/ - story

#accommodation #transport #disabilityadvocacy needed

#saveanna #melbourne

From @onelife_livedwell on IG: COVID floats in air the way a jellyfish floats in water. It’s airborne, which means the primary route of infection is inhalation of virus laden aerosol particles small enough that they can stay suspended for hours.
#covidisairborne #cleanair #healthscience #disabilityadvocacy #scicomm

1/

✨ NEW: Disability Bulletin Issue 1

Your source for disability rights news, policy updates, and community resources.

📖 Issue 1: Now available
📖 Issue 2: Coming soon

Stay ahead of the issues that matter to YOU.

Read now: https://t.co/7vtI7QecTg

#DisabilityAdvocacy #DisabilityCommunity #StayInformed

Hola Titánicos, cada 28 de febrero se celebra el día mundial de las enfermedades raras, este año bajo el lema: "Porque cada pERsona importa", poniendo el foco en quienes hay detrás de cada diagnóstico, cada tratamiento y cada investigación: las personas y sus familias.

https://somosdisca.es/dia-mundial-de-las-enfermedades-raras-2026/

#Diamundialdelasenfermedadesraras #diadelasenfermedadesrara #cebras #enfermedadesminoritarias #enfermedades
#salud #enfermedad #saludmental #enfermedadrara #enfermedadesraras #discapacidad #disabilities #DisabilityAccess #disabilityAdvocacy #disability #titanicos #visibilidad #titan #prevencion #cuidados #somosdisca #gentetitanica #investigación #diagnostico #cura #tratamiento #feder #somosgentetitanica

I just contacted my legislators about the Medical Foods and Formulas Access Act.

I use prescribed oral medical nutrition specifically to prevent needing a feeding tube. Right now the system will often cover the tube and hospital care but not the treatment that helps avoid it in the first place.

For many disabled and chronically ill patients this is the difference between staying stable and medical decline, especially for people on Medicaid or fixed incomes.

If you are in the US and this applies to you, the Rare Disease Action Network has a quick form you can use to contact your representatives.

https://rarediseases.quorum.us/campaign/154665

#MedicalFoods #RareDisease #DisabilityAdvocacy #HealthcareAccess #ChronicIllness #Medicaid #PatientAdvocacy