The Maryland budget deal was struck March 27. House Appropriations Chair Ben Barnes called the differences between House and Senate versions "minor." The conference committee met March 28 to iron out remaining details. Both chambers include the $126 million state cut to the Developmental Disabilities Administration (DDA). When federal Medicaid matching dollars are counted, the total loss exceeds $250 million. The budget moves to final legislative votes early next week.

The advocacy window is closed. This article covers what DDA waiver families should do now.

What the DDA Is and Who Uses It

The Developmental Disabilities Administration runs Maryland's Medicaid waiver programs for people with intellectual and developmental disabilities. In fiscal 2025, 19,100 Marylanders received services through DDA waivers: personal care, residential support, day programs, job coaching, and respite care.

Waivers aren't entitlements. States control enrollment and funding. Maryland has faced chronic waitlists, with thousands waiting years for services. The new cuts reduce what's available to those already enrolled.

This is the second consecutive year of cuts. Last year, the DDA absorbed $164 million in reductions. Each year's baseline is lower.

What Gets Cut and Who It Hits Hardest

The Senate rejected Governor Wes Moore's proposed $500,000 annual cap on person-centered plan budgets. That cap would've forced people with the highest medical and support needs out of community-based care, but advocates killed it in committee.

What stayed: payment rate cuts of 2 percent or more across most services. Self-directed care programs are hit hardest. Caregiver wages under self-directed programs will drop from roughly $37 per hour to roughly $23 per hour. That's nearly 40 percent. That's a resignation letter. If you hire through self-directed care, assume your caregiver is already job-hunting.

Provider agencies face the same cuts. Some will reduce available slots. Others will exit the DDA system entirely. The Medicaid provider network is already shrinking statewide as reimbursement rates fail to keep pace with operating costs.

Self-directed care enrollment surged from 1,618 families in 2021 to 3,632 in 2024. The program outpaced funding. The cuts are the correction.

The $40 Million Current-Year Deficiency

The DDA also faces a $40 million deficiency in the current fiscal year (FY 2026). The agency has spent more than budgeted for two consecutive years. That shortfall will be funded in the conference committee deal, but how it's covered affects what's available going forward.

This deficiency is why the state is at risk of losing federal funding entirely if program costs exceed 18 percent above the institutionalization cost baseline. Maryland's average institutionalization cost is $217,000 per year. The federal waiver structure requires states to demonstrate cost neutrality against that baseline. The DDA exceeded it.

What to Ask Your Service Coordinator This Week

If you receive DDA waiver services now, your service coordinator should contact you about changes. If you haven't heard from them by mid-April, call them. Ask these questions:

• Will my services be reduced?
• Will my provider's reimbursement rate change, and by how much?
• If I hire my own caregiver through self-directed care, what's the new wage ceiling?
• What happens if my provider stops accepting new clients or drops existing ones?
• Can I switch providers now, before the network shrinks further?

Document their answers. If they say they don't know yet, ask when they will know. Get a date.

If you're on a Medicaid waiver waiting list, enrollment will likely slow further. The waiting list already runs years long in some counties. Reduced funding means fewer people moving from the waitlist into services.

If Your Caregiver Gives Notice

Wage cuts this steep will trigger turnover. Caregivers earning $37 per hour can find work elsewhere. When your caregiver gives notice, here's what to do:

Document current hours and services immediately. Write down exactly what they do, when they do it, and how many hours per week. That documentation is your baseline if you need to appeal a service reduction.

Contact your service coordinator the same day. Ask for a replacement caregiver referral list. Ask how long placements are currently taking. If the answer is weeks or months, you need backup.

Reach out to family, neighbors, or respite providers now. Don't wait until your caregiver's last day. Coverage gaps happen. Have a plan.

Request an emergency service plan amendment if needed. If your care needs exceed what the reduced wage will support, request a plan amendment in writing. Your service coordinator can initiate it. The DDA may deny it given the budget cuts, but the request creates a paper trail.

How to Navigate Service Plan Changes

When the DDA reduces your service hours or changes your plan, you have the right to request a fair hearing. That process is slow and doesn't guarantee restoration, but it creates documentation.

Here's how to use it:

Request the reduction in writing. If your service coordinator tells you verbally that hours are being cut, ask for written notice. Maryland law requires written notice of Medicaid service changes.

File an appeal within 10 days if you want services to continue during the hearing process. If you file within 10 days of receiving written notice, your current services continue until the hearing is resolved. If you wait longer, services are cut immediately.

Document why the reduction harms your care. The hearing officer will ask how the reduction affects your safety, health, or ability to remain in the community. Specifics matter. "I can't get to medical appointments without assistance" is stronger than "I need more hours."

The appeal may not win. But it preserves your service level during the process, and it documents the harm for any future policy reversal or advocacy effort.

What This Looks Like in Other States

Maryland isn't alone. Indiana cut Medicaid waiver funding from $100 million to $40 million this year. Idaho's HB 863, a $22 million cut to residential habilitation rates, was signed by Governor Brad Little on March 27. Colorado is capping caregiver hours under its Medicaid waiver program. States facing budget shortfalls cut optional Medicaid programs first. Waivers are optional under federal law. They're politically easier to cut than entitlement programs with larger constituencies.

Del. Emily Shetty (D-Montgomery) noted that Maryland operates under federal "special permission" that caps what the state can spend relative to institutional care costs. That permission structure is the federal constraint shaping these cuts. The state exceeded the cap. The correction is these reductions.

What Advocacy Organizations Are Doing

The Arc Maryland, Disability Rights Maryland, and other advocacy organizations continue to track implementation. They'll monitor how service coordinators apply the cuts, whether the DDA honors existing person-centered plans, and whether families are given adequate notice.

Stay connected to these organizations. If service reductions violate your plan or Maryland law, they can escalate complaints to the state. Individually filed appeals matter, but coordinated advocacy through established organizations creates pattern documentation that policy-level responses require.

Contact information:

• The Arc Maryland: 410-571-9320, thearc.org/maryland
• Disability Rights Maryland: 410-727-6352, disabilityrightsmd.org
• Maryland Developmental Disabilities Council: 410-333-3688, md-council.org

The Reality Going Forward

The budget will pass, services will shrink, caregiver wages will drop, and provider networks will contract. Some families will lose care they've relied on for years.

That's the reality of where things stand. What remains is preparation: call your service coordinator, document your current services, line up backup care, learn the appeals process, and stay connected to advocacy organizations.

The system didn't protect this funding. It won't protect you from the consequences, either. You protect yourself by knowing what's coming and acting before it arrives.