An Already-Strained System Faces Unprecedented Pressure
Before Congress proposed cutting one trillion dollars from Medicaid, the waiting list for home and community-based disability services in the United States had already reached more than 800,000 people. Eight hundred thousand Americans with disabilities — authorized for services, eligible for care, waiting anyway. Some for months. Many for years.
In Florida, the APD waiting list has been a quiet crisis for families of adults with intellectual and developmental disabilities for as long as most providers can remember. At one point the list stretched to more than 40,000 individuals. Families applied for services when their loved ones were children and waited through their adolescence, their young adulthood, and sometimes their entire adult lives for funding that never materialized on any predictable timeline. The cuts being proposed now would not fix this crisis. They would dramatically worsen it.
What HCBS Is and Why It Matters
Home and community-based services — HCBS — is the federal category that funds the care most people with intellectual and developmental disabilities depend on to live outside of institutional settings. In Florida, this includes nearly everything the APD program authorizes: residential habilitation in group homes, personal supports, behavioral services, supported employment, transportation, and the Waiver Support Coordination that connects families to every other service.
These are not luxury services. They are the infrastructure of independence. Without them, the alternative for most adults with significant disabilities is institutional placement — nursing facilities, state-operated intermediate care facilities, or family caregivers who are themselves aging and have no sustainable plan for what comes next.
Medicaid is the primary funder of HCBS nationally. When Medicaid is cut, states face a forced choice: reduce the number of people receiving services, reduce the amount of services each person receives, or find funding that does not exist elsewhere in state budgets. In practice, all three things tend to happen simultaneously.
How the Waiting List Works and Where the Pressure Points Are
Florida's APD system operates on a prioritization structure. Individuals in crisis, those aging out of school-based services, and those whose primary caregivers have died or become incapacitated typically receive priority. Everyone else waits in a queue that moves at a pace determined by available funding, available providers, and available Waiver Support Coordinators — all of which are already strained.
The waiting list is not just a funding problem. It is a system-capacity problem. Florida has a documented shortage of qualified Waiver Support Coordinators. Caseloads that should allow for regular, meaningful contact with clients are stretched to 35 and 40 individuals per coordinator. Training pipelines are inadequate. Compensation has barely moved in a generation.
The result is a service delivery system where families can be approved for care and still wait — sometimes for years — while their loved one's needs go unmet, their file sits in a queue, or, in cases we have encountered firsthand, their paperwork is simply lost. One of the residents in our care arrived after more than a decade in exactly that situation. Authorized for services over ten years before we met their family. A system transition created a gap. The file was not recovered. The services were never delivered. The family carried the full weight of care alone for ten years while the authorization sat somewhere in a database, unfulfilled.
What the Proposed Cuts Would Do to the Waiting List
The cuts currently moving through Congress attack the waiting list problem from multiple directions simultaneously. Reduced federal Medicaid funding to states means Florida would have less to spend on waiver programs. States would likely respond by freezing new waiver slots — meaning the waiting list grows and stops moving. Families currently at position 3,000 on the list would find themselves still at position 3,000 two years later, with no movement in sight.
New bureaucratic enrollment requirements would make it harder for families to maintain the eligibility their loved ones already have. Paperwork errors, missed deadlines, and processing delays — all of which disproportionately affect families without professional advocates — would cause individuals to lose coverage they earned, effectively removing them from the system and forcing them to reapply and restart the queue.
Cuts to Waiver Support Coordinator funding would further strain a workforce already operating beyond sustainable caseload ratios. Fewer WSCs means longer wait times for authorizations, less monitoring of care quality, and fewer advocates positioned to catch the kind of systemic failure that kept one family waiting a decade for services that were already approved.
What Families Can Do Before the Cuts Land
- If your loved one is on the APD waiting list: Do not wait passively. Understand exactly where they are in the queue and what their priority designation is. Connect with an advocacy organization or an experienced provider who can help you understand your options, including crisis placement pathways if your situation deteriorates.
- If your loved one is currently receiving services: Do not assume the status quo is protected. Know the specific services authorized, the funding amounts, and the renewal dates for each authorization. Build a relationship with your WSC — a strong WSC relationship is the single best protection against administrative disruption to services.
- If you have been considering residential placement: The families who navigate transitions most successfully are the ones who plan before a crisis forces the decision. The window for deliberate, unhurried planning is available to you right now. It may not be available at the same quality in a post-cut environment.
- Contact your representatives: Florida's congressional delegation is deciding right now how to vote on legislation that directly affects your family. A constituent call takes five minutes and carries more weight than most families realize.
What Providers Can Do
Operators of group homes and residential care programs in Florida's APD system have a role in this conversation that goes beyond their own financial interests. Providers see the system from the inside. They know which families have been waiting longest, which clients arrived in crisis after years of inadequate support, and what the real cost of an underfunded system looks like in a human being's daily life. That knowledge is worth sharing publicly, with policymakers, and with the families searching for guidance in a confusing and frightening moment.
At Audubon Gardens Group, we believe that advocacy is part of what it means to be a quality provider. We are tracking this legislation. We are sharing what we learn with the families we serve. And we are committed to remaining a stable, trustworthy presence in this system regardless of what the political environment demands. The waiting list was already too long. The need was already too great. The families depending on this system deserve providers who will say that clearly — and who will show up, regardless.
Track the Cuts and Take Action at ProtectOurCare.org
Related Articles
- What the Medicaid Cuts Mean for Your Loved One's APD Services in Florida
- What Families Should Know About APD Pre-Enrollment
About Audubon Gardens Group
Audubon Gardens Group operates licensed APD group homes in Central Florida. Our homes — The Garden at Bennett and The Garden at Ibis — are staffed by credentialed nurses committed to nursing-level residential care for adults with intellectual and developmental disabilities.