Why It Matters
The American Disability and Aging Alliance faces an urgent challenge: federal Medicaid cuts threaten to slash hundreds of billions from home and community-based services, potentially forcing hundreds of thousands of disabled and aging Americans into more expensive institutional care. Over 5 million people currently rely on Medicaid-funded home care, while 700,000 more wait for services.
The ADAA’s lobbying push centers on a paradoxical but powerful argument: cutting community-based care actually costs more money. Research shows a 10 percent cut to California’s HCBS programs could increase long-term care costs by $1.17 billion as people shift to costlier nursing facilities.
By the Numbers
The American Disability and Aging Alliance launched federal lobbying in March 2025, investing $160,000 across five disclosures through January 2026 with McGuireWoods Consulting LLC. For the last quartr of 2025, the ADAA paid $50,000 which is consistent with prior quarterly spending.
Melissa A. Bair brings the most relevant firepower: nearly nine years in the House, including roles as Legislative Director for House Budget Committee Chairman Rep. Jodey Arrington and tax policy adviser for Ways and Means member Rep. Vern Buchanan. Scott G. Binkley and Clayton T. Cox round out the team.
The Agenda
The ADAA is lobbying on Medicare/Medicaid and health issues, targeting federal funding for community-based services. The organization’s last quarter priorities align with the HCBS Relief Act of 2025, which seeks emergency federal funding increases for state Medicaid programs.
This advocacy arrives as Congress debates significant Medicaid budget reductions. Democrats have actively opposed proposed cuts, with Rep. Chrissy Houlahan warning of impacts on the disability community and Rep. Lucy McBath highlighting over 700,000 Americans on HCBS waiting lists.
Broader Context
Congress is grappling with sweeping Medicaid cuts that directly threaten community-based services. The 2025 budget reconciliation law slashes approximately $911 billion in Medicaid spending over the next decade. States face an untenable choice: since nursing home care is mandatory under Medicaid while HCBS are optional, budget pressures historically force states to cut community services first.
The political environment offers both opportunity and obstacles. The HCBS Relief Act signals congressional support for community-based alternatives. Yet the Trump administration eliminated the Administration for Community Living, creating uncertainty about service continuity.
Between The Lines
Bipartisan support exists for specific initiatives. Rep. Vern Buchanan (R-FL-16) led legislation expanding home infusion access. Reps. Terri Sewell (D-AL-7) and Kevin Hern (R-OK-1) introduced a bill preventing Medicare home health cuts.
The ADAA faces a crowded advocacy field, competing with Help at Home, Addus HomeCare, and the National Alliance for Care at Home, all lobbying on similar Medicaid and HCBS issues.
Competitive Landscape
The National Alliance for Care at Home represents a substantial competitor, filing a major in-house lobbying report forthe first quarter last year worth $520,000 covering Medicaid HCBS and related legislation. Help at Home and Addus HomeCare are also actively lobbying on home care and HCBS issues.
This crowded field reflects the centrality of HCBS policy in current congressional debates. The coalition provides strength in numbers but means the ADAA must differentiate its message to influence key legislation.
The Bottom Line
The American Disability and Aging Alliance is ramping up federal advocacy at a critical juncture for Medicaid funding. With Melissa Bair’s significant Hill experience in budget and tax policy, the organization is well-positioned for upcoming negotiations. The ADAA’s sustained $160,000 investment since March 2025 signals commitment to securing funding for community-based services as cost-effective alternatives to institutional care. This aligns with emerging bipartisan support for targeted home-care initiatives despite broader Medicaid cuts.
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