By Rebecca Ullrich

The president’s budget proposal is commonly described as a messaging document. Last week, President Trump made his message clear: the wellbeing of 14.6 million children who have disabilities or other special health care needs is not a priority.

These children and their families face unique economic hardships. The costs associated with children’s special needs can place significant demands on household budgets as well as parents’ time. According to one analysis, having a child with a disability costs a family almost $11,000 per year, on average, in direct expenses and lost wages. Another found that the average cost of educating and caring for a child with autism exceeds $17,000 annually per family.

These costs can be burdensome for middle-class families, but they’re especially overwhelming for low-income households, where 45 percent of children with special needs live. These families are even more likely to struggle with their children’s health-related out-of-pocket costs and face high levels of material hardship, including food and housing insecurity and having their utilities shut off. It’s no surprise, then, that families raising multiple children with disabilities experience higher poverty rates.

Recognizing these families’ needs, the federal government supports services, research, and professional training through a number of different programs. The president’s budget would reduce or even eliminate funding for many of them. The proposed cuts to Supplemental Security Income (SSI) and Medicaid would be particularly devastating.

SSI ensures a basic standard of living for more than 1.2 million low-income children with significant disabilities and their families. Trump’s budget would reduce the benefit for households with more than one SSI recipient, a change that would affect child beneficiaries in more than 320,000 households Families with multiple beneficiaries could include two children with special needs or could include one child with special needs and a parent who is blind or disabled and unable to work. Of the multiple beneficiary households with at least one child beneficiary, over 40 percent include multiple children with special needs. 

Trump’s proposal assumes that two recipients living in the same household have lower individual living expenses compared to recipients in separate households. But families of children with disabilities commonly have expenses above and beyond those of a typical household, and economies of scale don’t always apply. For instance, prescription medication and occupational therapy don’t get cheaper when more people in the household use them. Even when the majority of costs are covered by Medicaid, small regular out-of-pocket costs can be a big burden for families already struggling to make ends meet.

The president also proposed dramatic cuts to Medicaid, the largest insurance provider for children with disabilities, on top of the cuts that would be imposed by the American Health Care Act (AHCA). The AHCA alone would reduce Medicaid funding by $834 billion over the next decade, restructuring how the program is financed and shifting a significant share of health care costs to states. Collectively, the proposed Medicaid changes would result in millions of people losing coverage and force states to ration care or eliminate services.

Those cuts would severely undermine children with disabilities. Many of the services and resources these children and their families depend on—such as prescription medication; occupational, physical, and speech therapies; respite care; and medical equipment—are optional for states to cover and could be among the first to go under budgetary pressures. This won’t just affect families’ access to services through their health care providers, either; it could also threaten Medicaid reimbursement for public schools’ special education services, as well as impair states’ ability to provide early intervention to infants and toddlers.

Medicaid also provides coverage for a significant number of middle-income families whose children have severe disabilities that require intensive services. Comprehensive health insurance through Medicaid prevents crushing medical debt that could place these families in poverty. However, Medicaid access is already limited for these families, and under the president’s budget, states could choose to eliminate coverage altogether for higher-income children.

On top of the proposed cuts to SSI and Medicaid, the president’s budget would undercut other core safety net programs that can help families of children with special needs. This includes nutrition assistance, Temporary Assistance for Needy Families, the Earned Income Tax Credit, and rental assistance. Reducing families’ access to these programs would undermine their financial security and threaten the health and wellbeing of some of the nation’s most vulnerable children—all to provide tax cuts for wealthy Americans and corporations.

The House and Senate must reject the president’s devastating assault on children and families as well as any other budget that would undermine these essential programs. 

CLASP is co-sponsoring a “Don’t Cap My Care” rally on Capitol Hill with the Consortium for Citizens with Disabilities and others on Tuesday, June 6. See the event page for more information.