By IRIT SKULNIK
Capital News Service
ANNAPOLIS – When Opal Foster, a Burtonsville resident, learned about proposed budget cuts to the state’s Developmental Disabilities Administration, she said she needed to find a second job.
Foster’s 18-year-old son Jeremiah, who has Down syndrome, has participated in a program since January that allows an individual or a representative to manage their support services. Under the “self-directed services” program, Foster is paid to provide that aid to Jeremiah.
“I’ve been told by everyone — Jeremiah’s caseworker, friends of mine who are also in self-direction — don’t let this be your only source of income because budget cuts are coming,” Foster said.
Foster, a single mom, started substitute teaching last month to help offset the expected drop in wages.
“I can’t afford to have the rug pulled from under our feet,” she said.
Disability rights advocates have been traveling to Annapolis for weeks to rally against proposed DDA funding cuts included in the state’s $70.8 billion operating budget. They warned cuts could harm some Marylanders receiving DDA services, including the roughly 19,000 enrolled in “self-direction” and other programs.
The proposed budget cuts $126 million to DDA, a reduction from $150 million after lawmakers restored some funding.
“We are grateful to both chambers, to the House and Senate, for agreeing to restore that funding,” said Laura Howell, CEO of the Maryland Association of Community Services. “Having said that, obviously these cuts are painful.”
The cuts total more than $250 million when taking into account federal Medicaid matching dollars, advocates said.
After ironing out differences between House and Senate versions of the legislation Friday, the proposal has been sent to Gov. Wes Moore.
The cuts, which come as the state faces a budget shortfall of $1.5 billion for fiscal 2027, would impact funding to DDA, including self-direction and community provider programs.
While “self-direction” allows people to directly manage their own services and staff, community provider programs coordinate services for individuals receiving them.
Under the proposed budget, funding would be cut by 2-4% for community providers, Howell said.
She said the cuts could make it harder for community providers to offer cost-of-living raises to direct support professionals, which is “critical” for reducing staff turnover and ensuring better outcomes for those receiving services.
Yan Orellana, of Silver Spring, rallied in Annapolis last month for his 26-year-old son Raphy, who has autism. Orellana said Raphy’s support services help him be more independent and have a better quality of life.
Without access to services, Orellana said Raphy will “stay home doing nothing.”
This is not the first time the DDA has been targeted for budget cuts. Last year, the agency faced more than $400 million in proposed cuts, however, most of the funds were restored, according to the agency’s 2027 fiscal year report.
According to Moore’s proposed budget, the reductions would help manage DDA’s rising expenses. Moore released a second supplemental budget Friday that provides the agency with $36 million to help close its deficit.
Del. Jason Buckel, R-Allegany, said at a press conference last week that while no one wants the cuts, the spending, specifically in cases where recipients receive hundreds of thousands of dollars for care, is “not sustainable.”
The state runs the program under a federal agreement that requires costs to stay below an average of $217,000 per person, the estimated cost of institutional care, Del. Emily Shetty, D-Montgomery, said at a House floor session last week.
If program costs increase by 18%, the state would surpass the cap and lose its federal funding, Shetty said.
“It is a structural challenge,” she said. “If we had a magic wand and can devote a billion dollars more to this program that has grown 200% in five years, we would 100% do it — if it was just about money.”
Trish Smelser, a White Marsh resident, attended a rally in Annapolis last week. She has two daughters with special needs and she said the program has allowed them to have a “fulfilled life.”
“They graduate from school, they don’t want to go out with mom,” Smelser said. “They want to be out with their friends and their staff, which allows them to do that.”
Foster, Jeremiah’s mother, urged lawmakers to consider the impact of cuts.
“Think about if it was your own loved one that’s an adult that is forced to be at home lonely because they don’t have a day program to go to,” Foster said.
CNS reporter Stella Canino-Quiñones contributed to this report.
Maryland losing the waiver is a false narrative. At the statewide waiver level: Maryland must fix the trend if it exceeds cost neutrality.
For the whole 1915(c) waiver, federal rules require that total HCBS expenditures remain below what Medicaid would have spent on institutional care. 42 CFR 441.310 governs the federal financial participation limits.
If Maryland trends over the Appendix J projection, CMS generally expects:
a waiver amendment
rate changes
enrollment controls
service redesign
utilization management
revised institutional cost assumptions
corrective reporting in renewal or amendment cycles
This is usually an administrative compliance issue, not a sudden waiver shutdown.
3) Financially: the real risk is the marginal overage
This is the most important practical point.
If Maryland spends above the approved cost-neutrality threshold, the state’s biggest exposure is generally:
no federal Medicaid match (FFP) on the amount above the approved limit
—not the loss of all federal funds.
So if the overage were, for example, $10 million above Appendix J, the state risk is typically the federal share of that $10 million, not the entire waiver budget.
That is why describing the situation as “the waiver could disappear” is often misleading.
The waiver remains in place while the state submits corrective action.
4) When it becomes serious
The risk becomes larger only if Maryland:
repeatedly exceeds neutrality
fails to amend the waiver
cannot show a credible correction plan
submits unrealistic future projections
continues growth trends CMS rejects
In that case CMS could:
refuse an amendment
require enrollment freezes
require stricter service controls
refuse renewal at the next waiver cycle in extreme cases
But this is progressive oversight, not an on/off switch.
Thank you! Maryland is choosing not to correct their cost neutrality measure with an amendment. This can be fixed. The question is why are they choosing not to fix it?