Lisa Beaudoin of Concord, principal of Strategies for Disability Equity, is the former executive director of NH’s leading disability justice organization.

The New Hampshire House of Representatives proposed to cut over $75 million from Gov. Ayotte’s recommended biennium budget for developmental disability services. For families like mine — and the frontline providers trying to support individuals — the question is simple: What do we do when there are no margins left to cut?

I’m a disability policy professional and the mom of a 29-year-old man with Down syndrome who recently moved into his home because the state’s longstanding and severe workforce shortage left him without the 10-12 hours per week of paid support he needs for a robust community-based life. Over time, that absence caused medical and lifestyle setbacks that never should have happened. Like so many family caregivers, my unpaid labor comes at a cost: the ability to grow my consulting business.

New Hampshire statute RSA 171-A mandates that there shall be no waitlist for services for people with developmental disabilities. But when families wait years for support hours to be filled because no one will take the job at today’s Medicaid reimbursement rates, this creates a shadow waitlist.

Some parents have to leave their jobs to stay home full-time with their adult child, a systemic failure with profound economic consequences leading to increased need for government funding, not less. Did you know that disability families fall out of the middle class and into poverty at the highest rates of any population?

The workforce crisis in developmental services isn’t new. It predates the pandemic and has only worsened.

Providers struggle to recruit and retain staff when direct support professionals can earn more at fast food restaurants than in roles requiring responsibility, empathy and skill. Many agencies have already reduced administrative capacity to the bare minimum, with executives doubling or tripling duties to keep essential operations running.

In 2023, the state increased Medicaid rates by 3% — a modest step toward helping providers raise wages and stabilize services. But now, the House has passed a budget that would impose a 3% across-the-board cut to those very same rates. We cannot allow providers to increase compensation in one year, then slash their ability to pay staff or electric bills the next. This contradiction undermines the intent of past investments and threatens the sustainability of the system itself. Do you want agencies to sell their buildings when remote work is now discouraged?

The House budget also reduced “Payments to Providers” by $42 million. These are not peripheral funds — they enable an area agency system, which is efficient, accountable and committed to person-centered care (not profits), to run. If we destroy this local service delivery system, we risk repeating former Rep. Neal Kurk’s buyer’s remorse when Step 1 of Medicaid managed care revealed upwards of $80 million in deeply-buried “administrative fees,” utterly failing to deliver promised savings.

Meanwhile, New Hampshire has cut business taxes and eliminated the Interest and Dividends tax. Austerity is being hoisted onto the backs of disability families who already donate about $339 million per year in uncompensated care. Families are being asked to do more while receiving less, all while unknowingly offsetting the state’s decision to reduce tax obligations for those with investment portfolios. I’ll happily pay the I&D tax to avoid Medicaid rate cuts.

Gov. Ayotte’s recommended $1 billion budget for developmental services signaled a commitment — yet, with falling revenues and the end of COVID-era monies, perhaps it was performative. What we need is not a number, but an authentic commitment to the people who rely on this system so they can have the robust community-based lives envisioned in RSA 171-A.

Caregivers are aging, with parents in their 60s, 70s and 80s providing daily support to their disabled adult children. They are exhausted and worry about what will happen when they die. It would be unconscionable to push these families further into isolation or crisis.

At the same time, federal threats to Medicaid funding remain a highly alarming danger. New Hampshire cannot assume that existing federal matches will remain stable, or that future federal contributions will insulate the state from the consequences of underfunding its share. If the floor collapses from both ends — state and federal — there will be no one left to catch people with disabilities and their families.

Lawmakers: What’s your plan for the inevitable federal Medicaid shortfall?

Our developmental disability services system has no excess to trim. The Medicaid rates undergirding this system are already inadequate. To reduce them further is to knowingly destabilize provider networks, create waitlists for services and place even greater pressure on families.

Do not cut Medicaid rates nor the budget for developmental disability services. Instead, be fiscally responsible and restore the Interest and Dividends tax.