MARYLAND — The Maryland Department of Health’s Developmental Disabilities Administration proposed wage cuts for family caregivers of people with disabilities in 2026. The change affects approximately 3,900 Maryland residents who self-direct their Medicaid services through home and community-based programs.

The proposed wage reductions would lower some caregivers’ pay by as much as $20 per hour. According to reports, certain caregivers currently earning around $47 per hour would see their wages drop to $29.98. Monique Duell, a family caregiver, is scheduled to see her hourly rate fall from approximately $41 in 2024 to $29.98 under the new tables.

The new wage tables were originally scheduled to take effect on July 1, 2026, but pushback from disability advocates delayed implementation to October 2026. Advocates have lobbied officials at the Centers for Medicare and Medicaid Services to delay the budget changes and even placed advertisements on barges along the Ocean City, Maryland, shoreline to oppose the cuts.

Monique Duell said she was never informed that her compensation could fluctuate annually based on budget decisions. "I was never told that every year that there was going to be some budget meeting, that your salary could be cut or not," Duell said. She added, "Had I known a lot of these things beforehand, I probably would not have run with this program, because now I’m left scrambling." Duell, who has incurred nearly $40,000 in medical debt, questioned how she could manage long-term financial obligations. "How am I supposed to sign a full mortgage when I don’t know from one year to the next what my salary is going to be?" she asked. In another statement, she said, "We’re supposed to go all the way down to $29.98 an hour. What am I supposed to do with that if I can’t work outside the home?"

Kristine Fifer, another family caregiver, described the emotional and financial toll of the proposed changes. "With these new cuts, I’m done. I’m going to foreclose," Fifer said. She added, "It’s either I ride it out until the very last day until they kick us out of our home, or I put him in an institution." Fifer also stated, "I lost everything," referencing past hardships that included her son losing care in 2018.

A spokesperson for the Maryland Department of Health defended the agency’s approach, stating, "MDH is committed to … supporting the health, safety, and independence of waiver participants." The spokesperson added, "Our implementation of FY 2027 budget requirements will continue to evolve in response to federal guidance and feedback from the stakeholder community and legislative and federal partners." Maryland state officials did not respond to questions about the specific rationale for the wage cuts or whether plans exist to reverse them.

Maryland lawmakers had suggested earlier in 2026 that reducing the home and community-based services budget was necessary to maintain the state’s ability to provide Medicaid waivers. However, a Baltimore Sun investigation suggested such budget reductions were not required to sustain those waivers. Health Secretary Robert F. Kennedy Jr. stated in April 2026 that Medicaid-funded programs paying family caregivers are "rife with fraud" and claimed caregivers are performing tasks they previously did for free. No data exist regarding the actual amount of fraud in self-direction care programs.

Why It Matters

The proposed wage cuts come amid rising reliance on self-direction programs, which have doubled nationally over the past decade to serve more than 1.5 million individuals, according to a 2024 AARP report. People with disabilities are more than twice as likely to carry medical debt compared to those without disabilities, increasing the financial vulnerability of families navigating these policy changes. The outcome could influence whether care remains in homes or shifts to institutional settings, affecting both caregivers and recipients across Maryland.