For years, people who care for loved ones with intellectual or developmental disabilities have known that Arizona offers some of the most generous Medicaid benefits in the U.S. So generous that people have re-located from other states because the services they need are too expensive for them to pay out of their own pockets.
But with state spending on support for the disabled soaring, and the federal spending cuts mandated by the One Big Beautiful Bill Act set to begin in January, 2027, big changes in Arizona look inevitable.
That's because the Medicaid benefits states provide are jointly funded by state and federal governments. So when federal payments are reduced, in some cases states can either choose to cut services, or increase their own spending to make up for federal reductions.
Those choices matter to people like Patricia Huber in Phoenix.
Her days begin with a lift.
Each morning, her mom steps into Tricia's suite – a living area, bedroom and bathroom, all decorated in hot pink – and helps her daughter prepare for the day.
On a recent spring afternoon, Cindy Middlestadt walks through the average morning routine while Tricia and her dad, Mark Huber, look on. A machine whirs across the ceiling with a hook and straps that can lift Trish from bed and into her motorized wheelchair, or to a mesh shower chair.
Tricia has cerebral palsy. For the lanky, short-haired 39-year-old, that means limited mobility and speech. She depends on her mom and other caregivers to help her out of bed, into the shower, into fresh clothes, to eat. And that's just the morning.
"I need help 24 by seven," Tricia says.
Tricia and her family relocated to Arizona from Alaska several years ago, in large part because Arizona's Medicaid benefits are more generous than Alaska's.
Still, Tricia and her family have struggled to get the Medicaid Home and Community Based Services (HCBS) they thought would be abundant here.
The state's long-term Medicaid services for people with intellectual and developmental disabilities include paying for healthcare; caregiving - ranging from simple respite to skilled medical care; supplies like wheelchairs and the lift that gets Tricia out of bed; occupational, speech and physical therapies; and housing if one's not living with family, which will likely be necessary for Tricia when her parents are gone.
The litmus test for qualifying for HCBS in Arizona is whether an individual would need to be institutionalized if they didn't receive any government assistance. Even though Tricia requires 24/7 care, her family had to apply several times before Arizona's system accepted her.
The Medicaid services are a lifeline — and not just for Tricia.
In Tricia's case, "if she loses her Medicaid, then it's all out of pocket [costs]," her father says. "She's not insurable at this point."
Mark turns to Cindy.
"Honestly, we'd be poor, right?"
And even with the benefits, decades of caregiving have taken a toll on Cindy, who is 56, and Mark, 65.
"From a physical capacity, my body is shot," Middlestadt says.
Keeping people out of institutions
The U.S. Supreme Court's landmark 1999 Olmstead v. L.C. case established that, instead of housing people with intellectual and developmental disabilities in institutions, the government must find ways to keep them in the community.
Medicaid foots the bill.
But Arizona is one of only two states (Rhode Island is the other), where, if you qualify, you are immediately eligible for services. Most other states have long waiting lists, according to a 2025 survey by KFF, an independent research group.
Arizona's costs to provide long term care services to Arizona residents with intellectual and developmental disabilities have soared from nearly $1.7 billion in 2017, to almost $4 billion last year.
The One Big Beautiful Bill Act is expected to cut between $26 billion and $43 billion of Arizona's Medicaid funding over 10 years, according to KFF.
But for now, funding for long term services is preserved. On June 15, Arizona Governor Katie Hobbs, a Democrat, signed a budget that includes no spending reductions for them.
In a statement, Hobbs' office said, "Federal Medicaid cuts would make it harder for Arizonans to get the care they need. When Washington shifts these costs to the states, it's Arizona families who pay the price. The governor is committed to protecting ALTCS-DDD and Medicaid."
State Rep. Stephanie Stahl-Hamilton, a Tucson Democrat, is concerned that won't be possible.
"It puts us in a no-win situation," says Stahl-Hamilton, who sits on the Arizona House Appropriations Committee.
"We know next year it's going to be even worse than this year, which was even worse than last year when it comes to [state budget] negotiations," she says. "I think it's gonna be a little more dire and a lot more anxiety-producing in the very near future."
Stahl-Hamilton and others mentioned the possibility of using Arizona's $1 billion rainy day fund if significant federal cuts are made.
KJZZ reached out to Republican state legislators and a spokesperson, but did not receive a response as of press time.
Some advocates for the disabled warn that Arizona's long term care program simply might not be viable.
"In its current form, and with the current generosity of Arizona's program, it may not be sustainable, " says Jon Meyers, executive director of the Arizona Developmental Disability Planning Council.
"It may be true that moving forward, Arizona is not going to be able to be as generous as it is now. I mean, certainly if there are fewer federal dollars flowing to the state, it's kind of axiomatic that you have to reduce."
Instead, Arizona's program continues to grow.
In 2025, when state lawmakers attempted to curb costs, the backlash from the community was so intense that political leaders have hesitated to say much in 2026, an election year.
"Part of it is the community's level of expectations," Meyers says. "I feel like in Arizona, we have a system that is too ingrained to change."
This story is part of "Uninsured in America," a project led by Public Health Watch, a nonprofit news organization that focuses on life in America's health-coverage gaps and the impact of potential Medicaid cuts and other changes.
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