Impact of Immigration Enforcement and Medicaid Cuts on In-Home Care Services

The in-home care sector in the United States faces a significant crisis exacerbated by immigration enforcement and cuts to Medicaid funding. As of January 2026, California's In-Home Supportive Services program served 897,224 individuals, supported by 803,609 caregivers, many of whom are immigrants. Kristy Madden, a 65-year-old coordinator for this program, highlights the precarious situation faced by caregivers and their clients. She fears that Immigration and Customs Enforcement (ICE) actions could lead to the loss of her aides, who are essential for her daily care due to her muscular dystrophy.

TruthOut

According to the American Business Immigration Coalition (ABIC), immigrants constitute one in four long-term care workers and 30 percent of nursing home support staff in the U.S. The reliance on immigrant labor is critical, particularly as the population ages. By 2030, it is projected that 3.5 million additional healthcare workers will be needed to care for the growing elderly population. Jonathan Gruber, a professor at the Massachusetts Institute of Technology, warns that deporting Haitian healthcare workers could lead to 9,000 premature deaths among those reliant on their services.

TruthOut

The financial landscape for caregiving is dire, with approximately $911 billion in Medicaid cuts projected over the next decade. These cuts threaten the viability of in-home care services, pushing many vulnerable seniors toward institutional care, which is often inadequate. The national median cost for nursing home care is exorbitant, with private rooms averaging $129,575 annually. Many families are left to shoulder these costs, often without adequate planning or resources.

TruthOut

Critics argue that the current administration's policies, including threats to deny minimum wage protections for home health aides, exacerbate the staffing crisis. Robert Moffit from the Heritage Foundation suggests that families should take primary responsibility for long-term care, neglecting the systemic issues that hinder access to affordable care. This perspective has drawn criticism for failing to address the realities faced by caregivers and those needing assistance.

TruthOut

In response to these challenges, organizations like Hand in Hand are advocating for better working conditions for caregivers. They encourage employers to create safety plans for immigrant workers and promote community solidarity. Brittanie Hernandez-Wilson, a lead organizer at Hand in Hand, emphasizes the importance of mutual aid networks among those requiring care. These networks aim to empower individuals to navigate the complexities of caregiving and advocate for their rights.

TruthOut

The intersection of immigration enforcement and Medicaid cuts poses a significant threat to the in-home care system, impacting both caregivers and those they serve. As the crisis deepens, community organizations are stepping up to foster solidarity and support among caregivers and clients. The ongoing struggle for caregiving equity highlights the urgent need for systemic change to ensure that vulnerable populations receive the care they need without fear of losing their support systems.

TruthOut

• “My biggest fear as a disabled adult is that our home care workers will just suddenly be gone.” — Kristy Madden, Coordinator, In-Home Supportive Services Consumer Alliance

TruthOut

• “Immigrants are an integral part of caring for the nation’s elders,” — Jonathan Gruber, Professor, Massachusetts Institute of Technology

TruthOut

• “Yes, there is a lot of fear because of ICE, cutbacks, and the racialized oppression that is disabling all of us, but when we pass the knowledge we’ve accumulated on to others, when we have open conversations and make plans for what we can and will do, it gives us strength,” — Brittanie Hernandez-Wilson, Lead Home Care Organizer, Hand in Hand

TruthOut