Disabled Iowans Face Cuts to Home Care Services

Families fear institutionalization as Trump-era Medicaid changes take effect

Published on Mar. 2, 2026

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Leisa and Kent Walker recently received a notice that the private company managing their 35-year-old son Sam's Medicaid coverage plans to cut nearly 40% of the funding for the in-home caregivers who help him live at home instead of in a nursing facility. Sam has severe autism and other disabilities, and the Walkers say without the in-home services, he would need to move to a specialized residential facility in another state, which would be devastating for their family and cost taxpayers much more money.

Why it matters

Patient advocates say state administrators in Iowa appear to be reining in Medicaid spending by cutting home and community-based services for people with disabilities, and they've heard of multiple families facing battles like the Walkers'. Disability rights advocates expect the pressure to intensify as states respond to reductions in federal Medicaid funding called for under the Trump administration's signature tax and spending law.

The details

The Walkers' son Sam receives about $8,500 a month in Medicaid funding for health workers who visit his apartment and help him with everyday tasks like dressing, bathing, and eating. The staffers also take him on outings to help maintain his routine. Iowa Total Care, the private insurance company managing Sam's Medicaid benefits, plans to cut his in-home care coverage by about $3,200 per month. The Walkers fought the cuts at an appeal hearing, and an administrative law judge ruled in their favor, but the insurer has appealed the decision.

  • In February 2026, the Walkers attended an appeal hearing in Des Moines to fight the planned Medicaid cuts.
  • Three days after the hearing, the administrative law judge ruled in the Walkers' favor, but Iowa Total Care appealed the decision to the director of the Iowa Department of Health Human Services.

The players

Leisa and Kent Walker

The parents of 35-year-old Sam Walker, who has severe autism and other disabilities and relies on Medicaid-funded in-home caregivers to live at home instead of in a nursing facility.

Sam Walker

A 35-year-old man with severe autism and other disabilities who relies on Medicaid-funded in-home caregivers to live at home with his parents.

Iowa Total Care

A private insurance company that manages Sam Walker's Medicaid benefits and plans to cut his in-home care coverage by about $3,200 per month.

Christopher Okiishi

Sam Walker's longtime psychiatrist who testified that Walker's family and their support staff spent years developing a 'fragile' but stable existence for him.

Andy Koettel

Sam Walker's main caregiver who has worked with him since he was in fourth grade and is a key reason Walker can continue to live at home with his parents.

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What they’re saying

“These are real people, real families, and this causes real suffering when you do this to people. It's a very scary time.”

— Leisa Walker (KFF Health News)

“If I was not there, it would be incredibly difficult for all of them.”

— Andy Koettel, Sam Walker's main caregiver (KFF Health News)

What’s next

The dispute over the planned Medicaid cuts to Sam Walker's in-home care could eventually wind up in district court if the Iowa Department of Health Human Services overrules the administrative law judge's decision in favor of the Walkers.

The takeaway

This case highlights the growing threat to home and community-based services for people with disabilities as states respond to reductions in federal Medicaid funding, potentially forcing more individuals into costly institutional care and causing real hardship for families like the Walkers.