Medicaid Cuts Threaten In-Home Care for Disabled Iowans

Families face battles to keep loved ones out of institutions as state reduces funding for home-based services

Published on Mar. 2, 2026

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This story highlights the challenges facing families in Iowa who rely on Medicaid's home and community-based services to care for loved ones with disabilities. As the state looks to rein in Medicaid spending, private insurers are cutting coverage for in-home care, forcing families to consider more costly institutional placements that go against their wishes and their children's needs.

Why it matters

The cuts to Medicaid home-based services threaten the ability of people with disabilities to live independently in their communities. Forcing them into institutions would be more expensive for taxpayers and detrimental to the health and wellbeing of the disabled individuals and their families.

The details

The Walker family in Ottumwa, Iowa, recently received 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 home. Sam has severe autism and other disabilities, and the $8,500 per month in Medicaid funding covers the cost of health workers who assist him with daily tasks and take him on outings. Without this in-home care, the Walkers say their son would need to move to a specialized residential facility, which would be heartbreaking for the family and cost taxpayers much more.

  • In February 2026, the Walker family attended an appeal hearing with an administrative law judge after the private insurer, Iowa Total Care, announced plans to cut Sam's in-home care coverage by about $3,200 per month.
  • Three days after the hearing, the judge ruled in the Walkers' favor, finding the insurer's attempt to cut care hours was improper. However, the insurer has appealed the decision to the director of the Iowa Department of Health and Human Services.

The players

Sam Walker

A 35-year-old man with severe autism and other disabilities who relies on Medicaid-funded in-home care to live with his parents rather than in an institution.

Leisa and Kent Walker

The parents of Sam Walker who are fighting to keep their son in their home with the help of Medicaid-funded in-home caregivers.

Iowa Total Care

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

Christopher Okiishi

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

Rachel Morgan

The administrative law judge who ruled in favor of the Walkers, finding the insurer's attempt to cut care hours was improper.

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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, Mother of Sam Walker (KFF Health News)

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

— Andy Koettel, Main caregiver for Sam Walker (KFF Health News)

What’s next

The dispute over Sam Walker's in-home care coverage could eventually wind up in district court if the Iowa Department of Health and Human Services overrules the administrative law judge's decision.

The takeaway

This case highlights the critical importance of Medicaid's home and community-based services for people with disabilities, and the devastating impact that cuts to these programs can have on families struggling to keep their loved ones out of costly institutions. It underscores the need to protect and expand access to these vital services.