Santa Cruz residents with disabilities worry about future of Medi-Cal and other essential services

Beth Stiles moved from North Carolina to Santa Cruz around 10 years ago to be closer to her elderly mother and father. Stiles is a leap-year baby, she said, and likes to think of herself as 16-and-a-half years young rather than 66 years old. An avid knitter and burgeoning business owner, her dream is to take her lived experience as someone with a physical and learning disability and help others with disabilities to advocate for themselves and their care.

She has had some issues over the years with her right lower leg, she said, explaining that she underwent surgery in February and also recently sprained her ankle. Her insurance programs worked together to cover essential care she needed in the wake of her injuries, like being in a rehab facility, going to urgent care, visiting her specialty doctor and getting an X-ray and ultrasound done. 

She is dually enrolled in both the government-funded public health insurance programs Medicaid and Medicare, because she has a disability and is over the age of 65. She depends on these programs to get the care and medical items she needs without going into severe debt. For instance, the medicines she takes four times a day are paid for through Medicare, and without that coverage she could be forced to pay around $50 out of pocket per month.

Stiles is one of more than 14 million people enrolled in Medi-Cal, California’s Medicaid program, including about 2.4 million people in the state’s “Seniors and Persons with Disabilities” enrollment category. She is also one of around 7.2 million people enrolled in Medicare in California – around 432,000 of whom qualify through disability instead of age – and 1.7 million who are dually enrolled in both programs. 

You can qualify for these types of coverage by age, disability or certain medical conditions, depending on the program. For Medi-Cal, eligibility is primarily based on factors such as income and household circumstances, although there are specific pathways for older adults and people with disabilities. For Medicare, most people in the U.S. qualify when they turn 65, while people under that age can qualify through disability benefits from Social Security, and generally the benefits begin after 24 months of disability benefits. 

Since her dual coverage is so essential to her well-being, Stiles often finds herself thinking about its flaws and what changes to the program could mean for her.

“I’m always antsy about Medicare because you never know when they’re going to go and just disappear, and that’s a big thing for people like myself, but also the elderly,” Stiles said. “I mean, as soon as we get one service, it’s like we start it up and then maybe a few years down the road, we will lose that because of the way the government is doing things.”

That uncertainty is growing as significant changes to public health care programs approach. A sweeping federal law enacted in 2025, known as H.R. 1 or the One Big Beautiful Bill Act, is expected to reshape Medicaid funding and eligibility over the coming years. At the same time, California is making changes to Medi-Cal, raising concerns about whether people who depend on the program will be able to maintain their coverage and access to care.

The full effects of these changes remain uncertain, particularly for people with disabilities who rely on a combination of health coverage and other public services. But advocates and service providers in Santa Cruz County say the prospect of tighter resources and changing eligibility rules is already creating anxiety among people who depend on these programs to live independently and remain connected to their communities.

“People are going to lose their services and die”

Kathleen Griffith has been working for a few years at Community Life Services, a Santa Cruz-based nonprofit that helps support people with disabilities. The organization’s goal is to help them navigate getting paid internships, having a safe environment to relax in, creating their own business or filling out forms for Medicare and Medicaid. Griffith is a community specialist, using her master’s degree in social work and experiences with her own disability to help others find and pursue their passions.

Among Griffith’s concerns are changes that could make it harder for some people to qualify for or retain Medi-Cal coverage. These include new work or community-engagement requirements for certain adults under federal law and a lower asset limit for some Medi-Cal recipients under California policy. The changes are unfolding amid broader concerns about the future of public healthcare funding and the pressure that could place on state programs and the people who rely on them.

Right now, any one individual with a disability who qualifies for certain Medi-Cal programs can have up to $130,000 in countable assets, such as money in a bank account, and still qualify for coverage. Starting July 1, 2027, that limit will drop to $21,000 for an individual. In a state where housing and other basic living costs can be exceptionally high, Californians living with a disability could be forced to choose between maintaining a financial safety net and keeping access to Medi-Cal, Griffith said. 

“It’s wild. In California, people are going to be expected to survive with $21,000 a year,” Griffith said. “People are going to die; I’m so afraid.”

The possibility of people with disabilities losing their benefits because they cannot meet an 80-hour monthly work or community-engagement requirement also worries her. The requirement is scheduled to take effect Jan. 1, 2027, for certain Medi-Cal recipients ages 19 to 64. Although federal law exempts people who meet specific disability criteria, questions about eligibility and how exemptions will be determined have added to the concerns among people who could be affected. 

“It’s a doable amount of time for some people, but for many, it’s not – like, at all,” Griffith said.

Jobs have historically been difficult for working-age people with disabilities to obtain and sustain. Between unspoken prejudice from employers, lack of accessibility in some buildings and inflexible hours that make it difficult for employees to balance health issues or regular medical appointments, as of 2025, only 22.8% of people in the U.S. with a disability were employed.

Julie Reno, a Santa Cruz local who applied for Medi-Cal benefits for the first time this year and who works at Community Life alongside Griffith, said many clients seeking their services can and should be employed more than they are, but have not been given a chance. 

This puts them in a situation where they have no choice but to rely on the types of benefits Medi-Cal and Medicare provide to pay for care related to their disability, which Reno said is “potentially the care that’s necessary for them to stay healthy enough to work to afford the care in the first place.”

An air of uncertainty 

The single most common anxiety Reno has heard among her friends and clients at Community Life is the fear that changes to health coverage and public services, along with uncertainty about future funding, could leave them unable to afford something they cannot live without. This includes essentials such as medication, as well as things that affect both mortality and quality of life.

“Like, ‘Will I be able to afford physical therapy appointments?’ ‘Will I be able to afford to have my wheelchair replaced, if it breaks?’ ‘Will I be able to afford to have a home caregiver?’” Reno said. “Because for a lot of people, depending on what the nature of their ability and disability is, wrestling with affording medical care means wrestling with the prospect of being able to pay to navigate the world around them at the same level that everybody else does.”

For instance, if someone uses a communication aid and the device they use to speak to others breaks and they cannot afford to replace it because their insurance coverage was cut, Reno continued, then their line to the rest of the world is broken. 

For people with disabilities in Santa Cruz, the challenge is not knowing what they may need to prepare for. The potential effects of policy changes and future funding pressures are still taking shape, Reno said, leaving people uncertain about whether their coverage or services could change and what those changes might mean for their daily lives. 

“These are people you work with every day. These are members of our community. To us, this is the same as our friends and family, our neighbors, the people whose businesses we attend,” she said. “So we don’t want to see them afraid that they won’t be able to afford to go to the doctor anymore, or that they won’t be able to afford their medication anymore. We also feel so awful because we know that that worry might not be unfounded.”

California’s Lanterman Act

When Debbie Wechsler thinks about the possible changes to Med-Cal and other public services, he often finds herself worrying about her 39-year-old son, Zachary Mabert, who has autism. A retired nurse, Wechsler feels lucky that Mabert is physically healthy so they don’t have to stress about frequent hospital or doctor’s visits. However, one area of concern for her is whether or not he’s going to continue to receive his many services. 

One such service that Mabert adores, she said, is his art program at Claraty Arts, a day program for adults with intellectual and developmental disabilities. As soon as Mabert was able to handle a pencil or pen on paper, he was drawing. His favorite medium is etching intricate black-and-whites, and he likes to try to finish his pen drawings in one take. He has been attending Claraty since 2010, after he graduated from his high school’s postsecondary program. 

Due to his intellectual disability, Wechsler said, Mabert struggled to express himself through verbal language growing up. Visuals, she continued, became an important method of communication for him and their family. Claraty Arts has helped him exhibit his art in various cities across the country, from San Francisco to New York. 

“He’s quite the artist,” Wechsler said. “I can’t even tell you how many things we’ve been able to explain to him through visual support. They’re very important to him.”

The cost of Mabert’s art classes is currently covered through the San Andreas Regional Center, one of 21 nonprofit regional centers in California that coordinate services for people with intellectual and developmental disabilities. The system was created under the state’s Lanterman Developmental Disabilities Services Act, a 1969 law that established a legal entitlement to services for eligible Californians with developmental and intellectual disabilities, including people with autism, cerebral palsy and epilepsy. Under the law, regional centers help determine what services a person needs and arrange for those supports to help them live as independently as possible in their communities.

The system is also facing a growing demand, as the number of people being served by regional centers has nearly tripled since 2000. Wechsler said the growing caseload has put additional strain on regional centers’ staffing and ability to provide services.

“I think there’s been an explosion of autism, truthfully, over more recent years. But one of the things is you’ll find big delays in people actually getting started on services. Now, they’ll get in, and then there’ll be delays on the intake, or on finding a provider,” she said. “You end up with providers who go, ‘Hey, we can’t find people for the pay rates that we have to get – you know, that people can survive on. So we don’t have room for any new people.’”

To keep up with the growing number of people receiving regional center services, California’s 2026-27 budget provides $21.6 billion for developmental services, including regional centers and the services they coordinate. This year’s budget fully funds services for nearly 527,000 people and does not include direct cuts to Lanterman Act programs. 

Even so, Wechsler worries about whether California will have the resources to sustain services as costs and demand grow and the effects of broader health care funding changes become clearer. The regional-center system relies on a combination of state and federal sources, and uncertainty about future funding raises questions about how the state will maintain services if financial pressures increase.

“If you’re going to have less money from the federal coffers, how and can you actually make up for that lack from the federal level? Can you make it up with state money? Very good question,” Wechsler said.

Despite the anxiety surrounding the uncertainty of the next year and beyond, Wechsler said one potential bright spot is that it could bring greater attention to services and systems that have long faced problems but could become even more strained in the coming year.

“I think things have to become a little bit more clear about what we are doing with these people, you know, what are we doing for them? How are we really supporting them?” she said. “There’s a lot of people a generation or two before that really wanted to fight for people with disabilities, and that was a good thing. I think where things are at now is how do you move to that next level where everybody’s accepted, and there’s not so much us and them.”

Kathleen Griffith has hope that this moment in history will spark a new generation of advocates for disability rights. It’s frustrating when people don’t pay attention to how things like budget cuts will affect those with disabilities, she continued, because disability is the only minority group that anybody can be a part of at any time.

“The ultimate hope is that people aren’t going to let the rage lead them into despair, they’re going to let the rage lead them into something better,” Griffith said. “We should all be concerned, and we should all be paying attention, because this can and will affect all of us, eventually.”

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