In the wake of Congress’s passage of the "Big Beautiful Bill," our most vulnerable neighbors—older adults with cognitive decline, people living with mental illness or intellectual disabilities, and low-income individuals without family—are facing the biggest threat to their well-being in decades.
Disguised as reform, this bill strips away vital Medicaid protections under the banner of fiscal responsibility. But the real price will be paid by those who can least afford it.
Without Medicaid, our clients lose access to life-saving medications, home health aides, and the care coordination that allows them to live independently and with dignity. For many, Medicaid isn't just a health plan—it's the bedrock of their survival.
Now, that foundation is cracking.
The "Big Beautiful Bill" slashes billions from Medicaid, imposes new work requirements for people who are often too sick to work, and shifts the financial burden to already-strained state systems. It’s a blueprint for abandonment. And in the absence of robust public benefits, guardianship is increasingly asked to do more—with less.
Let’s be clear: Guardianship was never intended to be a substitute for a functioning safety net. At Project Guardianship, we serve adults who have no one else to care or advocate for them. Many are isolated, mentally ill, or victims of elder abuse. They come to us after the system has already failed—after eviction notices, hospitalizations, or court orders. We manage everything from housing to health care to finances, and yes, we help them access Medicaid.
But even with our best efforts, we cannot fill the gap left by federal disinvestment. When Medicaid denies coverage, our clients go without. When home care hours are reduced, they end up back in ERs or institutions—at vastly greater cost to taxpayers. Our cost-benefits study estimates that nonprofit guardianship saves the system over $67,000 per person annually by helping people live and age in their homes. But without Medicaid to fund the services they need, those savings vanish.
The bill’s supporters argue that states can innovate their way out of this crisis. But innovation requires funding, and in New York, the guardianship system is already overwhelmed. There is no public guardianship system in the state. Nonprofits like ours are doing the work, absorbing the costs of a broken system while being held to rigorous legal and ethical standards.
The answer is not to cut Medicaid. The answer is to invest in social safety net programs that meet the changing needs of our communities. This includes building a public guardianship infrastructure that partners with nonprofits, ensures due process, and maintains oversight. That means funding programs that work, not gutting them.
We urge our state leaders to resist the downward pressure created by federal cuts. Fund guardianship programs. Expand Medicaid access. Protect the people who can’t protect themselves.
Our clients didn’t choose to be sick, alone, or aging without support. We, as a society, are choosing how we respond to them.
Let’s not choose cruelty.