Between President Trump urging people experiencing homelessness to leave as part of federal takeover of Washington, DC, and an executive order directing agencies to prioritize mental health and substance abuse services before other forms of assistance, the administration’s stance on people experiencing homelessness is clear: leave, accept treatment, or go to jail.

This policy shift, coupled with sweeping cuts to other social services, is a major departure from long-standing civil rights protections for disabled people—threatening their access to community-based care and increasing the risk of institutionalization, which can severely compromise their well-being. Already, disabled people face multiple intersecting crises when accessing adequate care: 

• About one in four adults in the US have a disability, which makes them more likely to have a lower income and experience discrimination in the private housing market; 18 million people with a disability are eligible for federal housing assistance but are not receiving it.
• Over a quarter of a million people endure unsheltered homelessness on any given night, and an additional half of a million are in shelters. People experiencing homelessness are about twice as likely as other Americans to have a disability, and the share of people experiencing homelessness with a disability is growing.
• Older adults, who are more likely to have disabilities, increasingly cannot afford housing and are the fastest-growing age group experiencing homelessness. In 2021, nearly 11.2 million older adults spent more than half their income on housing.

The new federal actions targeting homelessness, combined with the earlier funding cuts to social programs, raise serious questions about whether disabled people’s rights will be recognized or if disabled people will be pushed into institutions under the guise of public safety and cost savings. To ensure disabled people’s right to adequate care, local communities and service systems will need to protect and fund access to services that enable people with disabilities to live independently—services that are already too scarce and too difficult to access.

Disabled people and people experiencing homelessness want care, but there isn’t enough available

People experiencing homelessness are not homeless because they refuse to access treatment. There simply aren’t enough treatment resources available. Untreated substance use or mental health conditions aren’t the result of individual failure. They are the product of deliberate policy choices.

In the Urban Institute’s Los Angeles County Women’s Needs Assessment, 46 percent of women received mental health treatment services but still experienced homelessness, and an additional 24 percent said they wanted to participate in mental health services but did not receive them. Similarly, one in three women who wanted substance use services did not receive those services. Elsewhere, supportive housing staff members have described their programs as filling a gap caused by the lack of psychiatric and inpatient hospitals, skilled nursing facilities, and in-home caregiving support.

These existing gaps in treatment mirror those faced by disabled people and are likely to get worse as new federal legislation takes hold. In a 1999 decision, the US Supreme Court affirmed that people with disabilities have the right to receive services in a setting appropriate to their needs. Centers for Independent Living have long provided supports and structures for disabled adults to be fully included within their communities, emphasizing the dignity that all people deserve. But the 2025 budget reconciliation act made significant cuts to community-based services, reducing the number of appropriate settings available and exacerbating treatment challenges for older adults, people with disabilities, and their families.

Medicaid is the largest source of funding for home- and community-based supportive services, and the $990 billion in Medicaid cuts could deny services to large numbers of disabled people. At the same time, the US Department of Health and Human Services eliminated the Administration for Community Living (ACL), which housed Centers for Independent Living services and provided funding to states for services to help older adults and disabled people live independently.

In 2022, the ACL provided more than 261 million meals to older adults, assistance such as respite care to more than 1.5 million family caregivers, and independent living services to nearly 250,000 people with disabilities. Thousands of ACL civil servants have been laid off, and it is unclear whether or how these critical programs will continue amid the department’s reorganization. This leaves older adults and disabled people—including children—to face the real risk of being forced into nursing homes and other types of institutions.

Institutionalization will not solve homelessness or provide disability care

Forcing people into treatment, involuntarily institutionalizing people, or putting them in jail will not solve homelessness or people’s disability-related challenges.

Institutional settings—whether nursing homes, psychiatric facilities, or correctional facilities—strip people of critical rights. Institutionalized individuals are also excluded from federal census counts, which has serious consequences, leading to underestimates of the size of the disabled population, reduced federal resources, and lack of representation in Congress.

Further, many nursing homes that rely on Medicaid funding are likely to close, especially in rural areas, leaving people who need care few choices in their communities. Families will have to make decisions about providing care at home—which could mean loss of income for caregivers and economic hardship for the household—or placing their loved ones in faraway facilities. At the same time, immigrant detention and deportation operations, including the rollback of protected status, threatens to decimate the home and nursing home care workforce, as more than a quarter of direct care workers are immigrants. This workforce was already too small and struggling to keep up, and these policy changes risk pushing an already fragile system past its breaking point.

Expanding institutionalization while cutting community supports ignores both evidence and lived experience. Disabled people, including those experiencing homelessness, are not refusing care; they are being denied access to it.

Community-based services will better address homelessness and protect the rights of disabled people

Solutions to these intersecting crises—homelessness, disability rights, and access to care—already exist. The question is whether we will invest in them. To meet the moment, state and local policymakers need to prioritize the following:

• restoring and expanding the home- and community-based services provided by the ACL to help disabled people and older adults remain in their homes and communities
• protecting the rights of people experiencing homelessness and disabled people to avoid involuntary confinement and to receive care in the most integrated setting appropriate
• strengthening the direct care workforce through immigration policies that protect and expand the labor pool, as well as reforms that support higher wages, better benefits, and improved working conditions to stabilize and expand a field that’s long been underpaid and overstretched
• funding evidence-based alternatives to institutionalization, which are more humane, more effective, and more cost-efficient than confinement
• investing in affordable, accessible housing, particularly for older adults and disabled people, who are disproportionately affected by homelessness and housing instability

These are not radical ideas. They are proven, practical, and urgently needed.