People Feel Them in Hours. 

A five-percent reduction looks manageable on a spreadsheet. 

It is one line in a budget. One percentage in a report. One number among millions of dollars moving through state government. 

But disability services are not delivered through percentages. 

They are delivered through hours. 

Hours of help preparing a meal. 

Hours learning workplace skills. 

Hours getting to a medical appointment. 

Hours participating in the community. 

Hours of support that allow someone to remain safe and secure in their own home. 

When funding is reduced, those hours can become harder to provide. 

That is why changes to Maryland’s Developmental Disabilities Administration funding matter—not only to service providers, but to adults with disabilities, their families, the professionals who support them, and the communities in which they live. 

What Is Changing in Maryland? 

Maryland’s fiscal year 2027 plans include changes to the Community Pathways Waiver, the Medicaid program through which many Marylanders with intellectual and developmental disabilities receive community-based services. 

Some changes began July 1, 2026. Others, including a planned reduction to community provider rates, require federal approval. Until that approval is received, provider rates remain at their June 30, 2026 levels, according to the Maryland Developmental Disabilities Administration. 

The administrative details are complicated. 

The central concern is not. 

Providers are being asked to prepare for less funding while the cost of nearly everything required to provide high-quality services continues to rise. 

During a recent episode of the On Target Podcast, Dr. Matthew Ramsey, President and CEO of Target Community & Educational Services, described the broader effect as approximately a five-percent reduction for agencies like Target. 

That reduction comes on top of another concern: some people are being approved for fewer hours of service than they previously received or than their changing needs may require. 

For the person receiving support, that difference can be enormous. 

People’s Needs Do Not Shrink With the Budget 

Adults with intellectual and developmental disabilities are living longer and experiencing many of the same changes that affect everyone as they age. 

Health conditions can become more complex. 

Mobility may change. 

Daily tasks may require additional assistance. 

A person who once needed 20 hours of individualized support each week may now benefit from 25. 

But if that person is approved for only 15 hours, the real gap is not five hours. 

It is ten. 

As Dr. Ramsey explained: 

“We were working with 20 hours. The person really needs 25 hours, and we’re working with 15 hours.” 

That gap does not disappear because a budget says fewer hours should be enough. 

Someone still needs to prepare meals. 

Someone still needs to attend medical appointments. 

Someone still needs transportation, supervision, personal assistance, or help participating in community life. 

The need remains. 

The question becomes who will meet it—and how. 

A Waiver Is More Than Paperwork 

Many people outside disability services have never heard of a Medicaid waiver. 

In simple terms, a waiver helps an eligible person receive services and support in the community rather than in an institution. 

That support may include residential services, personal supports, employment assistance, or Meaningful Day services. 

Losing waiver eligibility, even temporarily, can interrupt the funding behind those services. Restoring eligibility can involve a lengthy process. 

Target has maintained a commitment to continue supporting participants during these interruptions while working through the process and anticipating reimbursement. 

Not every provider can absorb that financial risk. 

Some agencies may have no realistic option other than stopping services until funding is restored. 

For the person receiving support, this is not an administrative inconvenience. 

It can disrupt routines, relationships, employment, healthcare, and the stability of daily life. 

High-Quality Support Depends on People 

Disability services are deeply relational. 

A staff member does not become fully effective simply by completing required training. 

They become more effective by knowing the person they support. 

They learn how that person communicates. 

They recognize subtle changes in mood, health, and behavior. 

They understand routines, preferences, goals, and sources of anxiety. 

They know when someone needs encouragement, when they need space, and when something is wrong. 

As Dr. Ramsey explained: 

“The better I know someone I serve, the better I serve them.” 

That knowledge develops over time. 

A professional who has worked with someone for five years brings a depth of understanding that cannot be recreated by handing a new employee a binder on their first day. 

This is why staff retention matters. 

Providers must recruit qualified people, complete extensive training, offer competitive compensation, and create working conditions that allow good employees to remain. 

When funding tightens, retaining experienced professionals becomes more difficult. 

The resulting turnover does not affect only an organization’s payroll. 

It affects the people who must repeatedly adjust to new staff, rebuild trust, and teach someone else how to support them. 

“Doing More With Less” Has a Limit 

Organizations facing reduced funding are often told to become more efficient. 

Efficiency matters. 

Providers should use resources responsibly, reduce unnecessary expenses, improve systems, and look for better ways to deliver services. 

But there is a point at which “doing more with less” stops being innovation and becomes doing less with less. 

A direct support professional cannot be automated out of helping someone prepare dinner. 

Software cannot replace a trusted person accompanying someone into the community. 

An efficient database cannot provide reassurance during a medical emergency. 

Technology can reduce paperwork and give staff more time for meaningful work. It cannot replace the human relationships at the center of that work. 

As Dr. Ramsey put it: 

“Our business is not producing content. It’s the lives of people.” 

That is the line budget conversations cannot ignore. 

Tight Budgets Can Prevent Better Solutions 

Financial pressure does not affect only today’s services. 

It can also prevent organizations from developing better services for tomorrow. 

Innovation requires what Dr. Ramsey calls “headroom.” 

If every employee is already working at full capacity, adding more responsibilities does not create innovation. It creates strain. 

Staff need time to consider what could work better. 

Organizations need the resources to test new approaches, adopt useful technology, maintain homes and vehicles, strengthen partnerships, and respond as participants’ needs change. 

Without that capacity, agencies become trapped in survival mode. 

The urgent task consumes the time needed to prevent the next problem. 

Maintenance gets delayed. 

New programs remain ideas. 

Promising partnerships are never developed. 

Organizations may still keep the lights on, but they lose room to improve. 

Target Is Not in Crisis—but the Trend Matters 

It is important not to manufacture panic. 

Target Community is not currently in a financial crisis. 

Dr. Ramsey explained that Target navigated the latest budget process while maintaining its commitment to high-quality services, supporting its staff, and protecting the homes and resources participants depend upon. 

But responsible leadership does not wait for a crisis before paying attention. 

If reductions continue year after year while needs and operating costs grow, every provider will face increasingly difficult decisions. 

Should fewer people be served? 

Should services be reduced? 

Should vacant positions remain unfilled? 

Should vehicle replacement or home maintenance be delayed? 

Should plans for new services be abandoned? 

Those decisions may appear operational. 

Every one of them eventually reaches a person. 

Community Support Is More Than Writing a Check 

Public funding is essential. Community-based disability services cannot be sustained through bake sales, raffles, and goodwill alone. 

Still, community support can help protect the quality, flexibility, and innovation that public funding may not fully cover. 

That support can include financial contributions, but it does not end there. 

A business can donate products or professional services. 

A contractor can offer nonprofit pricing. 

A healthcare or fitness professional can contribute expertise. 

A company can employ a person supported by Target. 

Students can design service-learning projects around real organizational needs. 

Community groups can help maintain outdoor spaces or collect useful supplies. 

Volunteers can teach classes, share skills, or help create new experiences for participants. 

The most valuable partnership begins by asking: 

What do we know how to do, and how could that help? 

A small contribution still matters. 

A donated box of supplies is one less expense. 

A few hours of professional expertise can solve a problem. 

A $25 gift supports work that would otherwise have to come from the operating budget. 

No single action closes a major funding gap. 

Together, they make an organization more resilient. 

What Families and Advocates Can Do 

Families should pay close attention to service plans, approved hours, waiver status, and notices describing changes. 

Ask questions when something is unclear. 

Document how the person’s needs have changed. 

Request explanations when approved support does not appear to reflect those needs. 

Stay connected with coordinators, providers, and advocacy organizations. 

The Maryland DDA also maintains regional offices and an Advocacy Support Unit to help people receiving services understand and advocate for the support they need. Current information about fiscal year 2027 changes is available through the state’s Community Pathways Waiver updates. 

The system is complicated. 

Families should not have to become policy experts to protect essential services, but silence makes inadequate decisions easier to overlook. 

Support What You Want Your Community to Keep 

Disability services are sometimes treated as though they benefit only the people receiving them. 

That is not true. 

They allow family members to continue working and caring for their own health. 

They create jobs for skilled professionals. 

They connect employers with motivated workers. 

They help adults with disabilities live, work, volunteer, learn, and build relationships throughout the community. 

They make institutional care less likely by providing support where people actually live. 

The entire community benefits. 

Near the end of the podcast conversation, Dr. Ramsey offered a simple principle: 

“If there are organizations that we want to persist, that we want to exist, we need to support them in some way.” 

Funding decisions reveal what a society is willing to protect. 

Adults with disabilities should not lose opportunities, stability, or community connections because their lives were reduced to a line in a budget. 

A reduction may be written as a percentage. 

It will be felt in hours. 

And every one of those hours belongs to someone.