New York Gov. Kathy Hochul at a press conference.Sipa USA/AP

In late April, New York Democratic Gov. Kathy Hochul and state lawmakers finalized a $233 billion budget for the next fiscal year. One item in its 144-page official summary has sparked fear among disability advocates: dramatic changes to a vital home health aid program that may push more people into nursing homes.

A quarter of a million New Yorkers currently use CDPAP, a widely popular program launched in 1995, which facilitates Medicaid funding for home carers chosen by patients themselves at hours they arrange. Participants spoke to Mother Jones about how the program allows them to remain in their communities, rather than being institutionalized—a cause central to disability rights activism. Without access to workers who understand their needs, like assisting people with spinal cord injuries with toileting, those participants risk hospitalization, placement in restrictive long-term care, or both.

The program is run through “fiscal intermediaries,” which provide financial and administrative oversight; some specialize in helping certain groups, such as the Bengali immigrant community. Hochul’s plan would make the program an administrative monopoly: by October, one middleman—potentially an out-of-state, for-profit firm—will hold a $40 billion contract covering all 250,000........

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