Trump Administration’s Actions Threaten Employment Conditions and Care for Millions
Just three weeks since President Trump took office for his second term, his Administration has already brought unprecedented disruption to our federal government.
The President and his allies are taking steps that will significantly weaken the nation’s long-term care infrastructure, including by drastically worsening employment conditions for the more than 5 million direct care workers who provide essential care and support for older adults and people with disabilities each day.
In deeply concerning developments this past week, the broad sweep of federal agencies carried out by the Administration’s Department of Government Efficiency (DOGE) directly targeted the Centers for Medicare and Medicaid Services (CMS) and Department of Labor (DOL), among other agencies.
DOGE has focused on gaining direct access to the most sensitive data maintained by these agencies—including individual employment records, labor statistics vital to our understanding of the direct care workforce, and program beneficiary information— risking the breach, misuse, or even erasure of essential data sets.
These actions followed a January 29th Office of Management and Budget (OMB) freeze on federal grants and programs that directly impacted access to Medicaid payment portals across states, which sowed confusion and uncertainty about the provision of vital health and long-term care services.
During the same period, Elon Musk referred to Medicare and Medicaid services as “where the big money fraud is happening.” This rhetoric comes as CMS, which ensures health coverage for more than 160 million Americans, is a likely target for devastating reductions in spending, as DOGE seeks to cut $2 trillion from the federal budget.
According to multiple reports over the past month, Congressional Republicans are considering deep cuts to the Medicaid program, which by itself covers one in five Americans (72 million people). The impact of such ill-advised cuts will fall particularly hard on direct care workers. Medicaid is the primary payer of long-term care services, and nearly one in three direct care workers (31 percent) rely on Medicaid for their health coverage.
The Administration’s controversial federal employee buy-out offer—already accepted by more than 60,000 federal staff—will drastically undermine the power of agencies like CMS to bring essential services and supports to the people who need them most. These developments represent a systematic effort to diminish the capacity and standing of federal agencies, threatening the infrastructure of our nation’s vitally important care services.
Taken alongside threats of mass deportation and efforts to end diversity, equity, and inclusion initiatives in the public and private sectors, these policy shifts signal explicit disregard for the lives and livelihoods of millions, including but not limited to the women, women of color, and immigrants who represent the vast majority of direct care workers, and the people with disabilities and older adults who rely on their care and support.
The U.S. long-term care system has long struggled with inadequate funding and fragmented oversight, contributing significantly to underinvestment in the direct care workforce. Further dismantling of federal agencies and funding programs will only compound historical inequities that have held this workforce and the long-term care system back.
As legal challenges mount to the Trump Administration’s efforts, the stakes for advocates, provider employers, policymakers, direct care workers, and people and families across the country are clear: care for tens of millions of Americans—and the livelihoods of countless direct care workers—are at risk of being significantly compromised.
We need a long-term care system that provides affordable, high-quality, continuous care to Americans in the settings of their choice. Direct care workers deserve family-sustaining wages, meaningful opportunities for training and advancement, and professional recognition for the essential care and support they provide. Leadership choices that fail to acknowledge these realities—in fact, leadership choices that willingly risk catastrophic consequences for the millions of people and families whose lives intersect with an already challenged system—do not have our collective best interests at heart.
