Every Monday, Maurine Gentis, a retired teacher, waits for a delivery from Meals on Wheels South Texas.
“The meals help stretch my budget,” Ms. Gentis, 77, said. Living alone and in a wheelchair, she appreciates having someone look in on her regularly. The same group, a nonprofit, delivers books from the library and dry food for her cat.
But Ms. Gentis is anxious about what lies ahead. The small government agency responsible for overseeing programs like Meals on Wheels is being dismantled as part of the Trump administration’s overhaul of the U.S. Department of Health and Human Services. Roughly half its staff has been let go in recent layoffs and all of its 10 regional offices are closed, according to several employees who lost their jobs.
“I’m just kind of worried that the whole thing might go down the drain, too,” Ms. Gentis said.
In President Trump ’s quest to end what he termed “illegal and immoral discrimination programs,” one of his executive orders promoted cracking down on federal efforts to improve accessibility and representation for those with disabilities, with agencies flagging words like “accessible” and “disability” as potentially problematic. Certain research studies are no longer being funded, and many government health employees specializing in disability issues have been fired.
The downsizing of the agency, the Administration for Community Living, is part of far-reaching cuts planned at the H.H.S. under the Trump administration’s proposed budget.
While some federal funding may continue through September, the end of the government’s fiscal year, and some workers have been called back temporarily, there is significant uncertainty about the future. And some groups are reporting delays in receiving expected federal funds.
“There’s a lot of confusion,” said Becky Yanni, the executive director of the Council on Aging in St. Johns County in Florida. She said she has been told that the most recent funding for its Meals on Wheels program and other services might be late.
If the funding does not arrive, “in a lot of communities, you will be looking at cuts in services,” said Sandy Markwood, the chief executive officer for USAging, which represents the network of area agencies of aging.
The community living division helps coordinate services and provide funding for older and disabled Americans so they can stay at home rather than live in a nursing home. With a budget of $2.6 billion, the unit represents a minuscule fraction of total H.H.S. spending.
Under the reorganization introduced by Health Secretary Robert F. Kennedy Jr., the community unit’s responsibilities will be divided among other agencies, including the Centers for Medicare and Medicaid Services and the Administration for Children and Families.
“This consolidation allows the department to better meet the current health needs of vulnerable populations across the country,” a spokeswoman for H.H.S. said in a statement. “This does not impact the important work of these critical programs as it will continue elsewhere within H.H.S.”
So far, several programs under the unit will be eliminated under the proposed budget, including one that provides ombudsmen in nursing homes, to help ensure the safety and welfare of residents, and respite care programs, to provide a break for those caring for an older person or person with disabilities. States would also have more latitude in determining where funds should be allocated.
In addition to meal deliveries, the community living agency supports numerous programs, including the nonprofit Centers for Independent Living, that are staffed by people with disabilities, who help older adults and others with disabilities move out of nursing homes and back into the community, and find services, like transportation and legal assistance.
Theo W. Braddy, the executive director for the National Council on Independent Living, which represents the centers and people with disabilities, said the uncertainty has upended planning.
“Everybody is on edge. We can’t tell them anything because we don’t know anything yet,” he said, adding that no one from the Trump administration or H.H.S. has attempted to contact the group with updates.
Advocates say the recent cutbacks have further marginalized older Americans and those with disabilities. “The bottom line is that people in charge simply don’t care about large swaths of the American people,” said Dr. Joanne Lynne, a clinical professor of geriatrics and palliative care at George Washington University.
“We have made living with disability and old age exceedingly unpleasant,” she said. “We are on course to make it virtually intolerable.”
Community groups like Meals on Wheels are bracing for significant cuts. In addition to the potential loss of funding from the Administration for Community Living, Republican lawmakers are proposing reducing grants to states that use another stream of federal funding. The Trump administration and Republicans are also pushing for significant cuts to the Medicaid program, which provides heath care coverage for low-income Americans.
“We’re concerned about a number of potential threats happening all at once,” said Josh Protas, the chief advocacy and policy officer for Meals on Wheels America, an association of the local nonprofits. About a third of the association’s local units already have waiting lists, he said, and lower funding would result in fewer meals for fewer people.
People who are 60 or older with low incomes, and who have difficulty preparing food for themselves, typically qualify for Meals on Wheels. The demand for services is increasing as food prices rise and more people need assistance. More than two million older Americans receive food deliveries each year, and many say they would have difficulty paying for meals without the program.
“Meals on Wheels is a godsend for me,” said Richard Beatty, a 70-year-old with poor vision and limited mobility living in Baltimore. He receives deliveries four times a week and isn’t sure how he would manage without the program.
If there are cuts in funding, the programs would have to make hard choices about who would be eligible for deliveries. “We would have to make drastic changes to who we were serving,” said Dan Capone, the chief executive of Meals on Wheels South Texas, which serves roughly 300 people a week, including Ms. Gentis. His group also receives private donations, with federal funds accounting for some 40 percent of the budget, he said.
The federal community unit under the ax also plays a key role in supporting disabled Americans, including older individuals.
“So much of the work we do is about giving people dignity in their lives,” said Karen Tamley, the chief executive of Access Living, a Chicago-based center, one of 400 across the United States.
The centers connect people with a variety of services, and offer job and skills training to young adults with disabilities. They may teach someone to drive, or help them find affordable housing.
The Administration for Community Living has helped organizations navigate the state and local bureaucracies responsible for doling out federal funds. When Mr. Capone wanted more clarity as to how Texas was distributing the money, he got in touch with the unit’s regional office in Dallas. “We just started building that relationship with the field office, and that field office is gone,” he said.
“It is frustrating on a practical level,” said Fay Gordon, one of the regional administrators who was let go earlier this month. “These programs are live and need direction.”
Some groups are not waiting before starting to take steps to reduce costs. Brittany Boyd-Chisholm, the chief executive of the Center for Independent Living of Central Pennsylvania, said that more than half of her funding comes through the federal agency. She has asked all the managers, herself included, to take a cut in salary of between 5 and 10 percent and is weighing other actions. She said her center was already underfunded.
No one has provided her with any information about future grants, and her emails have not been returned. “It makes you feel completely on your own,” Ms. Boyd-Chisholm said.
Created under the Obama administration, the agency was intended to unify the work of three other agencies: the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities.
“These programs being together and working together was about efficiency and was about coordination,” said Alison Barkoff, the former acting administrator under President Biden, who stepped down last fall.
During the first Trump administration, at the height of the pandemic, the agency worked with the department’s Office for Civil Rights to ensure hospitals and doctors had clear guidelines so that if staffing fell short they wouldn’t deny care to those with disabilities.
“We had found common ground and issues to work on together,” said Daniel Davis, who worked for the agency’s Center of Policy and Evaluation, whose entire staff was laid off, according to former employees.
