amna: President trump's one big beautiful bill was passed into law last summer and, according to the nonpartisan congressional budget office, it will slash more than $1 trillion in federal spending from medicaid and the children's health insurance program by 2034.

Judy woodruff examines what those cuts could mean for home and community care providers who serve adults with special needs.

It's part of her ongoing series, "Disability reframed."

>> Frannie.

Judy: The mornings are often filled with fist bumps and high-fives.

What is the plan for today?

He is the president a bright center, a day center for adults with special needs in manassas, Virginia.

>> This is where we do a lot of our activities.

Judy: Five days a week the center provides education and a host of activities like exercise class, arts and crafts, and meditation.

In 2014, he started the center with his wife who was born with sickle cell anemia.

At the time she told him she had always dreamed of creating a center like this.

>> When she came through with that idea I was like, why do you want to do that?

[Laughter] After her explaining that to me, it was her passion, she wanted to get back to the community and make a difference.

>> By 2021 he was working three jobs to help that vision become a reality.

And when they moved to a larger building so they could help more special-needs adults.

But then his wife's condition took a turn for the worse.

>> June 3 was the worst day of my life.

The worst phone call of my life.

Even to this day I can picture it.

>> His wife Dr.

Called to say she had died unexpectedly in the hospital.

Leaving him without -- leaving him with two young children.

>> I was not able to function for a month and a half.

She was everything.

I can do this without her.

>> But today, more than four years later, he says he is still committed to keeping his late wife's dream alive for people like Imani bush who has an intellectual disability.

What kind of things you do when you are here?

>> What kinds of things?

Well, I like to color.

I like to do meditation.

I like to watch movies.

I like to hang out with all my friends.

Judy: In 2020, bright center was serving nearly 30 special-needs adults.

Nce the pandemic hit he said it has been a steady decline and today just 14 individuals attend and I'll pay with Virginia medicaid waivers which allow for care outside of institutions.

While the bulk of the cuts of medicaid are not expected to kick in until next year, states are bracing to lose more than 900 million dollars over the next decade.

>> This is the singha's stash single biggest rollback and people with disabilities are much more likely to rely.

>> Alice burns studied medicaid.

He said Virginia is expected to lose its funding.

In days like bright center could be dealing with funding cuts.

We know that community care for people disabilities is a significant source of medicaid funding and almost all the services are optional.

>> There are no cuts to medicaid, there are just restrictions to grow medicaid.

>> The trump administration has said there would be no cuts to medicaid and it is committed to rooting out waste, fraud, and abuse in the program.

The department of health and human services provided the news hour with this statement which reads in part, the one big, beautiful bill removes illegal immigrants from eligibility, implements work requirements for able-bodied adults, and safeguards medicaid for the vulnerable population.

Pregnant women, children, low income seniors, people with disabilities, and struggling families.

UT Lori sills is worried about what those changes will mean for her 28-year-old son Nicholas.

>> Quite frankly, Nicholas is a wonderful kid, he really is, but he needs some support in just about everything he does.

>> Is a young boy he was diagnosed with cerebral palsy and that autism.

He has been coming to bright center since 2019.

>> He is here with people his own age and hear with people he is involved with.

He has staff that cares for them and he loves the staff here.

It is a place that I know he's comfortable coming to and that I'm comfortable bringing him to every day.

Can you scoot over a little bit more?

> She says bright center is the only nearby day program that excepts the medicaid waiver to pay for the service and she says she would be forced to shoulder her son's around-the-clock care.

>> He is never left alone, he likes to go into the kitchen and he will press buttons, he will go to the stove.

I don't in general have babysitters or any family in the area.

I really don't have any other care for him but me right now.

Judy: It is a common story for parents of bright center.

>> Once they graduate from high school they wash their hands.

That is what we call it.

> Virginia's medicaid program currently reimburses bright center $69 per student per day, but he says that is barely enough to keep going.

While he is already relying on donations, in his own savings to stay open, it is what could come next that will resend most.

We are at a moment where the federal government is making some changes, how is that affecting what your outlook is.

>> It will affect us because we may end up losing the small students we have now.

>> For parents she is already feeling the impacts of budget cuts.

She said last fall the state reduced the number of hours she will be reimbursed as her son's primary caregiver going forward.

>> I'm sure there is some waste, fraud, and abuse, I'm sure there is throughout the system but every case is not waste, fraud, and abuse, summative visuals really need the care and quite frankly, that is my son that really does need to care.

Judy: Care that could become even harder to find for so many families across the country.

For the pbs news hour, I'm Judy woodruff in manassas, Virginia.

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