When people hear the words Medicaid cuts, they often picture numbers on a spreadsheet. On Wednesday in Frankfort, those numbers were projected on a PowerPoint presentation.

Yet several basic questions remained unanswered. Kentucky Medicaid Commissioner Lisa Lee and her team were asked about provider recoupments, Medicaid expenditures, and other financial data that could help explain how we arrived at this point. Some of those questions could not be answered with exact figures during the meeting. If we’re making decisions that will affect thousands of Kentuckians, shouldn’t we first be confident that we’re working from complete and accurate information?

Whether this situation is the result of years of financial mismanagement, unavoidable budget pressures, or something else entirely, one thing is certain: the people paying the price are not the ones who made those decisions. They are the people who rely on Medicaid every single day to remain healthy, independent, and connected to their communities.

Much of the public attention has centered on the more than 13,000 patients served by the Lee Specialty Clinic, and rightly so. But these funding pressures extend far beyond one clinic. They reach the direct support professional helping someone get ready for work in the morning, the community access staff member teaching someone how to grocery shop independently, the case manager helping a family navigate a crisis, and the staff member who spends Christmas morning making sure someone else isn’t alone. These are the quiet professionals who make community living possible, yet many earn less than people working jobs that carry far less responsibility. They stay because they believe this work matters.

As we walked toward the Capitol yesterday day, I couldn’t help but notice the beautifully maintained rose gardens. They were stunning. But I found myself wondering why, when budgets become strained, community supports for people with disabilities are so often among the first things placed on the chopping block. We always seem to find money to maintain the things people can see, while asking people with disabilities and the workforce that supports them to accept less.

Kentucky has spent decades moving away from institutional care because we recognized that people with disabilities deserve the opportunity to live in their own homes, build relationships, work, volunteer, worship, and participate in their communities. That isn’t just good policy, it is also fiscally responsible. Institutional care for people with intellectual and developmental disabilities can cost well into the hundreds of thousands of dollars per person each year, while Home and Community-Based Services are designed to provide support in the community at a substantially lower cost.

If our goal is truly to be responsible stewards of taxpayer dollars, then we should be asking whether we’re protecting the services that keep people out of institutions in the first place. Instead of reducing funding across the board, why aren’t we having more conversations about redesigning services to better reflect Kentucky’s own commitment to community inclusion? If there are services that no longer accomplish that mission, let’s have those discussions openly and transparently. But let’s not undermine the very supports that allow people to live the lives they choose.

Medicaid doesn’t just fund healthcare. It funds first jobs, Sunday morning church services, volunteer opportunities, college classes, grocery shopping, cooking dinner, paying rent, and coming home to your own apartment at the end of the day. It funds dignity. It funds independence. It funds belonging.

Budgets can be rewritten. Programs can be restructured. But once we lose experienced staff, trusted providers, and opportunities for people with disabilities to fully participate in their communities, rebuilding those things takes years. The true cost of Medicaid cuts isn’t measured only in dollars. It’s measured in the lives that become smaller because the supports that made independence possible slowly disappeared.