Funding for community-based services and other supports for people with developmental disabilities would be in jeopardy under a U.S. Senate proposal to radically alter Medicaid.

After weeks of secret discussions, Senate Republicans unveiled their plan to overhaul the nation’s health care system on Thursday and it calls for severe cuts to Medicaid much like the version passed by the House of Representatives in May.

Traditionally, Medicaid has operated as an entitlement with the federal government providing matching grants to states to cover the cost of caring for those who are eligible, no matter how expensive.

Like the House bill, however, the Senate proposal seeks to fundamentally transform Medicaid by shifting the program to a “per-capita cap” system where states would receive a set amount of money from the federal government for each beneficiary irrespective of actual costs. States would be left to make up the difference.

Republicans say this approach will strengthen Medicaid by giving states more flexibility. But disability advocates contend that less funding coming from the federal government will simply place critically-needed services at risk.

For people with disabilities, Medicaid pays for everything from traditional health services like doctor and hospital visits to personal care attendants, employment and behavior supports, assistive technology and other offerings that allow individuals to live in the community.

School districts across the country also rely heavily on Medicaid for about $4 billion annually to offer speech and occupational therapy, wheelchairs and specialized playground equipment, among other assistance, to students with disabilities.

“This bill will have a devastating impact on individuals with intellectual and developmental disabilities and their families,” said Peter Berns, CEO of The Arc.

“More than 10 million people with disabilities rely on Medicaid to live and work in their communities,” he said. “Home and community-based services are optional or waiver services for states and, when facing a loss of billions in federal funding, they are what is likely to be cut first.”

An analysis from the Congressional Budget Office indicates that the bill passed by the House would lead to $834 billion less in Medicaid spending over 10 years. An assessment of the Senate bill is not expected until next week, with a vote likely shortly thereafter.

As Senate Majority Leader Mitch McConnell, R-Ky., took to the Senate floor Thursday morning to hawk the bill he authored, dozens of activists with the disability rights group ADAPT converged outside his Capitol Hill office to protest the proposal by staging a “die-in.”

“To say people will die under this law is not an exaggeration,” said Mike Oxford, an ADAPT organizer from Kansas. “Home and community-based services are what allow us to do our jobs, live our lives and raise our families. Without these services many disabled and elderly Americans will die. We won’t let that happen.”

Numerous protesters removed themselves from their wheelchairs and laid on the floor blocking the hallway, according to U.S. Capitol Police who arrested 43 of the demonstrators citing them with crowding, obstructing or incommoding.

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