With a vote anticipated on a Republican health care plan that would fundamentally transform Medicaid, disability advocates say the threat to disability services remains very real.

After a week of ups and downs, Republican leaders in the U.S. Senate are determined to hold a vote on health care next week. But precisely what they will vote on remains unclear.

One option is a bill to repeal many tenets of the Affordable Care Act without any immediate plan to replace it.

Alternatively, the Senate could vote on a Republican proposal to repeal and replace the Affordable Care Act that’s been in the works for months and is similar to legislation passed by the U.S. House of Representatives in May.

That plan calls for monumental changes to Medicaid, a program which millions of Americans with disabilities rely on for everything from doctor and hospital coverage to supports that enable them to live and work in the community.

Currently, Medicaid operates as an entitlement, with the federal government providing matching grants to help states cover the cost of services for anyone who meets eligibility requirements. Under the Republican proposal, however, Uncle Sam would provide a fixed amount for each beneficiary regardless of the true cost of their care leaving states to make up any difference.

The Congressional Budget Office said this week that the most recent version of the Republican bill to replace the Affordable Care Act would lead to $756 billion less in federal funding for Medicaid by 2026.

Such a decline in spending would no doubt force states to scale back their offerings, disability advocates say. And, since home and community-based services are considered optional under current Medicaid policy, these offerings would likely be the first to go, they say.

It’s not certain that either approach — repeal and replace or repeal and delay — has the votes to succeed. But advocates are leaning on people with disabilities and their families to speak up.

“We’re telling our base, and people across the country, that it’s not over yet,” said Julia Bascom, executive director of the Autistic Self Advocacy Network. “We have to fight harder than ever in these final days to save Medicaid and protect our health care, and we need every voice to do it.”

Earlier this week, The Arc hand-delivered nearly 1,000 letters to Senate Majority Leader Mitch McConnell, R-Ky., and Senate Minority Leader Chuck Schumer, D-N.Y., from people nationwide expressing why Medicaid matters to them.

Meanwhile, the self-advocacy group ADAPT, which has held demonstrations on Capitol Hill and in numerous cities that have led to dozens of arrests over the last month, continues to hold protests calling on senators to oppose the health care bill. And, the National Council on Independent Living is hosting a march and rally for disability rights in Washington on Tuesday.

“We urge senators to oppose this legislation,” said Peter Berns, CEO of The Arc. “The cuts to Medicaid included in this bill are an assault on people with disabilities.”