With his latest budget proposal, the president is calling for significant changes to Medicaid that advocates say would have big consequences for people with disabilities.

President Donald Trump released a $4.75 trillion plan Monday to fund the federal government for the next fiscal year. The proposal features broad cuts to domestic spending, an increase in funding for defense and money for a wall along the border with Mexico.

Within the budget request is a plan to “give states additional flexibility over their Medicaid programs” through per capita cap or block grant systems.

Essentially, rather than send matching grants to states to cover whatever services are provided to beneficiaries no matter the cost, Trump’s plan would see the federal government provide a fixed amount of money to states each year for Medicaid services.

The approach has been pushed by Republicans several times in recent years as a way to rein in spending on the entitlement program. It is broadly opposed by disability advocates who say that limiting federal spending would squeeze states and jeopardize their ability to fund services that people with developmental disabilities rely on.

In a statement this week, The Arc said Trump’s budget request “would put the lives of people with disabilities at risk.”

“The proposal includes deep cuts to Medicaid, the core program providing access to health care and home and community-based services for people with disabilities,” the group said.

Aside from Medicaid, the budget request calls for cuts to numerous programs including state councils on developmental disabilities, independent living programs and respite care efforts while slashing funds altogether for Special Olympics’ education programs and doing away with a $51 million initiative to address autism and other developmental disorders.

One area spared from cuts is special education, with Trump proposing level funding for grants under the Individuals with Disabilities Education Act at $13.2 billion.

“Tough decisions were made, but we made sure that this budget protects our most vulnerable students by requesting level funding for Title I and IDEA,” said U.S. Secretary of Education Betsy DeVos.

Advocates have warned over the years, however, that maintaining the same amount of funding year after year does not yield the same level of services since it does not account for inflation.

The budget request serves as a blueprint of the president’s priorities, but it’s up to Congress to decide how to allocate federal dollars.

“The good news is that Congress will write the annual appropriations bills and it has been supportive of most annual funding programs that support people with autism,” said Kim Musheno, vice president of public policy at the Autism Society of America.

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