With former President Donald Trump returning to the White House, advocates say they are bracing for his administration to push major changes to Medicaid and other programs that people with disabilities rely on.

Trump reclaimed the presidency this week after defeating Vice President Kamala Harris. While the campaign largely steered clear of disability issues, advocates say that Trump’s record during his first term offers reason for worry.

“Based on actions taken during the first Trump administration, we are concerned with what (the) election will mean to the funding and structure of many important programs for people with disabilities like Medicaid, (Individuals with Disabilities Education Act) funding, enforcement of civil rights laws, among others,” said Eric Buehlmann, deputy executive director for public policy at the National Disability Rights Network. “Efforts to radically restructure Medicaid and pay for tax cuts for corporations by cutting other programs, are things we saw last time and expect to be tried again.”

Many of these types of policy changes are echoed in Project 2025, a 900-page conservative playbook from the Heritage Foundation. Though Trump has distanced himself from the plan, it is widely viewed as a possible blueprint for his second term.

Before this week’s election, the Consortium for Constituents with Disabilities, a coalition of national disability organizations, was raising alarm bells about Project 2025. The group called out proposals to restructure Medicaid and impose lifetime eligibility limits on the government health program as well as sweeping changes to the way that special education is funded, a plan to eliminate the U.S. Department of Education and measures that they say would weaken civil rights protections for people with disabilities.

“People with disabilities need strong federal laws, policies and programs that take their needs and aspirations into account,” reads a statement about Project 2025 from the Consortium for Constituents with Disabilities. “The Heritage Foundation’s Project 2025 plan would eviscerate these standards and push disabled people back to an earlier, shameful era of isolation, exclusion and institutionalization.”

Kim Musheno, vice president of public policy at the Autism Society of America, said her group is particularly worried about any moves the new administration might take to retool health care policies that benefit people with disabilities.

“The Affordable Care Act has been life changing for everyone, especially those with pre-existing conditions, such as autism. Medicaid is literally a lifeline for people with disabilities who depend on home and community-based supports to be able to live with their families, work in the community and stay out of more expensive institutions,” she said. “We fought back attempts to repeal the Affordable Care Act and proposals to (cut) Medicaid before. If similar proposals come forward in the new Congress, we will be ready to defend them again.”

Meanwhile, Zoe Gross, director of advocacy at the Autistic Self Advocacy Network, said advocates are also concerned about the possibility of the government circulating misinformation about autism and vaccines. Trump has reportedly promised a role in his administration to Robert F. Kennedy Jr., who has spent years speaking out about a link between the two, despite studies finding no connection.

During the campaign, Trump faced backlash from disability advocates and members of both political parties for referring to Harris as “mentally impaired” and “mentally disabled.” In addition, Trump’s nephew, Fred C. Trump III, alleged that the former president told him that people like his son, who has intellectual and developmental disabilities, “should just die.”

Nonetheless, Maria Town, president and CEO of the American Association of People with Disabilities, said she’s optimistic that it will be possible to find common ground.

“Regardless of who won, many disabled people have long felt that Social Security and Medicaid’s current levels of function have left a lot to be desired. It’s possible that Trump will be open to some of the changes the community has hoped for in those programs,” she said. “We hope we are all able to move forward and turn a new leaf to create the most positive working environment possible.”