The U.S. House of Representatives voted to approve a budget framework that could lead to more than $800 billion in cuts to Medicaid, an amount that would ravage the nation’s disability services, advocates say.

The move this week serves as a critical step for House lawmakers as they race to pass a government spending plan ahead of a March 14 deadline to avoid a shutdown. While the measure does not detail specific cuts, it calls for the House Committee on Energy and Commerce, which oversees Medicaid, to reduce spending by at least $880 billion over the next 10 years.

“We are gravely concerned,” said Lydia Dawson, vice president for government relations at the American Network of Community Options and Resources, or ANCOR, which represents disability service providers nationally. “This type of a drastic cut will almost certainly lead to significant and devastating cuts to Medicaid funding, which would negatively impact state budgets and reduce access to community-based services for people with IDD.”

The spending bill passed the House by a vote of 217 to 215. No Democrats voted for the measure.

Republicans are pushing through spending cuts to offset an extension of President Donald Trump’s tax cuts and deliver on other administration priorities. But, potential cuts to Medicaid are worrying even some Republicans and nearly derailed the House vote this week.

The Medicaid home and community-based services system, which serves as the backbone of supports for people with developmental disabilities in this country, is already under tremendous strain. More than 700,000 people are on waiting lists for Medicaid waivers, which provide home and community-based services, according to KFF, a nonprofit that conducts health policy research. Meanwhile, even those with waivers have struggled to get supports.

A recent survey of nearly 500 community-based services providers nationally found that almost all had faced moderate or severe staffing shortages in the previous year. As a result, 69% had declined new clients and 39% closed programs or services, with over a third saying they were considering further cuts.

Now, the House and Senate must agree on legislation with specifics about the budget plan and what it would mean for Medicaid and other programs.

Disability advocates are warning that the magnitude of cuts called for in the House blueprint would directly threaten home and community-based services, which are considered optional Medicaid offerings under federal law.

“If cuts of this magnitude are allowed to become law, it is not hyperbole to say that the results would be catastrophic for people with disabilities, family caregivers, direct support professionals,” said Nicole Jorwic, chief of advocacy and campaigns at Caring Across Generations, an organization advocating for caregivers and people who rely on them. “Service providers will have to close, the workforce crisis that already exists will get exponentially worse and waiting lists around the country will grow.”