Medicaid enrollment drops by 2.3 million in fiscal 2027 once the One Big Beautiful Bill Act's work requirement is running, the administration itself projects, and David Rouzer of North Carolina's 7th District gave that law his aye on July 3, 2025, after a May vote the House version needed. From 2027, a disabled adult in the expansion group must either fit one of the law's exemptions or log the hours.
In February and April 2025, Rouzer's ayes decided the budget resolution that gave Medicaid's committee an $880 billion target, pressure that lands on the home care disabled North Carolinians depend on. His district counted 31,600 Medicaid enrollees with disabilities in 2025, and 22,300 North Carolinians are on waiting lists for Medicaid home care.
David Rouzer's Votes on Medicaid for People With Disabilities
- Disabled Expansion Adults Will Have to Qualify for an Exemption or Log Hours, and 2.3 Million Lose Medicaid Nationally, Under Work Rules Rouzer Voted For. Rouzer was in the 218-to-214 majority that gave the One Big Beautiful Bill Act final passage on July 3, 2025, following his May aye as one of the 215 who carried the House version over 214. Starting by January 1, 2027, covered adults owe the state a monthly showing of 80 hours of work or comparable activity unless an exemption applies; the exemptions include people disabled under the SSI definition, people with a serious or complex medical condition, and a person "with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living." The federal Medicaid agency's own estimate is that "enrollment would be reduced by 2.3 million individuals in FY 2027."
- Rouzer's Ayes Decided the $880 Billion Savings Target for Medicaid's Committee, Leaving Home Care for Disabled North Carolinians More Vulnerable to Cuts. Twice in 2025 the budget resolution, H.Con.Res. 14, hung on Rouzer, adopted first by 217 to 215 (February 25) and then by 216 to 214 (April 10), margins his switch would have turned into a failed tie. It ordered the committee in charge of Medicaid to "reduce the deficit by not less than $880,000,000,000" across ten years. Home and community-based services, which keep people with disabilities out of institutions, are "largely an optional Medicaid benefit," in the Bipartisan Policy Center's words, and therefore "more vulnerable to reductions during periods of state or federal budget constraints"; experts it cites expect the law to "slow or reverse recent HCBS expansion efforts" across states.
What David Rouzer's Votes Cost North Carolinians With Disabilities
- Medicaid carries 31,600 disabled residents of North Carolina's 7th District. Among the 7th District's Medicaid enrollees in 2025, KFF's district figures count 31,600 with disabilities. Their aides, therapies and wheelchairs run through Medicaid, and starting by January 1, 2027, disabled adults in the expansion group will have to qualify for an exemption or report work hours to hold on to it.
- 22,300 North Carolinians are already on waiting lists for Medicaid home care. North Carolina's waiting lists for Medicaid home and community-based services held 22,300 names in 2026, KFF reports. Cuts that fall on optional benefits lengthen those lists, and the people on them keep waiting for the help that lets them live at home rather than in an institution.
- Provider taxes that fund North Carolina home care and behavioral health may be cut. With protecting the expansion likely to come first under the law's provider-tax limits, the state's assessments that pay for home care and behavioral health programs "may be in jeopardy of facing reductions or being eliminated entirely over time," the North Carolina Medical Journal reported.
- 278,281 disabled workers in North Carolina draw on a Social Security system the law strains. Social Security went to 278,281 disabled workers in North Carolina in December 2024, 25,358 of them in the 7th District, and the program's chief actuary estimates the law raises its costs by $168.6 billion through 2034.
Frequently Asked Questions About David Rouzer on Disability rights
What is David Rouzer's record on disability rights under Trump?
David Rouzer's record on disability rights under Trump includes the One Big Beautiful Bill Act. The law as enacted, which got his aye on July 3, 2025, puts disabled adults in the Medicaid expansion group, from 2027, to a choice between an exemption and 80 hours a month of reported work, a rule CMS expects to shrink national enrollment by 2.3 million in fiscal 2027. His decisive 2025 budget ayes set Medicaid's committee the $880 billion savings target that leaves optional home care more vulnerable.
Do disabled Medicaid enrollees in North Carolina's 7th District have to prove an exemption because of David Rouzer's vote?
Disabled enrollees in the expansion group will, under the law David Rouzer voted for: it exempts adults whose disability significantly impairs daily living, people disabled under federal SSI rules and others with serious medical conditions, and CMS says states must generally start "no later than January 1, 2027." KFF lists 56,500 expansion adults on Medicaid in North Carolina's 7th District in 2025; the district's 31,600 enrollees who qualify through a disability are a separate group in the same KFF figures.
What does David Rouzer's vote cost North Carolinians waiting for home care?
Some 22,300 North Carolinians were waiting for Medicaid home care in 2026, and David Rouzer's decisive budget votes handed Medicaid's committee an $880 billion savings target; optional services such as home care are "more vulnerable to reductions," the Bipartisan Policy Center says. Across ten years, the law Rouzer voted for removes $22.5 billion in federal Medicaid funds from North Carolina, KFF estimates.
Last updated: 2026-10-27