By Tami Wantola, BSN, RN and Sandra Zawalski, MSN, RN, CRRN, CCM 

In January 2025, Maryland’s disability community was blindsided by the unthinkable: a proposed $200 million slash to the Developmental Disabilities Administration (DDA) budget (Maryland Department of Health, 2024). This isn’t just an accounting adjustment—it’s a gut punch to thousands of families. Children with autism, cerebral palsy, and other developmental disabilities now face the loss of critical services that safeguard their progress, safety, and hope for a meaningful life (Disability Rights Maryland, 2024). 

What’s Being Cut—and Who’s Being Hurt 

The governor’s proposal threatens to unravel the very fabric of support for our most vulnerable: 

• Elimination of Geographical Differential Rates ($55 million cut): 
  In high-cost counties like Montgomery and Prince George’s, payments to residential providers could plummet by up to 20%. This means group homes will close, forcing children into unfamiliar—and sometimes unsafe—settings (Maryland Department of Health, 2024). 

• Termination of the Low Intensity Support Services Program (LISS): 
  Families will lose up to $2,000 a year for essentials like adaptive seating, sensory equipment, and emergency respite care—resources that often prevent a crisis from spiraling out of control (The Arc Maryland, 2024). 

• Reduction in Self-Directed Services Funding ($14.5 million cut, pending legislative approval): 
  Parents will no longer be able to hire and train trusted caregivers outside of traditional agencies, eroding cultural fit and continuity of care (Disability Rights Maryland, 2024). 

Together, these cuts don’t just trim fat—they dismantle the customized care model that gives families the power to meet their child’s unique learning, behavioral, and health needs. 

The Real-World Impact 

Regression and Safety Risks 
Without steady, one-on-one aides, children with severe communication or mobility challenges lose hard-won language and motor skills. When overnight respite is canceled, exhausted parents are pushed past their limits—emergency room visits spike, and the risk of injury or crisis skyrockets (Broadwater, 2024). 

Workforce Flight 
Direct support professionals are fleeing for better pay in neighboring states. In Baltimore City, vacancy rates top 30%. Untrained siblings and grandparents are left to fill the gap, risking both physical harm and emotional trauma (The Arc Maryland, 2024). 

Emotional and Financial Strain 
Parents now face mountains of paperwork—10 to 15 pages per service request. Many agonize over whether to cut work hours or risk losing paid leave, turning stable homes into financial tightropes (Disability Rights Maryland, 2024). 
 

How Case Managers and Caregivers Can Fight Back 

0. Amplify Family Voices: 
   Gather anonymized impact stories and bring them to budget hearings or county councils. Host virtual panels so parents and teens can speak directly to lawmakers. 

0. Educate Professional Allies: 
   Create toolkits for financial, legal, and HR partners outlining the true costs of service loss—higher ER bills, workplace absenteeism, and mental health crises. Host lunch-and-learns to connect policy changes to business realities. 

0. Support Self-Directed Families: 
   Develop checklist templates for new paperwork and appeals. Set up peer mentor circles so veteran parents can guide newcomers through the maze. 

0. Engage Legislators Strategically: 
   Coordinate district-wide letter-writing campaigns with clear, heartfelt talking points: “I am writing as a case manager…” Arrange in-district visits with coalition groups and arm legislators with budget impact maps (Maryland General Assembly, 2024). 

0. Build Community Resilience: 
   Partner with autism nonprofits, faith groups, and local businesses to create emergency respite co-ops. Launch volunteer buddy programs for daily tasks like grocery runs, giving parents a much-needed break. 

This Is About Commitment, Not Cost 

When lifelines are cut, progress unravels. Maryland’s disabled children and their families deserve more than empty promises—they deserve dignity, inclusion, and the resources to thrive. Now is the time to advocate for restored funding and remind our leaders: every dollar cut is a child left behind. 

Let’s transform outrage into action. Case managers play a vital advocacy role for vulnerable populations, ensuring their voices are heard and their needs are met. By standing together, speaking up, and taking action, we can ensure no family is marginalized or left without support. Empowering case managers means empowering lives and fostering equity in our communities. 

Bio: Tami Wantola is a registered nurse with 30 years of nursing experience in a variety of clinical settings that includes intensive care, cardiac catheterization laboratory and emergency room. She has extensive experience in case and utilization management in both the hospital and health plan settings. Tami has managed staff and developed training programs. In addition, some of her leadership responsibilities included oversight of pre-certification and concurrent review for commercial, governmental, indemnity, and self-insured health plans. Tami is a designated ATD Master Trainer and ATD Master Instructional Designer.

Bio: Sandra Zawalski is a registered nurse with almost 40 years of experience in a variety of clinical settings that includes orthopedics, brain injury rehab and neonatal intensive care. There is extensive experience in case management for payers and providers holding leadership positions in each, as well has owning her own consulting business. She has a Master’s in Nursing with a focus on education, is a board-certified case manager, certified rehabilitation nurse, certified as a Medicare Set Aside Consultant, a member of the American Board of Disability Analysts and a designated ATD Master Trainer. Sandra has published numerous articles in case management professional journals, is a regular contributor to CMSA Today and was a regular contributor for Just Begin magazine. Sandra is a former commissioner for CCMC, a former chair and has had the privilege of speaking at national conferences including CMSA and CCMC’s New World Symposium as well as a certified Cert 360 facilitator for CCMC.