Messages from our CEO: Kickin’ It with Kimberly
It’s essential to us that we keep you well-informed about current issues and barriers affecting people with disabilities. Our CEO, Kimberly Tissot, recognizes that you are at the heart of our efforts to promote disability rights, justice, and freedoms. Letters will be written to you, our key supporters, about the injustices we uncover and the solutions we can offer as a disability-led organization.
March 2026
Kickin’ It with Kimberly: When the Supports That Keep People Alive Are Called “Fraud”
Over the past few weeks, a narrative has been circulating nationally about Medicaid fraud and the need for stronger enforcement. Federal agencies like the Centers for Medicare & Medicaid Services have announced investigations and policy changes in response to concerns about the misuse of funds. Accountability in public programs is critical, and fraud should absolutely be addressed, investigated, and prosecuted when it occurs. The disability community wants integrity in these programs just as much as anyone else. But don’t punish us for a failed system.
But here’s the problem: when policymakers and commentators start throwing around broad rhetoric about Medicaid “fraud,” the people who end up paying the price are almost never the ones committing it. They are the people who rely on Medicaid to live.
For millions of disabled people, Medicaid funds Home and Community-Based Services (HCBS), the basic supports that make daily life possible. HCBS is the caregiver who arrives in the morning to help someone with significant disabilities safely get out of bed. It helps with bathing, dressing, and preparing meals. It is the support worker who makes sure someone takes their medication, gets to work or school, and participates in their community. It is the assistance that allows someone to sleep safely in their own home instead of being forced into an institution. These services are not luxuries but necessities for survival.
Without HCBS, many people would have only one option, and that would be being forced into institutions such as nursing homes or Intermediate Care Facilities (ICFs) for people with intellectual and developmental disabilities. These settings are restrictive, segregated, and often far more expensive for taxpayers than supporting someone in their own home or community-based setting. And why are policymakers ignoring the fact that supporting people in their homes costs roughly half the amount of institutional care? HCBS is not only the humane choice but also the fiscally responsible one.
Yet while policymakers debate “fraud,” some are making statements that reveal just how little they understand about the lives of disabled people. One recent appointee suggested that families should simply provide these supports themselves.
Let’s pause there for a moment.
Because apparently in this person’s world every disabled person has a full-time, medically trained, financially stable, emotionally available family member just waiting at home to provide round-the-clock care. No job. No bills. No aging bodies. Just unlimited time, energy, and a spare nursing degree sitting next to the crockpot. And I guess these families must also live forever.
That’s not reality.
Not everyone has family. Many disabled people live on their own in their own homes in the community. Others have parents who are in their seventies or eighties. Many families are already providing extraordinary amounts of unpaid care, often at the cost of their jobs, their finances, and their own health. Suggesting families can just “handle it” isn’t a serious policy proposal. It’s what happens when someone has never actually talked to the people affected by the policy.
And while the conversation is fixated on supposed fraud in community services, almost no one is talking about what actually happens inside institutions.
Fraud, abuse, neglect, sexual assault, and deaths in institutional settings have been documented for decades. South Carolina is no stranger to that reality. Just a few months ago, a teenager died in an Intermediate Care Facility after being restrained and held down. A young life lost in a segregated setting that was supposed to provide care and protection. Other youth witnessed it, yet people are still being admitted to these places.
Where is the national outrage about that?
Where are the press conferences about institutional abuse? The emergency hearings? The speeches about protecting disabled lives?
For decades, the disability community has been pointing out something policymakers still seem reluctant to acknowledge – segregated systems create the conditions where abuse thrives. When people are isolated from their communities and placed in settings where staff control every aspect of daily life, when meals, schedules, movement, and even personal choices are dictated by the facility, accountability becomes harder, and harm becomes easier to hide.
Community living does the opposite. When people live in their own homes and neighborhoods, surrounded by coworkers, friends, neighbors, grocery stores, bus drivers, and the regular chaos of everyday life, there are more eyes, more connections, and more accountability.
Integration protects people. Segregation isolates them.
And here in South Carolina, this conversation carries even more weight. Just recently, the state entered into a settlement agreement with the U.S. Department of Justice acknowledging that South Carolina must improve access to community-based services for people with disabilities under the Americans with Disabilities Act and the integration mandate established in Olmstead v. L.C.. In other words, the state committed to doing more to ensure people with disabilities can live in their communities rather than institutions.
Yet almost simultaneously, the South Carolina House of Representatives passed a $27 million cut to Medicaid.
You cannot promise the federal government you will expand community supports while simultaneously cutting the funding that makes those supports possible. That’s like promising to build a bridge and then selling the lumber.
South Carolina already has one of the largest waiting lists for disability home and community-based services in the country. Individuals and families wait years, sometimes decades, for the support their loved ones need. For far too long, our system has revolved around a harmful question: “Where do we put them?”
The real question should be: “How do we support them in the community?”
HCBS is the answer. It is how people get out of bed. It is how they eat, take medication safely, go to work, attend school, and participate in their communities. It is how people live with dignity rather than in isolation.
If anything needs to change, it is not that these services should be cut. It is that HCBS must be strengthened, stabilized, and fully funded. We should be investing in the direct care workforce, reducing waiting lists, improving oversight where necessary, and ensuring people with disabilities can live safely in their homes and communities.
So here is the challenge.
If you live in South Carolina, contact your legislators in the South Carolina General Assembly and tell them that cutting Medicaid and HCBS is unacceptable. These services are not political talking points. They are lifelines.
And to the broader public, I ask something simple: before repeating claims that Medicaid is riddled with fraud, take a moment to understand what these services actually are and the oversight process.
Because when people dismiss HCBS as wasteful spending, they are not just criticizing a policy. They are dismissing the supports that allow people to get out of bed, eat, breathe, work, and live in their own homes.
And if those supports disappear, the system will still spend the money.
It will just spend more on locking people away in institutions, which is both wasteful spending and true cruelty to the disability community. Y’all, that is the real fraud.
And frankly, the disability community is tired of being the punchline of policy decisions made by people who have never had to live with the consequences.
Join us in our advocacy by supporting our work: AllAble-SC.org.
– Kimberly Tissot, President and CEO, Able South Carolina
For nearly 32 years, Able South Carolina has been a critical force for disability rights, belonging, and the right to live on one’s own terms. As a disability-led organization, we don’t just serve our community—we are the disability community. We Are All Able SC! We’re calling on allies, advocates, and community members to generously invest in disability empowerment and justice. Please invest in those most affected and impacted by policy decisions. Visit allable-sc.org today to make a donation.