Paralyzed at 7, she fought for the life she wanted. Medicaid cuts threaten to take it away.

For a half-century, U.S. policy has pushed to keep disabled Americans out of institutions. Now Rebecca Anger and others fear that era could end.

CHICAGO — Rebecca Anger has spent much of her life chasing a dream. Not an extravagant one, but the sort that many Americans quietly work toward: a career with purpose, a home of her own and a spouse to share it with. At 41, despite extraordinary obstacles, she has largely built that life.

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She and her husband live in a condo overlooking Lake Michigan, a few blocks from Wrigley Field. They spend their free time cheering on the Cubs, attending concerts and traveling. During the week, she works as a lawyer helping vulnerable Chicagoans stay in their homes.

Increasingly, however, Rebecca is haunted by a question about her future: What will happen if she loses the paid caregivers who lift her out of bed each morning, bathe her, feed her and help her through her workday?

The past year has provided plenty of reasons to worry. She and millions of other disabled Americans rely on Medicaid for the care that enables them to live in their own homes rather than in institutions. But that fragile support system has come under assault. Massive funding cuts in President Donald Trump’s “big, beautiful bill” and mounting political attacks have left her terrified that the caregivers who make her dream possible might one day stop showing up.

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Around 8 a.m. on a recent Monday, she heard the familiar sound of a key turning in her front door and knew she wouldn’t have to confront that fear today.

“Good morning. How’d you sleep?” one of her longtime aides, Christine O’Connor, called as she stepped inside.

“Pretty good,” Rebecca replied from bed.

Over the next hour, O’Connor lifted her into her power wheelchair, slipped a blouse over her head, brushed her teeth, braided her hair, gave her medicine and fed her scrambled eggs. They’ve repeated the sequence so many times in the 11 years since O’Connor started working for her, words aren’t necessary.

That routine is the foundation beneath everything Rebecca has achieved. She became paralyzed from the neck down at age 7 and has only limited use of her left hand — enough to move a mouse or swipe a cellphone screen, but not enough to lift a glass of water.

Her husband, Greg Anger, has cerebral palsy and also uses a wheelchair. He can help with some tasks but can’t safely carry her. Instead, she relies on Medicaid to pay a rotating cast of caregivers $19.50 an hour to keep her alive.

Few relationships in Rebecca’s life carry higher stakes. If a caregiver skips a shift, she could be stuck in bed for hours, unable to eat, drink or use the bathroom. That’s happened before, and the fear never leaves.

“So you have to find people you can trust,” Rebecca said as she awaited a forkful of eggs from O’Connor.

The system has never felt entirely secure. Every year, Rebecca worries about state budget cuts. Finding reliable caregivers willing to do demanding, intimate work for little more than minimum wage is already difficult.

But over the past 12 months, she has watched the news with a growing sense of dread.

First came Trump’s “big, beautiful bill,” which is projected to slash federal Medicaid spending by nearly $1 trillion over the next decade — the biggest ever cut to the nation’s healthcare safety net. Although the law, signed last year, doesn’t directly target home care, experts expect many states will respond by cutting those services, which are optional under federal law.

Then, beginning this spring, Rebecca noticed a new message gaining traction in conservative circles: that Medicaid home-care programs were wasteful, unnecessary and riddled with fraud . To her, the rhetoric sounded like groundwork for deeper cuts to come.

The latest — and, to Rebecca, most startling — blow landed this month. In a memo , the Justice Department reversed the federal government’s longstanding interpretation of the Supreme Court’s landmark Olmstead decision, which for more than 25 years has required states to allow people with disabilities to receive care in their communities rather than forcing them into institutions. The message was stark: The federal government no longer stood behind the right of disabled Americans to live at home.

For Rebecca and many others, these ruptures feel like a broken promise.

“I’ve been lied to,” Rebecca said. “Go to college, get a good job, get married, build a life for yourself. I did all of that, and it’s all gonna go away because the government can’t afford $60,000 a year to keep me in my home?”

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The White House declined to comment and referred questions to the Justice Department, which didn’t respond to messages. The Trump administration has previously denied that it’s targeting programs for disabled people. Medicaid cuts in the “big, beautiful bill” and the administration’s focus on rooting out fraud aim to protect programs from waste and misuse while preserving services for those who truly need them, officials have said.

In several states, the dismantling is already underway. Disabled Americans have responded by packing statehouses this year to plead with lawmakers.

In Maryland, Alexia Flory, a 33-year-old seminary student with cerebral palsy, is bracing for state budget cuts set to hit July 1 that will slash how much her parents and other workers can be paid to care for her, forcing her family to consider draining retirement accounts. The changes seem destined to force more disabled people into institutions, Flory said, which she called “sadistic.”

In Colorado, Evan Stevens, a 35-year-old with an intellectual disability who relies on help from his aging parents to live independently, worries that a recent state decision to double wait times for a Medicaid residential-care program — one he’s already spent eight years waiting for — will leave him without support when they die. It reinforces his feeling, he said, that policymakers “don’t care about people like us.”

And in Ohio, where lawmakers are pursuing an aggressive Medicaid fraud crackdown , LaTisha Brown, 43, who has cerebral palsy, fears people with legitimate caregiving needs will be caught in the dragnet. If she lost the workers who help her live in her apartment rather than a facility, Brown said, “they might as well silently kill me, because I wouldn’t want to live.”

Back in Chicago, Rebecca has been trying not to dwell on the changes Illinois might consider once Trump’s sweeping Medicaid cuts begin hitting state budgets next year. It’s hard enough getting through each day — navigating the bureaucracy that keeps her caregivers in place while balancing a demanding career helping low-income tenants facing crises of their own.

Disabled people learn early that even hard-won rights are never entirely secure, Rebecca said. But this feels different.

“I’m more worried, honestly, than I’ve ever been,” she said.

For Rebecca’s family , Aug. 2, 1992, is a dividing line. There was life before that date, and life after.

The “before” ended abruptly on a sunny afternoon in Deerfield, a quiet suburb north of Chicago. Rebecca was 7 and had spent most of that summer on her bicycle — a two-wheeler with pink tassels — riding tree-lined streets her parents, Matt and Christie Wylie, considered safe and boring in all the right ways.

Christie had taken her to a birthday party at the neighborhood pool. Rebecca remembers splashing with friends. On the walk home, she noticed her neck was sore.

Had she fallen? Hit her head? Rebecca said no. Figuring she might be coming down with something, her parents sent her downstairs for a nap.

When they woke her an hour later, Rebecca remembers looking at her own motionless hand beside her and asking, “Whose arm is that?”

Matt reached down to sit her up. She immediately flopped back, limp and heavy. Rebecca was the oldest of four. For a moment, her parents wondered if this was an elaborate attempt to get attention amid the chaos of a crowded household.

“You better not be kidding,” her father recalls telling her. “This is serious.”

Her response was calm but certain: “Dad, I can’t move.”

Rebecca remembers her father carrying her to the car. Being wheeled through an emergency room. Struggling to take a breath.

After intubating her, doctors began to piece together the mystery unfolding inside her: At the birthday party that morning, or perhaps days before, Rebecca’s immune system had made a catastrophic error. Having recently fought off a virus, it had begun attacking her own spinal cord — a condition called transverse myelitis that is so rare that it touches perhaps 1 in a million people each year.

White blood cells and inflammatory proteins were flooding into her backbone, damaging nerve fibers that carry electrical signals between brain and body. Neural pathways controlling core bodily functions — feeling in the limbs, movement and breathing — were collapsing one by one, like circuit breakers tripping in rapid succession. By the time doctors understood what they were dealing with, the window to reverse the damage had closed.

Rebecca woke two days later with a ventilator breathing for her — “a brain trapped in a body,” she remembers thinking.