From the Coordinator’s Desk
Facing Fiscal Reality—and Defending What Matters
February 2026
Mayor Bowsers recent budget briefing for the city council made clear that the District is entering one of the most difficult fiscal environments since the Great Recession. If current services are maintained, the city is facing a projected shortfall of at least $1.15 billion.
Two forces are driving this challenge.
First, operating costs are rising sharply—more than $450 million across government—driven by transit subsidies, overtime, and other core expenses. Second, the one-time surplus funds that helped balance budgets over the past five years are now largely exhausted. Those temporary resources are gone.
At the same time, revenue growth is modest. Current projections show only about $9.6 million in new revenue for FY 2027—far too little to absorb growing demands. The result is clear: the next budget cycle will involve extremely difficult choices, likely more severe than last year’s.
We are already seeing reduced funding in future years for violence prevention, emergency rental assistance, and other essential supports. Medicaid and publicly funded health care continue to grow, even after recent cuts, with more than 40 percent of DC residents relying on these systems. Child care subsidies face major gaps. Agency directors have been instructed to submit reduced budgets, not expansions.
City leaders have been candid. They have compared this moment to the depth of the recession years.
So why does this matter for long-term care?
Because our sector sits at the intersection of health care, workforce development, housing stability, and family support. When fiscal pressure increases, long-term care is often among the first areas to feel cuts and the last to be fully restored.
This moment requires realism and strategy.
We cannot assume that investments in workforce stability, home- and community-based services, and quality care will be protected without strong, coordinated advocacy. We must be disciplined, data-driven, and unified in making the case that long-term care is not optional. It is essential infrastructure for the District.
Yesterday’s briefing was meant to ensure that everyone is operating in the same reality. Now, so are we.
Our task is to ensure that older adults, people with disabilities, caregivers, and frontline workers are not sidelined in this environment.
When things get bad sometimes it seems like gravity keeps pulling things down. On the federal tax “decoupling” issue—where the District sought to retain roughly $600 million in prior tax cuts, Congress on a party line vote decided to nullify the City Council’s wishes and force DC to implement Trumps tax’s cuts. So instead of a child tax credit and an enhanced earned income credit we will cut taxes on tipped wages. These cuts will have devastating impact on low-income families. To make matters worse, Office of Tax and Revenue may need to suspend the filing season, require tens of thousands of taxpayers and hundreds of businesses to amend their return. This is also a gross affront to DC’s self-governance.
At the same time, national labor data highlights both opportunity and risk for our sector.
More than half of new jobs in the latest employment report were in healthcare. Hiring in other industries has largely flattened, while healthcare continues to carry the labor market. This growth reflects demographic reality: more than 10,000 Americans turn 65 every day, increasing demand for care.
Yet DC is not training enough people for these high-demand jobs. We are already falling behind.
Meanwhile, federal policy points toward potential cuts in Medicaid and healthcare spending over the next decade. Hospitals and health systems are reporting rising costs, financial distress, and increasing merger activity—often accompanied by job losses.
This combination is dangerous: rising demand for care, shrinking public resources, and an underdeveloped workforce pipeline.
If we do not act now, shortages will deepen, quality will suffer, and families will bear the burden.
That is why our work in the coming months is so critical.
We must protect investments in caregivers and frontline workers. We must strengthen training pathways. We must defend community-based services that allow people to age with dignity. And we must make clear that long-term care is not a peripheral issue—it is central to the District’s economic and social health.
These are challenging times. But they are also moments that demand leadership, coordination, and resolve.
Our Coalition will be meeting with all the members of the city council on March 19 on our Long Term Care Coalition Advocacy Day to address these issues and more. Please join us!
The Coalition is prepared to meet this moment. And we will do so together.
From the Coordinator’s Desk offers brief reflections on emerging issues, policy developments, and shared priorities shaping long term care in the District and beyond.
Neil Richardson
Coordinator, DC Coalition on Long Term Care
ltccoalition@homecarepartners.org