From the Archive
This piece originally appeared in the November 2025 edition of the Virtual Love Letter. I’m adding it to the library because the “services cliff” is one of the realities facing disabled adults and their families that too often goes unseen.

Falling Off the Cliff

Falling Down

by Mel Goldstein

My birthday came and I tumbled down,
I dropped my dreams, nowhere to be found.
I meant to climb but gravity frowned,
So from up I fell, then down I found.

I tried to catch my future’s hand,
But there it stayed, on solid land.
So down I fell, and further more,
Nothing but empty space in store.

The world yelled, “Fly!” I yelled, “How?”
My wings were paper anyhow.
The helpers gone, the services flee,
Happy, Happy Birthday to me.

The Fall

When the candles go out at twenty-one, so do the services and supports that families of adults with I/DD (Intellectual and Developmental Disabilities) have spent years building. This sudden disappearance of services is often referred to as “falling off the cliff.”

With one in four individuals with I/DD also being autistic, this is a harsh reality the autistic community and their families cannot escape.

Further compounding the crisis, one in four dually diagnosed children under seventeen, and many working-age adults with I/DD, are already living below the poverty line. Another 50 to 60 percent of autistic children live in low-income families.

Without the resources and supports these families once relied on to bolster their now-adult child, many find their family’s stability and well-being falling right along with them.

The Numbers

Of the roughly 8.4 million Americans with intellectual and developmental disabilities, around 6.3 million live with their families or in small group homes.

Among that group:

• Only 831,000 receive Medicaid Home and Community-Based Services (HCBS), the primary form of federal support.

• Another 710,000 are on waiting lists that can stretch from years to decades.

• The average wait time is 50 months — a little over four years.

Many families only receive services when someone else leaves the system or, tragically, passes away. Funding rarely expands fast enough to meet the need.

The Unseen

That leaves 4.7 million Americans living in the shadow of the cliff — unseen, unserved, unfunded, and statistically invisible.

For every one person who receives funding and supports, five more struggle without them.

These are the families who live outside the data:

• Parents who leave their jobs to become full-time caregivers

• Siblings who grow up knowing they will become the bridge so their brother or sister does not fall further

• Extended family members and communities who step in when no one else is left to take over the watch

Their labor keeps the system from collapsing, but it remains largely invisible.

The Cost

Some politicians call solutions to this crisis “too expensive.”

But the numbers tell a different story.

To serve everyone currently on waiting lists, the United States would need to invest about $35 billion annually.

If every American with I/DD who cannot live independently received full support, the cost would rise to $310 billion per year.

However, most individuals do not require full-time care. When services are scaled appropriately — some intensive, some part-time, some supportive — the cost to support the entire 6.3 million people who rely on these systems lands closer to $74 billion per year.

That is less than what the U.S. spends annually on corporate tax breaks or subsidizing excess crops that are destroyed each year.

The truth, stripped of political spin, is simple:

We can afford to support disabled Americans.

We just choose not to.

The Cliff

At 21, most young adults celebrate freedom.

For those with intellectual and developmental disabilities, it marks a very different threshold.

The helpers gone, the services flee,
Happy, Happy Birthday to me.

They don’t fall because they grow up.

They fall because we let go.

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