By Sarah Shapiro & Arielle Atherley
This week marked National Disability Voter Registration Week, a week of action focused on increasing the political power of people with disabilities while also engaging candidates and the media to address critical concerns of the disability community. Today, access to health care is one of the most hot-button topics for the disability community. For people with disabilities, access to quality health care is especially important as it helps them receive the regular or long-term treatment they need to live full, independent, and self-sufficient lives.
In the United States, over 80 million people rely on the Medicaid program to access the treatments and services they need. Millions of low-income adults with disabilities get health care coverage through Medicaid. Medicaid provides essential medical care and supportive services that help people with disabilities remain in their homes and communities. These essential services, such as nursing home care, coverage of wheelchairs and lifts, and supportive housing services, enable people with disabilities to maintain their health and independence. But many states are seeking to adopt new requirements – including imposing stringent work requirements – that are likely to make it more difficult for people to gain and keep their coverage.
In January 2018, the Trump administration announced a new policy that would allow states to take away Medicaid coverage from beneficiaries who do not work or participate in work-related activities for a specified number of hours each month. States can operationalize work requirements by submitting waiver requests to the Centers for Medicare and Medicaid Services (CMS) that would require work as a condition of eligibility for Medicaid coverage. As of July 2018, seven states (Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin) have pending waiver requests. Although a federal court blocked one of these waivers from Kentucky, that has not stopped other states from moving forward with implementation of work requirements.
Imposing work requirements on Medicaid enrollees could cause between 1.4 and 4.0 million people to lose their health insurance. That loss of coverage would worsen their health and increase the financial strain of low-income people and those struggling to make ends meet. For people with disabilities, this loss of coverage would be particularly harmful. Because approximately 5 million non-elderly adult Medicaid enrollees with disabilities do not receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), work requirement policies will disproportionately impact people with disabilities. Eligibility for SSI – the income subsidy that qualifies people with disabilities for Medicaid – is narrower than many definitions of disability, with fewer than four in 10 applicants ultimately awarded benefits. In fact, 57 percent of non-elderly adults covered by Medicaid have a disability but do not qualify for SSI cash assistance, meaning they are ineligible for work requirement exemptions despite their disability.
Furthermore, though the CMS guidelines for state waivers require exemptions for people who qualify for Medicaid on the basis of disability, studies of work requirements in other programs such as the Temporary Assistance for Needy Families (TANF) program show that people with disabilities are disproportionately penalized despite qualifying for exemptions. The complicated system of documenting work or filling out the paperwork to prove their eligibility for an exemption can be difficult for anyone to navigate, but it can be especially hard for people with disabilities. This means that even individuals who qualify for an exemption could potentially lose their coverage.
Work requirements put people with disabilities in an impossible position: they must work a minimum number of hours per week to keep their health insurance, but they need the support of Medicaid programs to be able to work in the first place. Not only does Medicaid provide access to the vital care needed to support the health and physical functioning of many people with disabilities, but it also covers other services needed to support the basic needs of people with disabilities, to help them get to and from work, and to allow them to do their jobs. If they do not work, they will lose their coverage. But if they do not have coverage, they cannot work.
Among adult Medicaid recipients who can work, most do. Though proponents of work requirements argue that they will increase workforce participation, a workforce can only be productive if its members are healthy. Making it harder for people to access the health care they need will only harm some of our most vulnerable communities, including low-income people and people with disabilities, but especially those who fall at the intersection.
As National Disability Voter Registration Week comes to an end, it’s important to recognize that the disability community has a huge stake in the results of local, state, and federal elections this November. The disability vote can be a powerful means to encourage elected officials to take positions on issues important to this community, including opposing work requirements for Medicaid beneficiaries. The future of work requirements in Medicaid is still unclear, but the solution is simple: states should not impose them, and the federal government should not approve waivers that will put health care out of reach for millions of people. Because it’s not just about economics – it’s about people’s lives.