As the Senate prepares to vote on the largest Medicaid cuts in history, one of the most troubling measures included in the budget bill, called the “One Big Beautiful Bill” Act, is work requirements crafted to strip vital coverage from millions of people. While the bill purportedly exempts people with disabilities from the onerous work requirements, inevitably many people with disabilities will be swept up in this massive new mandate. People with disabilities will be at risk because many disabled people are eligible through Medicaid expansion, and not through disability-related eligibility categories.
As the following hypothetical examples compiled from real people demonstrate, disability-related eligibility processes for Medicaid are often lengthy and overly restrictive, ultimately creating barriers to enrollment.
- Sam, 52, juggles multiple part-time jobs while experiencing uncontrolled type 2 diabetes and debilitating nerve pain. As a Georgia resident, he tried to get Medicaid through the Pathways to Coverage program. But since he reduced his work hours due to his pain, he did not meet the program’s work requirements. He earned too little for Marketplace subsidies, leaving him uninsured and reliant on his local hospital’s sliding-scale program—costing $50 per office visit and $60 for his diabetes medication. Due to these costs, Sam cut back on his medications and office visits. He applied for SSI and his state’s Medicaid-based disability program, but they required medical documentation which he has been unable to afford given his lack of insurance. Sam’s health eventually deteriorated to the point of hospitalization for gangrene pain and vision loss. Although he later qualified for Medicaid for Aged, Blind, and Disabled, the coverage arrived too late for him to return to work, illustrating the paradox facing people with chronic conditions in gaining disability eligibility.
- Cara, 47, devoted over 20 years as a nurse aide caring for seniors and people with disabilities in their homes. After a car accident caused a severe back injury, she had to stop working due to significant pain and weakness. She applied for SSDI but her claim was initially denied and she was told the appeal process would take up to two years or longer. Fortunately, her state provides Medicaid through the Medicaid expansion, and thus she can get health care without having to prove she has a disability. With Medicaid, Cara can access essential treatments like physical therapy, imaging, and pain management. However, if work requirements were imposed, Cara might be forced to work in pain without coverage until her disability benefits are approved.
- John is 27 and unhoused. Six months ago, he was civilly committed for 14 days and received a diagnosis of bipolar disorder, but has not received mental health services since then. He does irregular gig work when he can, helping with yard cleanup. While he tries to keep his medical records with him, some have been destroyed in the rain, and others were lost when all his belongings were stolen. While some shelter social workers have tried to help him, due to his mental health condition, he often does not make it to appointments and examinations, even when scheduled for him. Therefore, John has struggled to establish eligibility for Medicaid under the disability-based rules. Just in the past 6 months, John qualified for coverage through Medicaid expansion due to his income alone after a hospital-based social worker signed him up when he went to a hospital for an infected foot. If work requirements were imposed, John would not be able to comply with reporting requirements on a regular basis. While he should be eligible for an exemption, he would likely be unable to reliably report and prove his need for an exemption, and thus would lose access to his only source of health care.
If the Republican work requirement proposal is enacted, Sam, Cara, John, and millions like them will lose their coverage or be repeatedly forced to seek exceptions and rely on screening processes that do not work. Other exemptions for disabilities, like medically frail, will also force people with disabilities to undergo similar hurdles to show they qualify for the exemption, all to get crucial healthcare.
Guest author Gelila Selassie is a Senior Attorney at Justice in Aging
