People with disabilities in several states stand to lose their health insurance if they are unable to work, because Trump administration is allowing states to impose work requirements on people covered by Medicaid, according to disability rights advocates and analysts.
In a recent memo to state officials, the Trump administration said that people who qualify for Medicaid because of a disability should be exempt from rules requiring working-age beneficiaries be employed or at least looking for a job and contributing to their communities. However, those exemptions may vary from state to state, and critics say that any new requirements or restrictions placed on Medicaid recipients are bound to squeeze vulnerable people out of the program.
Even if an individual with a disability is exempt, work requirements will create red tape that will result in people being kicked off Medicaid rolls.
"There's going to be red tape, there's going to be gaps, people are going to fall through the cracks," said Lawrence Carter-Long, director of communications at Disability Rights Education and Defense Fund (DREDF), in an interview with Truthout.
Since the Trump administration announced in mid-January that it will allow the work requirements, 10 states have applied for federal waivers to impose such requirements on working-age adults who receive Medicaid. The Trump administration has already approved one waiver for Kentucky. Louisiana Gov. John Bel Edwards, a Democrat, is also developing a work requirement waiver proposal for his state, according to reports.
Some people qualify for Medicaid automatically because they receive Supplemental Security Income (SSI) or Social Security Disability Insurance, programs that require beneficiaries to prove that they are low-income and living with a disability. These recipients will likely be unaffected by work requirements. However, the Kaiser Family Foundation reports that 57 percent of non-elderly Medicaid enrollees have a disability but do not receive cash assistance from the Social Security office and have qualified for Medicaid in other ways.
About 77 percent of adults with disabilities who do not receive SSI payments are unemployed, and only 15 percent work full time. Analysts say the high unemployment rate among people with disabilities is probably due in part to functional difficulties that impact mobility, independent living, self-care and cognitive function, according to the Kaiser Family Foundation. Over 50 percent of adults who could face work requirements report serious difficulty with mobility.
Work requirements will widen health and employment disparities because individuals will lose access to health services they need to support themselves while seeking and maintaining a job.
Although the Trump administration's memo directs state policymakers to "comply with federal civil rights laws" and "ensure that individuals with disabilities are not denied Medicaid for inability to meet these requirements," analysts say that any exemptions states construct for people with disabilities will not keep all of them from losing health coverage. For example, Kentucky's waiver is supposed to protect people who are "medically frail" from the requirement, but there is little detail on how the state will determine who fits that definition, or how people will be required to prove that they do.
Even if an individual with a disability is exempt, work requirements will create red tape that will result in people being kicked off Medicaid rolls, according to DREDF. Beneficiaries will need to verify their disability based on criteria constructed by individual states, which may involve screening and gathering medical documentation. If they miss an appointment or lose some paperwork, they could lose their health coverage.
The Trump administration's move to allow Medicaid work requirements comes as conservatives seek ways to trim rolls and pay for tax cuts. Republicans in Congress failed to pass legislation repealing the Affordable Care Act last year, but critics say the White House is finding ways to undermine it through administrative action. Carter-Long said the Trump administration's vague guidance on work requirements suggests that policymakers have not thoroughly considered the disabled community in their rush to place restrictions on Medicaid.
"Time and time again, with this administration, we've seen them rush to get something out and ignore the details, and that is going to result in a lack of coverage; that is going to result in people being left out," Carter-Long said.
Conservatives claim that work requirements will boost employment and improve health outcomes by encouraging people to find jobs and become more involved with their communities. DREDF claims work requirements will have the opposite effect and widen health and employment disparities because individuals will lose access to health services they need to support themselves while seeking and maintaining a job.
There are many communities within the disabilities community, which includes a broad spectrum of disabilities and people from different walks of life, including LGBTQ people, people of color and people of all ages. Carter-Long said that the Trump administration did not consult with any of these communities as it rolled out its policy encouraging states to seek waivers and impose work requirements on Medicaid beneficiaries.