New Trump rules will drive people with disabilities off Medicaid and out of work In the end, work requirements will mean less health coverage under Medicaid, leading to worse health and less work for people with disabilities.

Marty Ford | Opinion Contributor

During last year’s fight against efforts in Washington to repeal the Affordable Care Act, poll after poll showed most Americans opposed Medicaid cuts that would turn back the clock on decades of civil rights progress for people with disabilities.

Disability rights activists vividly and compellingly pointed out that Medicaid delivers essential health care as well as long-term supports and services that make life in the community possible for millions of people with disabilities. Thanks in large part to their brave efforts, so far we have thwarted congressional proposals to dismantle Medicaid.

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But in 2018 we face a new looming threat: Medicaid work requirements, recently permitted by the Trump administration in three states: Kentucky, Indiana and — just this week — Arkansas. Work requirements like these could cause serious harm to hundreds of thousands of people with disabilities or serious illnesses, costing many of them their Medicaid coverage.

At first blush, you might not think so. Many low-income adults qualify for Medicaid because they’re receiving disability benefits through Social Security’s Supplemental Security Income (SSI) program — and the administration is excluding those people from work requirements.

But that won’t help millions of other Medicaid beneficiaries with a disability or serious illness. The Social Security definition for disability is quite strict, with fewer than four in 10 applicants ultimately awarded benefits. Nearly three-fifths of all non-elderly adult Medicaid enrollees with disabilities — or nearly 5 million people — don’t get SSI.

Many of these people have a mental illness, intellectual disability or physical limitation — like an injury that makes it hard for a person to stay on their feet — that impedes their ability to work for the required amount of hours per month. But they don’t meet the stringent criteria for federal disability assistance and others are unable to complete the often lengthy and complex application process for such assistance.

People with these kinds of conditions qualify for Medicaid based on their incomes, mostly thanks to the ACA’s Medicaid expansion, through which states can extend coverage to more low-income adults. For these nearly 5 million people with disabilities, a work requirement could mean less coverage, worse health and, ironically, fewer chances to find or keep a job.

Administration officials acknowledge that some people with disabilities will be subject to work requirements and unable to meet them. The guidance permitting states to impose a work requirement says the administration “recognizes that adults who are eligible for Medicaid on a basis other than disability… will be subject to the work/community engagement requirements [but]… may have an illness or disability as defined by other federal statutes that may interfere with their ability to meet the requirements.”

That’s true. Medicaid beneficiaries with disabilities or illnesses are far likelier than other beneficiaries to be out of work, working part time or sporadically, which means many will lose coverage unless they can show they’re exempt from a work requirement.

However, exemptions clearly won’t solve the problem. Take Kentucky. Its new work requirement includes limited exemptions for people with certain health conditions. But they’re narrow, and many people with disabilities or serious health conditions won’t qualify. What’s more, even people who should qualify may have difficulty obtaining the records, testimony from a doctor and other documents they need to prove they are exempt.

In Arkansas, people with disabilities or other health problems that keep them from working 80 hours each month will have to prove they’re still exempt every two months, according to the state’s proposal. Red tape and paperwork tend to drive down Medicaid enrollment in general. People with serious mental or physical illness are likely to have an especially difficult time coping with those hurdles.

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In the end, less health coverage under Medicaid will mean worse health and less work for people with disabilities. Many people with serious health conditions require access to health care services to maintain their health and function. Requiring individuals to work to qualify would create a situation in which people cannot access the services they need to work without working — setting an impossible standard. Instead, for many it will trigger a downward spiral of health insurance coverage losses, worse health, rising out of pocket medical costs and reduced economic security.

Coverage losses are particularly tough on people with disabilities and serious illnesses because they need often regular medical care to manage their conditions. For them, less coverage will mean more emergency room visits or hospitalizations, along with higher health costs. That’s why physician groups like the American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics and others oppose Medicaid work requirements.

More states are preparing or submitting requests for work requirements. The more that take effect, the more that Medicaid beneficiaries with disabilities and chronic illnesses will face grave risks to their health. The Arc calls on policymakers to once again listen to the disability community and reject this bad policy.

Marty Ford is senior executive officer for public policy with The Arc of the United States.