How Medicaid Work Requirements Could Harm Autistic People


This month the Administrator for the Centers of Medicare, and Medicaid, Seema Verma, released a policy document outlining how CMS would begin accepting Medicaid Section 1115 demonstration waivers from states adding, “community engagement activities,” otherwise known as “work requirements,” for certain “able-bodied” individuals receiving Medicaid benefits.

In my last post, I explained why the proposed Republican budget cuts to Medicaid were harmful to autistic people on the spectrum like me, and why people should oppose them. Now, when states are seeking to impose work requirements on Medicaid beneficiaries, I want to make my response as a disability rights activist clear: Medicaid work requirements are harmful and will prevent people from getting the care they need.

While Verma claims disabled people like me would be exempt from Medicaid work requirements, each state seeking to impose them has a different definition of what a community engagement activity is, and these definitions might impact people on the spectrum. Additionally, many of these states have different definitions of who would be exempt, or what constitutes “medical frailty.”

As a person on the autism spectrum, I oppose Medicaid work requirements because there will almost certainly be disabled individuals who qualify for Medicaid for reasons other than Supplemental Security Income. This will include individuals on the spectrum who appear to be “high functioning,” but may have additional support needs and invisible disabilities. These individuals will likely be negatively impacted by work requirements. The Kaiser Family Foundation published a summary table of the latest Section 1115 waivers on January 12th, and listed exemptions from the requirements. One state, Kansas, does not even give any exemption to medically frail individuals, or disabled parents who have children.

Just a few days ago, Kaiser released another report on disabled adults who qualify for Medicaid for reasons other than SSI, and found many of them would be subjected to work requirements. Kentucky’s Medicaid work requirement includes a lock out period for any person who fails to pay a premium, or meet the requirement. Individuals who are locked out of coverage would only be able to restore their coverage if they paid the premium, met the work requirement, and took either a health literacy course or a financial management course. These lockouts will leave people uninsured and at risk for major health crises.

Many disabled adults qualify for Medicaid for reasons other than SSI because applying for disability benefits is a very burdensome process, and most applicants are rejected initially. Appeals for denial of SSI benefits can be made to federal judges, but it can take months, even years before you get a hearing. If you are lucky enough to qualify for SSI, you are subject to a $2,000 asset limit. It keeps many disabled people from gainful employment. On top of the federal asset limit, many states impose their own income limits for Medicaid. One life changing event, like a marriage, could cause a person with autism to lose all of their benefits. As I described in my last post, Medicaid is so important for autistic other developmentally disabled people because it provides home and community services, which keep autistic people in their communities and out of institutions.

While part time work has been beneficial for me as a person with autism, we need to encourage voluntary employment in Medicaid, not one-size-fits-all work requirements. As experience with TANF shows, blanket work requirements just push people away from getting the benefits they need, sending them further into poverty and isolation. As an autistic person who receives SSI, I won’t be affected by a Medicaid work requirement. However, other autistic people could be, and as a disability rights activist, I firmly believe in the principle: nothing about us without us. Medicaid work requirements do not help disabled people, and therefore as a person with autism, I oppose them.

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