For disabled Americans, Medicaid work requirements don’t work

For millions of disabled people with high health needs, Medicaid is an essential lifeline to care.

By Mia Ives-Rublee and Nicole Jorwic

The Republican’s budget bill that passed the House after a marathon overnight session includes a historic slash to the committee that oversees Medicaid, adding draconian paperwork requirements and cutting $700 billion. If the bill passes the Senate, about 17 million people will lose health care coverage. The threats to Medicaid have sparked outrage across the country, resulting in contentious town halls, rallies, and vigils. This bill will cause catastrophic harm to disabled people and aging adults, while doing irreparable harm to the care workforce and creating more suffering for people who are already experiencing hardship.

House Republicans are trying to hoodwink their constituents into thinking their bill is only addressing “waste” and “fraud.” The bill requires recipients to report their working hours, recertify twice a year, and regularly verify their address. These paperwork requirements will create significant administrative burdens for both recipients and Medicaid offices, costing money and time. None of these requirements will get people jobs.

In fact, a vast majority of adult Medicaid recipients work. Those who aren’t working are often not working because of a disability, providing caregiving, attending school, or job loss. Many individuals who work in low-wage jobs can end up with unsteady hours or episodic unemployment through no fault of their own. In practice, rather than encouraging people to work, paperwork requirements add unnecessary bureaucracy while taking coverage from people who are otherwise eligible for Medicaid, all while creating massive administrative costs to states. Yet politicians like Republican Rep. Darrell Issa and Sen. John Cornyn continue to promote these policies that will actively harm their own constituents.

Every paperwork requirement that has been implemented has resulted in taking access to Medicaid away. Available data on states that have implemented these requirements suggests that they were confusing to enrollees and resulted in substantial coverage loss, including among eligible individuals. In Arkansas, when the state briefly implemented a new work requirement for Medicaid recipients in 2018, more than 18,000 people—nearly 1 in 4 who were subject to the requirements—lost their health care coverage in the policy’s first seven months.

Disabled people are particularly harmed by Medicaid paperwork requirements because of discrimination and inaccessibility. Republicans state that the new requirements would not harm disabled people, but they are only referring to those already receiving Social Security Insurance Disability or Supplemental Security Income. Becoming eligible for these programs is extremely difficult: 62 percent of applications were denied in 2022. Disabled people who aren’t eligible or aren’t able to get through the application process might face employment discrimination or have difficulty working or volunteering enough hours under the Republicans’ requirements. For example, under the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families, disabled people and those with serious illnesses or substance use disorders might be disproportionately likely to lose benefits, even when they are exempt from work requirements, because of the burden of proving their disabilities.

Paperwork requirements also place undue burdens on the Medicaid system overall and particularly for state administrators and budgets by forcing these systems to spend millions to set up processes that ultimately strive to save costs above all else. A Medicaid experiment Georgia called Pathways to Coverage shows just how expensive these new administrative costs can get. The program has cost Georgians at least $86 million, with more than three-fourths spent on administrative costs and consulting fees instead of on the critical care Georgians need. The Pathways to Coverage is so ineffective that only about 6,500 of the 246,000 eligible Georgians have enrolled. It raises the question of whether the goal of these requirements is truly to prevent fraud and waste or to prevent Georgians from accessing the care they need. It is critical that Medicaid funding go toward actual services, not the additional administrative costs that ultimately mean fewer people are served.

For millions of disabled people with high health needs, Medicaid is an essential lifeline to care, preventing unnecessary and expensive hospitalizations, improving health outcomes, and helping bring people who can work into the workforce. Disabled people cannot afford the cuts to Medicaid being championed by Republicans in Congress. To be clear, these new paperwork requirements would equate to massive cuts to the program that would lead to fewer services for health care and care in the home. In Georgia alone, more than 7,000 people with intellectual and developmental disabilities languish on waiting lists for Medicaid home- and community-based services, services they depend on to meet their high health needs. At a time when we should be expanding and investing in Medicaid to accommodate a growing demand for care, especially in the home, the last thing we should be doing is creating barriers to access.

Georgia’s Medicaid paperwork requirement does not exempt family caregivers from having to report working at least 80 hours per month, despite the reality of their intensive care responsibilities that enable older adults and disabled people to live with dignity. Family caregivers enable thousands of Georgians to remain in the home, which is where most of us prefer to live as we age, saving the Medicaid system money overall as institution-based care is much more costly to states. As a result of the reporting requirements, the family caregivers in Georgia who rely on Medicaid for health insurance could be forced to choose between providing care for their loved one or receiving health insurance for themselves.

The data is clear: Medicaid paperwork requirements don’t work. This is true even with exemptions for certain groups. Moving forward with such a policy at a time of economic uncertainty would result in millions of people losing care, and more than 15,400 avoidable deaths, all to pay for tax cuts for the wealthy. As the budget bill is debated in the Senate, disabled people, family caregivers, care workers, and allies will continue to remind senators that Americans need more access to health care, not more red tape. Medicaid is a health care program, a long-term care program, and a workforce program. It is a program that works—and most of its beneficiaries do, too. Medicaid provides life-saving, work-enabling services. Instead of cuts, penalties, and requirements, we should be investing in and expanding Medicaid so that it can be there for every American who needs it.

Mia Ives-Rublee is the senior director of the Disability Justice Initiative at the Center for American Progress. Nicole Jorwic is the chief of Advocacy and Campaigns at Caring Across Generations.

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