The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities. Home and Community-Based Services (HCBS) are particularly important.
On April 26, 2023, the House of Representatives passed a Republican debt ceiling bill (HR 2811, the Limit, Save, Grow Act of 2023) that includes a requirement for states to implement work requirements for certain Medicaid enrollees. Data show that 91% of non-elderly Medicaid enrollees who are not on Supplemental Security Income or Medicare are working or face barriers to work. We estimate that if the proposal were fully implemented in 2024 and the rate of Medicaid eligibility loss was as the Congressional Budget Office (CBO) estimated, then 1.7 million enrollees would not meet work or reporting requirements and potentially face disenrollment in that year.
Research suggests that some populations would be especially harmed by these work-reporting requirements, including people with disabilities, women, people who are experiencing homelessness, and people with mental health conditions or substance use disorders. Even though exemptions would apply to some in these groups, states often lack the capacity to hire sufficient staff to respond to people’s questions or manage work-reporting systems and the exemption process. People who have fewer transportation options or live in rural areas, face language or literacy barriers, are in poor health or have limited mobility, or have limited internet access would face particular barriers to understanding the new requirements and navigating reporting systems, applying for exemptions, and collecting the verification needed to prove that they meet an exemption criterion.
There is no upside to Medicaid work-reporting requirements. Research has not found any impact of the requirements on employment, and data from Arkansas show that few enrollees engaged in new work-related activities. Instead, work-reporting requirements strip health coverage from people with low incomes — most of whom are already meeting or exempt from the requirements — leading to gaps in care that damage their health and financial security and make it harder for them to find or keep a job.