Introduction to Medicaid and Work Requirements
By Tony Leys, KFF Health News
PLEASANTVILLE, Iowa — Zach Mecham has heard politicians demand that Medicaid recipients work or lose their benefits. He also has run into a jumble of Medicaid rules that effectively prevent many people with disabilities from holding full-time jobs.
“Which is it? Do you want us to work or not?” he said.
Mecham, 31, relies on the public insurance program to pay for services that help him live on his own despite a disability caused by muscular dystrophy. He uses a wheelchair to get around and a portable ventilator to breathe.
The Role of Medicaid in Supporting People with Disabilities
A paid assistant stays with Mecham at night. Then a home health aide comes in the morning to help him get out of bed, go to the bathroom, shower, and get dressed for work at his online marketing business. Without the assistance, he would have to shutter his company and move into a nursing home, he said.
Zach Mecham gets ready for his workday with the help of Courtnie Imler, a home health aide who comes to his house in Pleasantville, Iowa. (Tony Leys/KFF Health News/TNS)
Private health insurance plans generally do not cover such support services, so he relies on Medicaid, which is jointly financed by federal and state governments and covers millions of Americans who have low incomes or disabilities.
Medicaid Buy-In Programs and Their Limitations
Like most other states, Iowa has a Medicaid “buy-in program,” which allows people with disabilities to join Medicaid even if their incomes are a bit higher than would typically be permitted. About two-thirds of such programs charge premiums, and most have caps on how much money participants can earn and save.
Some states have raised or eliminated such financial caps for people with disabilities. Mecham has repeatedly traveled to the Iowa Capitol to lobby legislators to follow those states’ lead. The “Work Without Worry” bill would remove income and asset caps and instead require Iowans with disabilities to pay 6% of their incomes as premiums to remain in Medicaid. Those fees would be waived if participants pay premiums for employer-based health insurance, which would help cover standard medical care.
The Impact of Income and Asset Caps on People with Disabilities
Disability rights advocates say income and asset caps for Medicaid buy-in programs can prevent participants from working full time or accepting promotions. “It’s a trap — a poverty trap,” said Stephen Lieberman, a policy director for the United Spinal Association, which supports the changes.
Lawmakers in Florida, Hawaii, Indiana, Iowa, Maine, Mississippi, and New Jersey have introduced bills to address the issue this year, according to the National Conference of State Legislatures.
Efforts to Reform Medicaid Buy-In Programs
Several other states have raised or eliminated their program’s income and asset caps. Iowa’s proposal is modeled on a Tennessee law passed last year, said Josh Turek, a Democratic state representative from Council Bluffs. Turek, who is promoting the Iowa bill, uses a wheelchair and earned two gold medals as a member of the U.S. Paralympics basketball team.
Proponents say allowing people with disabilities to earn more money and still qualify for Medicaid would help ease persistent worker shortages, including in rural areas where the working-age population is shrinking.
The Importance of Employment for People with Disabilities
Turek believes now is a good time to seek expanded employment rights for people with disabilities, since Republicans who control the state and federal governments have been touting the value of holding a job. “That’s the trumpet I’ve been blowing,” he said with a smile.
The Iowa Legislature has been moving to require many nondisabled Medicaid recipients to work or to document why they can’t. Opponents say most Medicaid recipients who can work already do so, and the critics say work requirements add red tape that is expensive to administer and could lead Medicaid recipients to lose their coverage over paperwork issues.
National Disability Rights Activists’ Perspectives
National disability rights activists say income and asset caps on Medicaid buy-in programs discourage couples from marrying or even pressure them to split up if one or both partners have disabilities. That’s because in many states a spouse’s income and assets are counted when determining eligibility.
In Iowa, for example, the monthly net income cap is $3,138 for a single person and $4,259 for a couple.
Iowa’s current asset cap for a single person in the Medicaid buy-in plan is $12,000. For a couple, that cap rises only to $13,000. Countable assets include investments, bank accounts, and other things that could be easily converted to cash, but not a primary home, vehicle, or household furnishings.
The Need for Reform
“You have couples who have been married for decades who have to go through what we call a ‘Medicaid divorce,’ just to get access to these supports and services that cannot be covered in any other way,” said Maria Town, president of the American Association of People with Disabilities.
Town said some states, including Massachusetts, have removed income caps for people with disabilities who want to join Medicaid. She said the cost of adding such people to the program is at least partially offset by the premiums they pay for coverage and the increased taxes they contribute because they are allowed to work more hours. “I don’t think it has to be expensive” for the state and federal governments, she said.
Conclusion
The current Medicaid system can be complex and limiting for people with disabilities, preventing them from working full-time or accepting promotions. Efforts to reform Medicaid buy-in programs, such as the “Work Without Worry” bill in Iowa, aim to remove income and asset caps, allowing people with disabilities to earn more money and still qualify for Medicaid. This could help ease worker shortages and promote employment among people with disabilities.
FAQs
Q: What is a Medicaid buy-in program?
A: A Medicaid buy-in program allows people with disabilities to join Medicaid even if their incomes are a bit higher than would typically be permitted.
Q: What are the limitations of Medicaid buy-in programs?
A: Many Medicaid buy-in programs have caps on how much money participants can earn and save, which can prevent people with disabilities from working full-time or accepting promotions.
Q: What is the “Work Without Worry” bill?
A: The “Work Without Worry” bill is a proposal in Iowa that would remove income and asset caps for people with disabilities, allowing them to earn more money and still qualify for Medicaid.
Q: How would the “Work Without Worry” bill help people with disabilities?
A: The bill would allow people with disabilities to work more hours and earn more money without losing their Medicaid coverage, promoting employment and financial stability.
Q: What are the national implications of Medicaid buy-in program reform?
A: Reforming Medicaid buy-in programs could help ease worker shortages, promote employment among people with disabilities, and reduce the complexity of the Medicaid system.
