Medicaid is a vital source of care for people with disabilities across the country. According to the Centers for Disease Control and Prevention, one in four, or 61 million Americans, have a disability. Research has shown the people with disabilities covered by Medicaid are more likely to receive comprehensive and consistent care than those who are either privately insured or uninsured. The Medicaid program also provides half of all long-term care in the United States, which includes essential home- and community-based services for people with disabilities. Protecting access to Medicaid is essential to ensuring people with disabilities continue to get the care they need.
Despite former President Trump’s war on Medicaid, the program is stronger than ever. Medicaid has served as a critical safety net as millions have lost jobs and their employer-based health insurance. Experts say an overwhelming majority of the people who have lost coverage during the pandemic have been able to get covered under the Affordable Care Act (ACA) or through Medicaid. By November 2020, Medicaid enrollment had grown to an all-time high of 78 million Americans. Unfortunately, however, 14 states have not yet implemented the ACA’s Medicaid expansion, blocking as many as 6 million from coverage.
President Biden is taking bold steps to strengthen the Medicaid program by signing the American Rescue Plan into law. This historic legislation includes the most significant health care expansion in a decade. Importantly, the American Rescue Plan provides additional financial incentives for the 14 states that have not implemented expansion. If the remaining states expanded Medicaid, an estimated 500,000 people with disabilities could gain coverage. Expanding access to health care is particularly important as millions of Americans have contracted the COVID-19, with some “long haulers” facing the possibility of lifelong disabilities.
|By The Numbers
Republican Efforts To Block Medicaid Expansion Limits Health Care Access For People With Disabilities
Eleven years ago, the ACA opened the door for states to expand Medicaid, and the results are piling in: Medicaid expansion works. In addition to covering 15 million people, expansion has resulted in healthier people, communities, and economies.
Study after study shows that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes. The program has increased access to lifesaving cancer screenings, improved infant and maternal health, and increased access to substance abuse treatment — and the list goes on. A growing body of evidence shows that expanding Medicaid has saved lives. Roughly half a million people with disabilities are being shut out of Medicaid coverage as a result of Republican efforts to block expansion.
People With Disabilities Rely On Medicaid Expansion For Coverage. Of the 8.7 million disabled adults enrolled in Medicaid, only 43 percent qualify for supplemental security income (SSI). The remaining 5 million beneficiaries do not receive SSI and therefore do not qualify for coverage based on their disability status alone, meaning they rely on the ACA’s Medicaid expansion or eligibility as low-income parents.
Medicaid Expansion Helps Adults Gain Access To Care Without Having To Wait On A Disability Determination. Medicaid expansion helps adults with disabilities gain quicker access to coverage without waiting for a disability determination, which can take years. Per the Kaiser Family Foundation: “The ACA Medicaid expansion has enabled some people who were not previously eligible for coverage, and otherwise would be uninsured, to gain coverage. Some of these people have conditions that may not rise to the stringent level required to establish SSI eligibility, yet still have an ongoing need for health care services. Others may qualify for Social Security Disability Insurance (SSDI) benefits but, without the Medicaid expansion pathway, could be uninsured during the required 24-month waiting period before Medicare eligibility.”
Medicaid Expansion Reduces Out-Of-Pocket Health Care Spending, Which Is Especially Important For People With Disabilities Who Often Have Limited Incomes. According to the Georgetown Center for Children and Families, between 2010 and 2015, the average out-of-pocket spending decreased in states that expanded Medicaid and increased in non-expansion states. A majority, or nearly 85 percent, of adults with disabilities who have Medicaid coverage earn annual incomes of less than 200 percent of the FPL, $12,060 for an individual, making access to affordable health care even more essential.
Medicaid Is A Vital Source Of Care For People With Disabilities
Medicaid Helps People With Disabilities Receive Comprehensive, Consistent Care. “Nonelderly Medicaid adults with disabilities are four times as likely to receive nursing or other health care at home, more than 2.5 times as likely to have three or more functional limitations, and more than 1.5 times as likely to have 10 or more health care visits in a year compared to people with disabilities who are privately insured.” [Kaiser Family Foundation, 3/16/17]
Medicaid Covers A Broad Range Of Preventive And Medical Services. “Through Medicaid, nonelderly adults with disabilities have access to regular preventive care as well as medical care for illnesses and chronic conditions. States must provide certain minimum services for adults, such as inpatient and outpatient hospital, physician, lab and x-ray, and nursing home services. States also can choose to provide a broad range of optional services, many of which are important to people with disabilities, such as prescription drugs, physical therapy, private duty nursing, personal care, rehabilitative services, and case management.” [Kaiser Family Foundation, 3/16/17]
Adults With Disabilities Are More Likely To Have Medicaid, And Less Likely To Have Private Insurance, Than Those Without Disabilities. “Those with disabilities are about three times as likely to be covered by Medicaid and about half as likely to have private insurance compared to those without disabilities. These differences are influenced by the greater health needs of people with disabilities and the fact that they are less likely to have access to employer-sponsored coverage.” [Kaiser Family Foundation, 3/16/17]
Medicaid Provides Half Of Long-Term Care In U.S. “Medicaid provides half the nation’s long-term care. Over the decades, states, CMS, providers and consumers have worked to broaden access to care in home and community based settings, where many seniors and people with disabilities would prefer to live…In 2013, the Medicaid program reached a major milestone: for the first time, the majority of Medicaid spending on long term services and supports (LTSS) was for home and community based services (HCBS) rather than for institutional care.” [Centers For Medicare & Medicaid Services, January 2017]
Medicaid Helps People With Disabilities Who Need Long-Term Care To Stay In Their Communities. “As of 2011, 80% of nonelderly people with disabilities who use Medicaid long-term care are served in the community, with the remaining 20% in institutions (Figure 13). Over the last several decades, states have made substantial progress in serving more nonelderly adults with disabilities in the community instead of in nursing homes. HCBS typically are less expensive than nursing homes and are preferred by many nonelderly adults with disabilities.” [Kaiser Family Foundation, 3/16/17]
Julie Reiskin, Executive Director of ColoradoCross Disability Coalition: Medicaid Helps People With Chronic Disabilities To Access The Care They Need In Their Communities. “It is Medicaid that provides the in-home aid who helps get an adult with quadriplegia out of bed, dressed and able to go to work in the morning. It is Medicaid that provides the in-home occupational therapist who works with the autistic child so she can live at home with her family — not be pushed into an institution.” [Reiskin, The Hill, 6/21/17]
Medicaid Increases Financial Security For People With Disabilities
Medicaid Is One Of The Most Effective Anti-Poverty Programs, Particularly For People With Disabilities. “Medicaid reduced the health inclusive poverty measure by 3.8 percentage points. This is comparable to the combined effect of all social insurance programs and greater than the effects of non-health means tested benefits and refundable tax credits…The poverty-reducing effects were greatest for adults with disabilities, the elderly children, and racial/ethnic minorities.” [Georgetown Center for Children and Families, 3/8/18]
Medicaid Expansion Increased Employment For People With Disabilities. “Individuals with disabilities are significantly more likely to be employed if they live in a state that has expanded Medicaid under the Affordable Care Act, a new study has found. Researchers at the University of Kansas co-authored a study that found a 6 percentage-point difference in employment rates among working-age adults with disabilities in states that expanded Medicaid and those that chose not to.” [The University Of Kansas, 12/21/16]