The Trump administration’s war on people with disabilities launched another assault last week, in revising Medicaid rules. States will now be able to require those who receive Medicaid to do community service, job training, or work if they wish to keep their health care. Yet these new rules will cause serious problems not only for those with disabilities, but their families and those who care for elderly or disabled relatives.
Medicaid Fight Is 1 of Many Battles for People with Disabilities
This latest hurdle is far from the first health care threat for people with disabilities under the Trump administration. Congress has still failed to renew funding for the Children’s Health Insurance Plan (CHIP) which provides crucial health insurance for kids, including those with disabilities whose parents make too much to qualify for Medicaid.
People under age 19 are exempt from these new Medicaid rules, as are pregnant women and older recipients. The exemption age varies, however, and may be between 50 and 65 depending on the state. Because Medicaid is administered differently across states, this is just 1 example of how the new rules quickly become complicated.
The Centers for Medicare and Medicaid Services (CMS) have said that reasons people may be exempt from the new rules “include, but are not limited to age, disability, responsibility for a dependent, participation in a drug addiction or alcohol treatment and rehabilitation program, or another state-specified reason.”
But who decides which conditions should be considered a disability? In Kentucky, 1 of the first states to adopt this policy, those on Medicaid do not have to work if they are “medically frail.” Yet if someone has persistent migraines or arthritis but looks fine, should they be considered “able bodied?”
History Repeats Itself
By instituting new Medicaid rules, the Trump administration is continuing Americans’ decades-old fear that people who are able to work are sponging off public funds. Because of this pervasive myth that disabled people are actually frauds, individuals with disabilities must continually prove their impaired status to nondisabled individuals.
Disability is more easily believed if impairments are visible or apparent, such as needing to use a wheelchair, or having a hearing or visual impairment. While many people with disabilities are able to hold full-time jobs, due to anti-disability discrimination they needed the Americans with Disabilities Act (ADA) to give them greater access to the workplace. At the same time, the unemployment rate among people with disabilities remains high since employers are nervous about hiring them, increasing the need for programs such as Medicaid.
On the other hand, people with invisible disabilities such as fibromyalgia and chronic fatigue syndrome may be unable to work, yet have a greater burden to “prove” disability. These individuals may look fine, despite being in a constant state of pain or exhaustion. People with invisible disabilities are often stigmatized, and told their pains are “all in their head,” which makes the task of qualifying for benefits even more difficult.
Those who receive Medicaid and are black will likely face even greater hurdles, since research continually shows that doctors believe black people are more likely to lie to gain benefits, and they have a higher pain threshold. It is evident than many people with disabilities will now be at the mercy of their health care providers to vouch for them, then hope for sympathy on the part of the state.
No Clarity for Caregivers
While Medicaid for people with disabilities is in peril, equally confusing is who may be exempt from the new Medicaid rules if they are caring for a dependent. In many states, this term is defined as a child under 19 or an adult who is “permanently or totally disabled.” Seven criteria are used to decide if an adult is a dependent, including their income and relation to the caregiver. Yet some elderly and disabled people may not be considered dependents if they are receiving Social Security, which would make their income too high.
Many caregivers are unable to work outside the home since providing care is itself a full-time job. It’s easy to imagine how these caregivers would now be prevented from getting Medicaid benefits, if their relative was also receiving Social Security.
In some states such as Kentucky, individuals caring for relatives would still be able to enroll in Medicaid, since caregiving would cover the work requirement of 80 hours per month. Caregivers would have to keep records of their duties to get these benefits, however, and this provision may not be available in every state.
There is no question that the Trump administration’s vow to slash regulations only includes ones that harm corporate profits. Our most vulnerable citizens, including those with disabilities, have only faced a higher regulatory burden in fighting to maintain the health care services they deserve.