Medicaid Restructuring Under the American Health Care Act and Nonelderly Adults with Disabilities
Kaiser Family Foundation analysis of 2015 National Health Interview Survey (NHIS) data. The total number of nonelderly adults with disabilities is likely higher as people living in long-term care facilities are excluded from NHIS.
As approved by the House Energy and Commerce Committee, the bill would eliminate the ACA’s enhanced federal matching funds for expansion enrollees as of January 1, 2020, except for those enrolled as of December 31, 2019, who do not have a break in eligibility of more than one month.
Applicants have their Medicaid eligibility assessed solely on the basis of income as the first step in the eligibility determination process. To the extent that different coverage groups receive different benefit packages, people who qualify for Medicaid both as an expansion adult and in a disability-related group can choose to remain in the expansion group or change their enrollment to the disability-related group so that they can access the benefit package that best meets their needs. 42 C.F.R. § 435.911(c)(2).
The expansion is optional for states, as a result of the Supreme Court’s ruling on the ACA’s constitutionality. Prior to the ACA, there was not a Medicaid coverage pathway for childless adults regardless of how low their income was, and this remains the case in the 19 non-expansion states, except for Wisconsin, which covers childless adults up to 100% FPL.
To be eligible for SSI, beneficiaries must have low incomes, limited assets, and a significant disability that impairs their ability to work at a substantial gainful level.
Jean P. Hall, et al., Effect of Medicaid Expansion on Workforce Participation for People with Disabilities, 107 Amer. J. Pub. Health 262-264 (Feb. 2017), doi: 10.2105/AJPH.2016.303543.
These pathways were not changed by the ACA.
Kaiser Family Foundation analysis of 2015 NHIS data.
States also can provide HCBS through waivers which allow them to target particular populations and limit enrollment.
In Olmstead, the Supreme Court held that the unjustified institutionalization of people with disabilities is illegal discrimination under the ADA.
States have the option to allow beneficiaries to self-direct their services by selecting or dismissing personal care attendants and/or allocating their service budgets among available services.