People with Disabilities Are At Risk of Losing Medicaid Coverage Without the ACA Expansion
The ACS questions used to classify an individual as having a disability include: (1) Is this person deaf, or does he/she have serious difficulty hearing? (2) Is this person blind, or does he/she have serious difficulty seeing, even when wearing glasses? (3) Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions? (4) Does this person have serious difficulty walking or climbing stairs? (5) Does this person have difficulty dressing or bathing? (6) Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone, such as visiting a doctor’s office or shopping? U.S. Census Bureau, American Community Survey, Why We Ask Questions About… Disability, (last accessed Oct. 12, 2020).
People who qualify for Medicaid both as an expansion adult and based on a disability can choose the group through which they enroll in coverage; benefit packages may differ by coverage group. 42 C.F.R. § 435.911 (c) (2), (d).
The maximum SSI benefit is about 74 percent of the federal poverty level (FPL, $9,396/year for an individual in 2020), and the asset limit is $2,000. The ACA Medicaid expansion covers individuals up to 138% FPL ($17,609/year for an individual in 2020) without an asset test. States have the option to extend financial eligibility for certain other disability-related Medicaid coverage pathways up to 300% of SSI ($28,188/year in 2020).
As of 2018, when 37 states (including DC) had adopted the ACA Medicaid expansion, and 14 had not, just under half of expansion states elected the option to cover seniors and people with disabilities up to 100% FPL, compared to less than one-third of non-expansion states; nearly three-quarters of expansion states offered the optional medically needy pathway for seniors and people with disabilities, while just over one-third of non-expansion states did so; over two in five expansion states elected the Katie Beckett state plan option for children with significant disabilities, compared to just over one-third of non-expansion states; nearly all expansion states elected the option to cover working people with disabilities, compared to less than two-thirds of non-expansion states; and both states opting to use Section 1915 (i) as an independent eligibility pathway were expansion states.
KFF analysis of the 2019 American Community Survey, 1-Year Estimates.