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Medicaid expansion boosts employment for people with disabilities, study finds

The trend has broad policy implications as many states consider work requirements for Medicaid eligibility.

Jeff Lagasse, Associate Editor

People with disabilities are much more likely to be employed in states that have expanded Medicaid coverage as part of the Affordable Care Act, new research from the University of Kansas has found. Similarly, the number of those who report not working because of a disability has greatly declined in expansion states. 

Neither trend happened in states that chose not to expand Medicaid.

The findings come amidst continuing debates about the Affordable Care Act, healthcare in America and work requirements for Medicaid eligibility. They help illustrate the importance of coverage and independence, the authors said.

Many states are considering adding work requirements for Medicaid eligibility after the Trump Administration promoted these ACA waivers. The requirement is expected to lower the number of Medicaid beneficiaries. The study suggests that Medicaid expansion has already resulted in a greater number of disabled beneficiaries being employed.

"In effect, Medicaid expansion is acting as an employment incentive for people with disabilities," the researchers wrote.

In June, a federal judge blocked Kentucky's attempt to add work requirements to Medicaid eligibility though this has reportedly not stopped the Centers for Medicare and Medicaid Services from considering other states' proposals. CMS has reopened the comment period on Kentucky's request, to get comment from stakeholders on the court's decision.

The study's connection between Medicaid coverage for the disabled and work builds on previous research showing similar results. The new data showed that in 2013, 41.3 percent of people with disabilities in expansion states reported being employed or self-employed. In 2017, that number rose to 47 percent.

In the same timeframe, the percentage of the same population that reported not working because of disability dropped from 32 to 27 percent. Those trends were not present in non-expansion states.

People with disabilities are often confined to lives of poverty or unemployment so as to qualify for Medicaid and those whose earnings are too high are deemed ineligible, the authors said. Yet those who surpassed income limitations were still often unable to afford health insurance on their own. In non-expansion states, most adults with disabilities are required to apply for supplemental security Income and undergo a disability determination to confirm they can't substantially work to be eligible for Medicaid. 

The researchers hypothesize that the incentive for employment could expand to individuals without disabilities as well. For example, a childless adult with a chronic illness cannot apply for Medicaid in non-expansion states. In expansion states, they would be able to do so and move from having no health insurance to being covered by Medicaid.

The ability to work has benefits for individuals, their families and the state, the authors write. Having coverage and being able to gain employment makes individuals more independent, lowers unemployment and results in more people paying taxes and boosting state economies, while simultaneously reducing the number of people reliant on government programs such as food stamps, housing and child care subsidies and others.

The data analyzed for the study was from December 2014, when 26 states and the District of Columbia had expanded Medicaid. As of this month, 33 states and the District of Columbia have decided to expand coverage.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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