As federal officials begin to outline more stringent Medicaid eligibility rules, worries are running high about what the changes will mean for people with disabilities.
Congress approved sweeping legislation last summer that includes nearly $1 trillion in Medicaid cuts. Central to the plan are so-called “community engagement” requirements stipulating that many Medicaid beneficiaries must prove that they are working, volunteering or going to school in order to qualify for coverage.
Now states are tasked with establishing systems to determine whether beneficiaries meet the new standards and there are big questions about how they will do so.
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The Centers for Medicare and Medicaid Services issued initial guidance in December. It specifically exempts individuals who are “medically frail” or who have “special medical needs” including those with physical, intellectual or developmental disabilities from the new rules. Parents, guardians, caretaker relatives and family caregivers of those with disabilities are also exempt.
“I am very pleased that CMS is providing clear direction to states using breakthrough Medicaid community engagement tools that restore the dignity of work and lift people out of poverty, while supporting the sustainability of Medicaid for the most vulnerable,” said U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr.
However, the informational bulletin did little to quell concerns that people with disabilities could be adversely affected.
“The guidance provides no additional detail and simply re-states what is in the statute,” said Michael Lewis, vice president of policy at the American Association of People with Disabilities. “Congress promised that the ‘community engagement’ requirements would only cause coverage losses among those who can work but choose not to. People with disabilities and chronic health conditions that limit their ability to find and keep work need significantly stronger assurances that they will not lose coverage when these requirements start.”
The concerns lie in the details, advocates say. Many people with disabilities qualify for Medicaid because they already receive Supplemental Security Income or benefit from another disability program, but data show that there is a significant percentage who access coverage through Medicaid expansion, which is the target of the new federal requirements. Regardless, any added steps to prove eligibility could inhibit access for people who should be eligible.
“CMS’ new guidance is an important step, but nowhere near enough to protect people with disabilities from the very real risk of losing Medicaid because of red tape,” said Kim Musheno, senior director of Medicaid policy at The Arc of the United States. “For people with intellectual and developmental disabilities and caregivers, the details on verification, lookback periods, and the possibility of only short-term exemptions will determine whether people who should be exempt lose care. Their critical care and support hinges on new layers of paperwork or if their disabilities show up neatly in state data.”
In a letter to CMS Administrator Mehmet Oz last fall organized by the Consortium for Constituents with Disabilities, dozens of advocacy groups noted that when similar work requirements have been implemented in the past for Medicaid and other government programs “exemption policies and processes have failed to capture everyone who should qualify and resulted in people with disabilities, older adults who have retired, and caregivers falling through the cracks and becoming uninsured.”
A guide issued recently by the Bazelon Center for Mental Health Law and the Corporation for Supportive Housing outlines steps that states should take to ensure that they remain in compliance with the Americans with Disabilities Act and other disability rights laws as they implement the new requirements.
The groups recommend that states use existing data to verify eligibility rather than mandating new paperwork, provide assistance with applications and renewals as a reasonable modification and use broad definitions of “medically frail” and “special medical needs.” States should also allow individuals to self-attest for exemptions and ensure that their notices, online portals and other communications are accessible, the guide indicates.
“Taking steps that help people with disabilities avoid losing Medicaid coverage even though they remain eligible is not just good policy; it is also required by disability rights laws,” said Jennifer Mathis, deputy director at the Bazelon Center.
CMS is expected to release further guidance and regulations this year. In the meantime, however, the clock is ticking. States are supposed to implement the new community engagement requirements by the start of next year. With that deadline fast approaching, states are being encouraged to plan now.
“States are being asked to start building systems with significant uncertainty,” Musheno said. “The Arc is urging CMS to use that rulemaking to maximize automatic exemptions, allow long-term protections for people with lifelong disabilities, and keep verification requirements as simple as possible, so that work reporting rules don’t become a back-door cut to Medicaid for people with disabilities.”
